A “Healthy” Pregnancy
We now know that what you do when you’re pregnant has profound implications for the health of your baby, and yourself. But the information and advice surrounding pregnancy is seemingly never-ending and often contradictory. What does a healthy pregnancy actually look like? Should we be changing the way we eat? Exercising? How much weight should we gain during pregnancy? What about prenatal vitamins? Today, we will be speaking to Professor Beth Murray-Davis from McMaster University about what we need to know to increase our chances of having a happy and healthy pregnancy and baby.
Read Professor Murray Davis’s paper HERE.
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Juna: Food We Need to Talk is funded by a grant from the Ardmore Institute of Health. Home, A full plate living. Welcome to the final episode of our women's wellness series.
Eddie: What a journey it's been.
Juna: What a journey, guys. I feel like I see this for every episode and I'm like, This is an episode we get so many questions about. But it's true. It's because we've gotten so many questions about all these episodes. So today we're actually going to be talking about pregnancy.
Eddie: So talk about the importance of health pregnancy as a time when you're eating and exercise. It's not just about you anymore. You've got a soon to be person inside you, Right?
Juna: And I feel like when you think about pregnancy, you're just like, oh my gosh, yes, I can eat whatever I want and I can have whatever junk food is going to be so fine. Yeah. As it turns out, that's not exactly the case, as you find out in today's episode. So today, what are the common misconceptions around pregnancy? What is a healthy or unhealthy amount of weight gain during pregnancy and how should we be eating and exercising to ensure that not only we are healthy but our baby is healthy when we actually do have the baby? I'm Juniata.
Eddie: And I'm Dr. Eddie Phillips, associate professor at Harvard Medical School.
Juna: And you're listening to food. We need to talk. The only podcast that you will be craving when you're pregnant. Before we start the episode, we want to shout out one of our favorite reviews from the Week air.
Eddie: Oh, I like this one. Yeah. The only podcast I listen to At Normal Speed, I love this podcast and never want it to end, so I slow it down to one time speed. Everything else is at 1.5. I like food and fitness and health, but I wouldn't say they're my favorite topics. I love this podcast though. They make the episodes so interesting and informative. The flow is great and I love their personalities. I definitely be friends with them in real life. That's what I like.
Juna: Did you know that? Oh, good job.
Eddie: You know, I. Wow. I picked up a few things. I've also heard that Yuna tends to speak quickly, and that's why people say that.
Juna: I knew you were going to say I was like. Eddie's going to say that it wasn't that one X because I talked to X. They need a listen at one X just to hear it. No. Anyways, thank you so much. We appreciate you. Whoever you are, I can do it. We love the two of you. Thank you for listening to us at one speed. That's so kind of you spending extra time with us. And we just love getting interviews, guys, because they help Apple know that we're a good podcast. So thank you to everyone. We love shouting you out and if you are enjoying the podcast, please you be sure to go. Leave us a five star rating and review and you might get a shout out on the show. Now to the episode. So today we are speaking to Professor Beth Marie Davis, and I'm going to have Beth actually introduce herself because she has so many amazing titles and accomplishments that it would be it would be impossible for me to know them. Beth, can you just go ahead and like, let us know who you are, what you do there?
Beth: I'd be happy to, and thanks for having me. So first and foremost, I'm a midwife. I practice in Hamilton, Ontario, Canada, and I've been a midwife for over for 20 years. So lots of babies under my belt, if you will. And then my main role, though, these days is is to work at the university at McMaster, where I do teaching and research. So I am an associate professor there in our midwifery education program, and I teach our undergrad and graduate students. And then I'm also the director of our research center. So I try to divide my time between teaching practice and research to keep it really interesting and and to never sleep, basically.
Juna: Very cool. Okay, this may be very uneducated of me, but I didn't even know midwifery was taught in universities. Like I thought you had to go to, like a different, like place to be educated about it. So it's really cool that it's actually at McMaster.
Beth: Yeah. So I think the periphery in Canada is different than, you know, I think it's state by state differences in the US, Canada, it is a regulated health profession across the country. Some of our provinces have had, you know, a slower route to regulation. But in Ontario, it's been 30 years that we've been a regulated health profession. We do about 20% of the births in the province. Our focus is normal, low risk pregnancy, birth and postpartum care. So we provide care across the full spectrum. People can self-refer to us when they start their pregnancy, or they can be referred by their family physician and we care for them throughout the pregnancy. We attend the birth usually in hospital, but we can do home births as well. But that's the choice of the person giving birth. But I'd say 80% of our births occur in hospital. And then we look after the the mom and baby for six weeks postpartum. And a lot of that follow up care is often done through home visits and that kind of thing. So, yeah, it's a it's a cool profession. And yeah, we we I think, bring a good a good addition to the health care system and it's been a nice change in Ontario to have that.
Juna: So our first question was what are some of the misconceptions that we have about pregnancy? I will just say for myself, like the way I think of pregnancy is like you get to order people around to get you whatever you want at whatever time you want. It's like you just get to eat like whatever you want all the time and everyone has to do what you say. I'm guessing that's not like the reality of pregnancy. So can we just talk about some of the misconceptions?
Beth: Yeah, I think it's a great question because I think there are still lots of misconceptions and maybe it's informed by the media or TV. We think pregnant people crave pickles and ice cream or something like that. Yes, But I think, you know, I think the three big misconceptions are, one, that you're eating for two. So that's like a common belief that, okay, you're pregnant, you can now just eat as much or double what you would normally be eating because you've got this growing baby and that's somehow your job and you know, that's not actually the case. I think the other kind of misconception relates to harm. So people either feel that exercise is harmful or that foods are harmful, right? So there's a lot of fear and a lot of worry about like, what if I eat the wrong thing? What if it makes me sick? Or if I exercise, I'm going to lose the pregnancy, have a miscarriage, you know, hurt the baby, those kinds of things. And then I think the third big misconception is around the idea that what you eat or what you do doesn't have any impact on the baby. Right? That it doesn't it doesn't really matter. And so, again, that feeds into this idea of like eating for two and just doing what you want and yeah, getting people to bring you whatever snacks and junk food you like because it doesn't matter what you eat.
Juna: Hmm.
Eddie: Can you pull these apart a little bit? So first off, you're not eating for two but a year, are you eating for 1.1?
Juna: 1.2.
Eddie: What is the caloric difference? Yeah.
Beth: So believe it or not, the caloric difference in pregnancy is really only about 350 to 450 additional calories. And that's actually only in the second and third trimester. So first trimester, you don't actually need any additional calories. And it's it's a small increase. So like we talked to people about maybe adding two or three more servings per day to their diet. And so that's like literally one more piece of fruit or a yogurt or something like that, Right? So we're not talking about a huge increase in the caloric demand to grow a baby. You know, I've heard some phrasing that's kind of helpful around that, that like instead of this eating for two or eating twice as much that you should think about eating twice as healthy. So that's kind of like a positive refrain.
Eddie: All right. So what is twice as healthy and what kind of recommendations would you give to your to your patients?
Beth: Yeah, I think twice as healthy as about being really mindful about what we're eating and making, like, nutrient rich decisions and choices, you know, so. You are in those moments when you're hungry, tired, you know, craving something that you're you're reaching for. That kind of healthier option, I think is is a good way to go.
Juna: And do we have studies showing that what you eat during pregnancy, like, directly affects the health of the baby or even how the baby grows up? Because I know there are there are insane studies about like if a pregnant mother gets the flu, like the rates of depression or obesity are like skyrocket of like the child, even like in their twenties. Things that happened to you when you're pregnant affect the baby or the grown up for decades afterwards. But do we have any research about that with food?
Beth: For sure we do. I mean, some of the the most recent research we have that relates to this is around gestational weight gain. So gestational weight gain has been a kind of a big topic for the last decade, looking at, you know, can we find this sweet spot where if people gain the right amount, that then we are optimizing outcomes for, you know, the childbearing person and the baby? And we do see that when we get that wrong. So if they gain too little or if they gain too much, that there are these adverse, you know, kind of complications to both the pregnant person and the newborn and the child in the long term. So, you know, when we look at that, we see things like, you know, excess gestational weight gain is associated with kind of the complications related to high blood pressure and pregnancy. So pre-eclampsia and just gestational hypertension, certainly you're at more risk for gestational diabetes for the baby. They're more likely to be large for gestational age, which can be a factor that then complicates things around delivery, including higher rates of shoulder dystocia where the shoulders get stuck at the time of the birth. The baby's more likely to have hypoglycemia when they're born, so difficulty regulating their own blood sugar. And then we do see that for those newborns that later in life they are at more risk for those cardiovascular complications and diabetes. So, you know, we are it's an area that I think that we're really exploring in more depth recently. But certainly, you know, I think the the evidence is there that there is this long term impact. And we have seen as well that for the pregnant person themself, they have a higher risk of cardiovascular disease later in life. So it's this window of time where you have an opportunity to optimize health. And the consequences, I think, are, you know, can be serious.
Juna: And beyond the weight gain, do we know if also diet quality has an impact on this? Because I could see somebody doesn't gain too much weight, but their entire pregnancy, they're eating junk food. Do we know that that also impacts the health?
Beth: I think we're probably less certain about that, probably just because the research is messier on how to do that and and tedious for the person who's participating and keeping, you know, rigorous dietary, you know, journals and things like that. But we do know like there is, again, this area, I think that's really taken off about the developmental origins of health and disease and looking at how does that kind of pre-conception conception and pregnancy environment impact and, you know, translate into future health concerns for that person or even what we see is it goes a generation before that. So one of my colleagues at McMaster, Deb Sloboda, does some great research on this and she always says you are what, your grandmother eight And so your grandmother, your grandmother's diet and exercise and health status at the time that your mother was in utero, that's when the eggs were formed.
Juna: That make you, oh, my God.
Beth: Right. And so there is this generational trajectory that I think often we aren't really thinking about when it comes to, you know, the impact of diet or even the quality, like you said, of of what people are consuming and the impact that has.
Eddie: Can we just go back to something that I was not familiar with? You know, you were bringing up that if the mom gets the flu, that it's going to affect the child. Does that what do we know about that?
Beth: You know, Covid's been a real insight into all of this as well, the impact of infection during pregnancy and and certainly what that might do in the long run, again, to the health of that newborn. I think the evidence is a bit murky on that. But, you know, certainly episodes of high fever for mom can be concerning and can at a cellular level actually change things.
Eddie: Can I just pick up on a few more points that you just brought up in the beginning? Tell us the story about craving.
Beth: What is.
Eddie: On and how fast was I supposed to get to the Chinese restaurant to get the dumplings that my wife.
Beth: Wanted?
Eddie: Just just for our friends, you know? Tell me.
Beth: Yes. Well, it's hard to say where the cravings thing comes from. Like, I do think that people you know, I do think that your body is speaking to you and telling you like you need food and you need nutrients. And but we're, I think, probably not very attuned to listening to that or knowing what it really means. And so, you know, often we feel like we're craving sugar when probably we're craving hydration. So we we misinterpret those signals from. Our body. But there are there are signals, obviously, from our body about what nutrients we need to be ingesting. And they probably are there for a reason. But then I think we misinterpret them. And then I also think there's like the social cultural stuff around it where it is acceptable to have these crazy cravings and to demand all these odd foods and things like that. So there's not a lot of science behind the actual cravings. I mean, there you know, there's one pregnancy complication where you crave really strange things, but that's actually, you know, a metabolic and, you know, vitamin deficiency. But otherwise, for the average person there, you know, it's more it's probably something else. And they're interpreting it as a need for sugar or salts or something. It's probably more related to hydration.
Eddie: So is it the same in other cultures, other like other than Western cultures.
Beth: The craving.
Juna: Is common. Yeah, that's.
Beth: A good question. I don't I don't have an answer for that. I don't know.
Juna: Yeah, certainly.
Beth: Food. You know, there's lots of food rituals around pregnancy, birth and that very dramatically around the world. So in many cultures there's very unique postpartum healing recovery foods, whereas I think, you know, we're fairly disconnected from that kind of concept in Western North America.
Juna: Content Cool. So what is a normal weight gain during pregnancy and does it depend on the starting weight of the person? And along with that question, if you're overweight, should you be trying to lose weight during pregnancy or should you be like still gaining weight?
Beth: Yeah. So these are good questions. So it is we do have recommendations about what is kind of that magic target for gestational weight gain. And it is based on pre-pregnancy body mass index. And there's, you know, lots of other discussion about how accurate is body mass index, should we use it as a tool. But it's kind of what we have for now. So then based on, you know, where you fall within those those categories, we would make recommendations about how much to gain in pregnancy for the typical healthy person that's got a normal BMI. The recommendations are around 25 to £35 through the whole pregnancy. So that's, you know, kind of half a pound a pound a week. And most people will gain the bulk of their weight in the second and third trimester. The first trimester usually should be a fairly slow weight gain. You know, that's something that we would keep an eye on as well as like, you know, sudden weight gain in the first trimester is probably laying the groundwork for a more extensive weight gain as the pregnancy progresses.
Juna: And then if you're overweight, you still gain weight during pregnancy.
Beth: You will still gain weight during pregnancy. You know, if you're in that more elevated BMI category, then the recommendations would be to gain, you know, less weight. So in in the range of something like 10 to 15 can be the minimum pounds that we might recommend, depending again, on what BMI category you're in. I think personally it's very hard for people to gain really less than about £15. And that's and when I talk to clients of mine, you know, we talk about all the normal reasons why you gain weight. So you're carrying a fetus of 7 to £8, right? You've gained that. You've increased your blood volume by about £5 of extra blood volume.
Juna: Wow.
Beth: So that's already accounted for. Then there's fluid retention, then there's amniotic fluid, there's, you know, breast changes and tissue changes. So there's there's lots of normal physiologic reasons why you're gaining weight in pregnancy. But when someone's starting pregnancy at that more elevated BMI category, we know that that amount is going to happen. But we would recommend that they're not gaining much more on top of those basic physiologic reasons for weak weight.
Juna: That's so funny. I never thought about this this whole time. I thought the weight you gain during pregnancy is because of the fetus. But now that I think about, I'm like weight, like a fetus isn't £30. So why would you gain £30 again?
Beth: Like even the placenta. The placenta weighs one sixth. The baby's weight. Like, that's that's wow. That's right. Like, there's all of those normal, healthy reasons why people gain weight.
Juna: Okay, Now let's talk about exercise during pregnancy. So we got a bunch of questions on our Instagram. I think one of them is from Daniella. And she said, Ah, no, this woman from Jeff, I'm sorry, Jeff is there. Jeff saying that he gets a lot of conflicting messages about whether or not exercise is healthy during pregnancy. And he said he's like, seen both things like you shouldn't be exercising, you should be exercising. I know you have a very ah, the research actually has a very strong stance on this though. Can you talk about that?
Beth: Yeah, I think the research is pretty clear and most of the organizations who, you know, make recommendations and summaries in pregnancy. So like, you know, our Canadian Society of Obstetricians and Gynecologists, the American group, the Royal College in the UK, they all are in favor of exercise in pregnancy. And that's because the evidence is clear it can have a benefit. And there's really aside from very specific cases. There are no reasons not to write other than you might not like it or, you know, those kinds of reasons, motivation. But really, there's so few contraindications and there's no evidence of harm and there is evidence of benefit. So we know that exercise is really important in pregnancy for, you know, decreasing some complications. So again, we see, you know, it has an impact on gestational weight gain and that whole cycle of the complications associated with that. It again, is related to things like hypertension and diabetes in pregnancy. It's useful for combating some of the common complaints of pregnancy. So something like constipation that's very common in pregnancy is actually improved by the better your circulation and your activity level. So that's a really tangible change that people can see. We also see that there's an impact on the intra pada more birth experience, so you're less likely to have a cesarean section, you're less likely to have a vacuum or forceps delivery. They actually say that your labor is likely to be shorter if you're a more physically active person, which I think is motivation for lots of people, like sign me up for the shorter labor that rather than the longer labor. I think, you know, the mental health benefits alone are probably one of the best reasons for people to stay active in pregnancy. We see so many people that are, you know, that the mental load in pregnancy of your to do list your anxieties about things you know lots of hormonal changes that might affect mental health. It's certainly an area that we've seen really, you know, being more and more prevalent for lots of people. And I think exercise obviously as well known to to improve that. And I think body image is one of those other things that lots of people feel really lots of feelings about how their body is changing and pregnancy and exercise can be a way to make it feel more positive to see your body as strong and active and healthy rather than feeling like you're on this runaway train and your body's doing things that you can't, you know, you can't control. Yeah, And then, I mean, the final plug for exercise and pregnancy is also that it it's shown to improve your postpartum recovery. So you're more likely to kind of get your energy back and recover quicker and to feel, you know, back to your old self sooner if you're active during pregnancy.
Juna: And I saw in a paper that you coauthored that actually even if you didn't exercise before pregnancy, you should start exercise during pregnancy.
Beth: Yeah, definitely. There's no such thing as it being too late. And we see that really, even for people who have been completely inactive and sometimes pregnancy is this motivating window of opportunity where they might think about doing it because, because they might have this notion that it will help their baby. And so you channeling that window of opportunity and motivation to help people kind of start exercise, I think is really useful because it does We still see all of those benefits that I talked about, even if you weren't an active person before pregnancy.
Eddie: So let's go down that path a little bit. So the most earth shattering foundational change that I've experienced in my entire life was becoming a father.
Beth: And.
Juna: To Eddie's kids.
Eddie: And that pales in comparison to the same, oh, I don't know, transformation that my wife was going through, except she was also pregnant and carrying a baby and actually doing all the hard work. So here's my question, though, is, is there literature or is it your experience that that's enough to get some people like off the couch and to begin doing exercise because they realize that while there's a baby? But also one of the things about becoming a parent is that your priorities are so dramatically shifted that now all of a sudden you have time to take care of this infant, etc.. So I guess my my long winded question is, do you find in your practice or do we know in the literature whether it actually is effective because getting people to exercise, you know, is still a challenge?
Beth: Yeah, it is a challenge. I would say for some people it is. So for some people, the idea of like wanting to be healthy for the baby, you know, is motivation enough, I'd say for other people like that, you know what you're describing as that change that happens as a new parent, that moment of like your priorities are completely different. This world revolves around this new little being and you would do anything for them. I don't In my experience, that doesn't start in pregnancy. It starts a little bit, but it's like the kind of like earth shattering wake up call that happens when you have this little thing in your arms that's completely reliant on you. I don't I don't see the impact of that as in such a significant way during pregnancy. But yeah, like we've I mean, we've done of a lot of research on the beliefs that shape behaviors related to diet and exercise and pregnancy and the whole concept of like how much people believe that their actions impact the health of their baby is one of the biggest kind of health beliefs that will shape their behavior. So if you're someone who. Believes that. Yes. What I do right now as a pregnant person is going to have a direct impact on my baby. I would like to have a healthy baby and therefore, I will change my behavior. You know, we see that as one kind of end of the spectrum. But then we also see people who think that that's not true at all. And, you know, where they get their information. I mean, it's not it's not from me, but it would be like people who think that, you know, it doesn't matter what I do in pregnancy, it doesn't matter what I eat. It doesn't matter how active I am. The baby is going to develop however it was going to develop. And, you know, really, I'm just a vessel and, you know, I kind of carry on and do my thing. So where people fall on that spectrum of like the interconnection of the the pregnant person and the fetus and the direct, the impact that they have will be it's one of the biggest factors that will guide their behavior.
Juna: Oh, my. I feel like if there is something growing inside you like, how could the things you're doing not like 100,000% impact. Like, you know what I mean? It's it's a part of you at that point. Yeah, well, it's so.
Beth: Funny because this is where this is where like, old family kind of beliefs or sometimes cultural beliefs that might not be based on evidence or even into total information from friends and family and social media shapes their beliefs more than what their health care provider says or what they might read. So they you know, if they know somebody who like, well, they gained £60 in pregnancy and the baby was only £6 and the baby was totally healthy, then they they latch on to this idea of, yeah, it doesn't matter what I do in pregnancy. Look at my friend. This is what happened to them.
Eddie: So we're going to take a brief break and have a chance to analyze our health beliefs. And we'll be right back. Food We Need to Talk is funded by a grant from the Ardmore Institute of Health, the home of full plate living. Full plate living helps you add more whole plant based foods to meals you're already eating. These are foods you're already familiar with apples, beans, strawberries and avocados. It's a small step approach that can lead to big health outcomes. Full plate living includes weekly recipes and programs for weight loss, meal makeovers, and better blood sugar management. Best of all, full Plate Living is a free service of the Ardmore Institute of Health. Sign up for free at full plate living, dawg. And we're back with Professor Beth Murray Davis from McMaster University.
Juna: So another question we had from a listener was whether or not there are specific exercises you should or should not be doing in certain parts of your pregnancy. I think I remember saying something like, After you give birth, your core is all messed up or something because you just. Utah. Am I wrong?
Eddie: No, no, no. You want to start with that, Beth? And then we could talk about relaxin and your ligaments getting stretched and.
Juna: Oh, my.
Beth: Yes.
Eddie: We'll get. We'll get there.
Beth: That's right. Exactly. So it's a tough question because in general, I would say any activity is still better than no activity. And there are lots of activities that are healthy and safe in pregnancy. And as I mentioned at the misconceptions kind of discussion we had earlier, you know, I don't think there are any exercises that are really harmful. However, there are things like the hormonal changes of pregnancy that do relax your joints, make everything feel more unstable, your hips feel wiggly. And so as the pregnancy progresses, you know, you do want to do things that are like safe choices where you're not at risk of a fall. Your joints may feel unstable. So, you know, often what we'll see is that people can do fairly normal, you know, exercises and activity in the first trimester, in the second trimester. And then we'll probably need to modify things in the third trimester. So walking is a fantastic exercise throughout pregnancy. Perfectly safe swimming is a huge hit with pregnant people. Although, you know, I always found like the idea of swimming is like, oh, I got to go and get wet and then I got to get changed and, you know, it's a whole hassle. But people like swimming because it takes away some of that joint discomfort you feel, you know, lighter, buoyant, all of those nice things. So for lots of people, that's a good exercise. I think we're seeing more and more benefits as well in pregnancy of stretching. So yoga is a really popular exercise and can be done throughout pregnancy. And, you know, even pelvic floor exercises are really good to do throughout pregnancy that can strengthen your pelvic floor and, you know, reduce chances of urinary incontinence and promote pelvic floor health kind of after the birth. You brought up postpartum exercises. So we do generally recommend that you don't do like crunches or AB kind of core work until about six weeks postpartum. And that is because you can get like that separation of the abdominal muscles. Sometimes it's not it's not something that happens to everyone that, you know, that repair process has to happen first.
Eddie: And then there's there's a few others that hopefully are obvious to folks that if it is third trimester, like contact sports.
Juna: Oh, my God.
Eddie: Well, but, you know, let's let's just put them out there.
Beth: I've got trauma to the abdomen is usually a good idea that there.
Juna: Oh, my gosh.
Eddie: So horseback riding, you probably, you know, best give up for your try. Third trimester.
Juna: Running.
Beth: Running is usually safe again as long as you feel stable and you're like, I would say, run on flat surfaces, not crazy terrain. And the main risk then like in the third trimester, your you know, your baby bump is bigger and therefore any contact with the abdomen can put you at more risk for trauma to the abdomen and which can cause things like placental abruption. So we want to make sure that we're not, you know, having any kind of heart, you know, heavy blows to the abdomen. So we don't want anything where you're going to fall really easily. So cycling in the third trimester, we would really recommend like a stationary bike is probably better than a road bike where you again have more risk of falls. Yeah, stuff like that.
Juna: But so when we talk about food in pregnancy, I know we touch on like eating twice as healthy. Can we talk about like is caffeine off limits? Alcohol obviously is off limits. There are certain foods that people kind of know. Why are those foods off limits? And then are there foods that we should be trying to include extras of or no?
Beth: Yeah. So foods that you should be including would be the basic stuff of, you know, the like the food guides that are recommended for folks like we have the Canada Food Guide. You've got you have a US food guide. So like lots of fruits and vegetables, when you're looking at your kind of starchy grains, you want to make sure they're whole grains as much as possible. Dairy is helpful for calcium and then sources of protein. So that's your go to what you want to eat. I think it's helpful in pregnancy to obviously decrease alcohol. We don't know the amount of alcohol that's safe in pregnancy and that's why most of the time the stance is no alcohol in pregnancy. You will find that that is actually a cultural thing. So when you go to different countries, their recommendations around alcohol in pregnancy may be stronger or softer based on that. But it's kind of a public health stance, like it's easier to tell everybody no than to have to like have these engaged discussions about how much is safe. And really we don't know how much is safe. So it's best to avoid alcohol, caffeine. There's been actually quite a lot of literature and. It's around what's a safe amount of caffeine in pregnancy. And they actually say three cups of coffee a day is fine. The concern about caffeine is that it has been linked to low birth weight and growth concerns for the fetus. So you do want to like be mindful of your amount of caffeine. And I think when it comes to caffeine, we need to think about all of the sources of caffeine that may not be immediately obvious. So we think about I only have one cup of coffee a day, but then I also have like tea and then I also have like a Coke at lunchtime or something. And then I also have like five squares of chocolate or, you know, something like that. And all of those little bits of caffeine actually do add up. So there is there is kind of a less is better for caffeine, but you don't need to cut your coffee out altogether. It's just kind of being mindful of of keeping it within that range. I'd say the other big thing to watch is sugar levels. I think that's one of the biggest culprits for some of the gestational weight gain factors that we see. So I think being again, more mindful about that, looking at natural sugars like fruits and stuff like that is probably better avoiding juices and pops and that that is.
Juna: Not going to be what people want to hear.
Beth: About.
Eddie: And, you know, you brought up about supplements and Beth, maybe.
Juna: Talk about also.
Eddie: Talk about folate and other that might Yeah.
Beth: So like really the only vitamins that I think you really absolutely need in pregnancy is folic acid. And so you need like what is.
Juna: That and why do you need it?
Beth: Folic acid is found in lots of foods and it's fortified in cereals and breads and things like that. But a lot of times people don't get an adequate amount in their diet. But it is a really important vitamin that's needed for neural tube closure in pregnancy. So the spinal cord, as it closes, you know, the body closes around the spinal cord, folic acid plays a big role in that. So we do recommend that people have a good amount of that. It's 0.4 milligrams, which is in most prenatal vitamins or even a regular multi-vitamin. That's the one thing that you need. And actually, though the important thing to know about that is that the neural tube is closed by around 11 to 12 weeks of pregnancy. So you can take as much folic acid as you want later on. And it's not going to have that same benefit.
Eddie: But that's also why women of childbearing age often take folate.
Beth: Yeah, exactly.
Eddie: By the time you realize it might be.
Juna: Oh, wow.
Beth: Exactly. Pre-conception is beneficial because you might be pregnant long before you know you are.
Juna: Oh my.
Beth: I think for lots of pregnant folks as well, it's important to think about an iron supplement. So we do see lots of people who suffer from iron deficiency anemia at various times in pregnancy. So having iron can be useful. I think vitamin D, we're seeing lots of new evidence around the benefit of that. Calcium and magnesium can be helpful. And there's there's growing research around the impact of calcium to maybe even prevent things like hypertensive disorders of pregnancy. But other than that, you know, I would say folate are big one are folic acid and some iron, but you don't need to necessarily be on a prenatal vitamin. A lot of that other stuff is just extra and you probably get enough of it in your diet.
Eddie: Is there anything in the literature talking about optimal vitamin D levels for maybe pre-conception and then through the pregnancy?
Beth: Yeah, I think it's a thousand international units is still kind of what you're aiming for for vitamin D And so again, that could be really dependent on where you live. You know, how much vitamin D you get. I know up here in the north we don't get as much sun, So we do recommend and it's the same for newborns, actually. Right? We actually supplement all newborns with vitamin D now because of the health benefits. So.
Eddie: But is there a lab level that you're looking for? Because there's a lot of debate about.
Beth: I don't know, the lab level, we don't test a lot of people for to see if they're vitamin D's adequate.
Eddie: You just assume they're Canadian and they're there.
Beth: And that's right.
Eddie: They're like, well.
Beth: Pasty skin gives it away from that Vitamin D.
Juna: Another question we got on our Instagram was about stress levels during pregnancy. Just based on our previous discussion, I think we can kind of infer the answer. But does being very stressed during her pregnancy impacts the health of your baby?
Beth: I think it's a hard one to answer because we can't you can never isolate stress to then look at the impact in terms of clinical outcomes. And, you know, you can do a randomized controlled trial where we have a stress group and a non stress group and we compare them to impact. So it's very hard to know that. It's hard to answer. I mean, I think we should do what we can to optimize sleep, to optimize diet and exercise and to promote healthy mental health. I think, you know, really targeting those things and we know the link with all of those with stress and stress reduction. I think, you know, I think those are all beneficial to just optimizing health and well-being. So it's still worth it and might benefit your stress level too.
Juna: And do we know what percentage of women are actually following the exercise and nutrition guidelines for pregnancy?
Beth: Well, we do know that when it comes to gestational weight gain about this is Canadian data. I don't know what it is in the States, actually, but about 55% of people gain excess gestational weight gain. So more than recommended, it's about kind of 15% of people who gain under about 30 or so that are in the healthy gestational weight gain range. And then, yeah, more than half in the gaining too much camp. And then when it comes to exercise recommendations, only about 15 to 30% of people actually meet the exercise recommendations which again, for us here in Canada, the recommendation is 150 minutes per week and, you know, kind of spread out over a few days, obviously not all in one go, but just, you know, kind of around 30 minutes a day, four or five days a week. And I think that's pretty similar with the U.S. recommendations.
Eddie: Mm hmm. Same.
Juna: Wow.
Eddie: One of the things I didn't appreciate before until speaking to you today is that midwives will continue to care for the postpartum. The six weeks. Yeah. During that time, how much do you get involved with encouraging or helping with breastfeeding? Because I'd love to. Yeah. Tell that conversation.
Beth: Yeah. It's a huge part of what we do and I think we see, you know, we see the impact that that has. I think that breastfeeding is one of those areas that really falls through the cracks in terms of general practice and family medicine, often just because of time that, you know, helping people to, you know, kind of work through breastfeeding and the challenges that go with it, particularly in that first week, is very time consuming. So and that's one of the I talked to as well about the fact that we do home visits in the first kind of few weeks after the birth. And that's one of the main reasons, too, is anybody who's ever had a newborn knows that like getting out the door is almost an impossible task. So getting out the door to then go and have a checkup and to then spend time like, you know, doing a feed and having somebody watch and give you feedback, you know, that's like 4 hours of your day. And it's like, how do you do that? So yeah, we do a huge amount of breastfeeding support. We do work in collaboration too, with, you know, lactation consultants and other supports if, if needed, because, yeah, it can be, it can be tricky. It's one of those things where I think a lot of people, you know, really want to breastfeed, have good motivation and interest in it. But the realities of what it looks like every day in those first few days is really challenging. And so having that support is really key.
Eddie: And the health of the infant is enormous to have even a modicum of breastfeeding, right?
Beth: Yeah, exactly.
Juna: And then when we talk about since pregnant postpartum, the weight gain after pregnancy I think is like a big thing people are very concerned with. Is it normal to maintain a higher after pregnancy or is that like a result of us gaining more than we should have during pregnancy?
Beth: Yeah, it's you know, I do think probably right off the bat you will lose a little bit of weight. Like again, all those physiologic reasons I mentioned, right. You've got the baby is now out, the placenta is now out like extra fluid. Amniotic fluid is gone. So most people will see some kind of decrease. And then yeah, I think it depends as well as in that activity and diet in that postpartum time period and and having realistic views of what does postpartum recovery look like. And so I think it's really important for people to know that it took you nine months to build a baby. It will take you at least nine months to have your body returned to what was kind of a pre pregnancy state. So in terms of weight loss and returning to that, you know, whatever might have been your weight, the magic number before, we typically would say it's 9 to 12 months like it takes a year. And I think one of the hard things in that as well is, you know, breastfeeding that you actually need more calories when you're breastfeeding than you did when you were pregnant. So appetite changes a lot. Hydration levels change a lot. And so people, you know, people will notice lots of changes about how they're feeling And again, interpreting those messages and learning how to, you know, kind of make healthy choices through that time is different and. People feel cooped up. Sometimes if you're at home with a baby and as I said, getting out the door is a challenge. Never mind finding time to exercise.
Juna: Right. So what are some of the obstacles you think that women most commonly encounter in trying to have a healthy pregnancy?
Beth: Yeah, I think there's you know, I think there's kind of the big pieces that are obstacles. So, you know, we've talked a lot about kind of like knowledge just around what if people know how to kind of cultural beliefs or anecdotes from friends and family. How does all of that come together in their knowledge? And so I do think we see a bit of a knowledge gap and people don't have the correct information. And so that's an obstacle. I think motivation is a huge obstacle for lots of people and that's that's outside of pregnancy, right? We all know that like getting people to be motivated to move their bodies and be healthy is is a whole thing, a whole science in and of itself. Right. And then but I think what's unique about the pregnant population is that they also have like very real physical things happening that might be obstacles. So particularly in the first trimester, they're going to be suffering from, you know, extreme fatigue sometimes, you know, really debilitating nausea and vomiting and lots of physical changes that make it very difficult to want to eat anything remotely healthy or to move their body. You know, lots of pregnant people will tell you that, like by the time they come home from work, they'd they'd just go to bed. Right. They're so tired. So I think that's hard because even people who start pregnancy with the best of intentions then feel like, you know, whoa, this is not going to plan and what am I going to do now? And everything I thought was true is out the window. And and that can be a real setback again for your motivation, which then feeds into other obstacles, other barriers that we've heard from people are, you know, again, common barriers to exercise, but unique to this population like cost, you know, access to something like good healthy food or a gym or, you know, exercise equipment and things like that can be costly. Childcare is a huge barrier. So if you've got little kids at home, how do you find time to, you know, go out and exercise and make yourself a priority? And then what kind of social support do they have again, to like, make this a priority? You know, do they have like a partner or family members who could come and watch the kids or help make healthy meals or that kind of thing? So support around the pregnant person and their family, I think is really key and can be a big obstacle.
Juna: And then what are the things that you do with your patients to overcome some of these obstacles?
Beth: Yeah. So when we when we were looking at these like health beliefs and you know how the health beliefs feed into behaviors, at the end of the day when we took all of those health beliefs and the thought about, like, what do we do to target those, I think it's kind of two to pieces that we need to be addressing. And one is around knowledge that I've been talking about. And, you know, I mentioned before this concept of like the developmental origins of health and disease. And a lot of people in our culture and in society don't have good knowledge and understanding of the fact that what you do in pregnancy does impact the health of your baby, the health of you later on, the health of your child going forward, maybe even the health of your grandchildren. So I think, you know, we need maybe some better messaging about that type of just common knowledge. And I think we have to start to think creatively about how to do that knowledge, you know, dissemination and engagement with people. You know, we're looking at some exciting stuff here at McMaster as well, where we look at art as a mechanism to teach people about these core concepts, or how do we put that education into like children's information and schools and high schools so that it becomes embedded all the way through people's kind of cultural awareness that pregnancy is this time where health really matters and that we all have a shared understanding of what that kind of health looks like, obviously, as well. That speaks to the importance of the health care provider, that they play a huge role in it. And we have seen that, you know, when a health care provider does talk about these things, actually addresses them, brings them up, seems like a good source of information. People will trust their recommendations and and, you know, kind of work to address some of those things in their life. So I think knowledge is one big part of how we address the obstacles. I think the other part comes back to this kind of like belief about how much control do I have over all of this? Like what's, you know, a sense of agency, a sense of like, does it even matter what I do? And so I've talked about that before. But I think, you know, we have to kind of we have to help people to see that their choices do matter and that they do have control. And like what you eat, you're making choices every time you go and reach for something in the fridge. Right. And and or, you know, your choice to get up off the couch and to go for a walk and that that choice has an impact on things. So I think there's a cool kind of a UK, a group of people that do what's called healthy conversation skills, or they also talk about this concept of. Like make every contact count. And what they talk about is this idea that when you when people come to you with questions or with an issue like pregnancy about diet or exercise, that we can have those conversations by recognizing that that person, you know, is the one who has control, makes decisions that we can kind of like personalize our approach to them and that they come to us with solutions. So instead of us saying, as health care providers, you know, you need to go for a walk every day for 20 minutes. Like, that's that's what you have to do. Just make it happen. How likely do you think it is that the person is going to do that? Whereas if I in my discussion with that person say, like, you know, what are some of the reasons why you haven't been able to exercise on a regular basis or, you know, what activities do you think you could fit into your daily life? So starting with where that person is at, starting with their expertise about their life and about what what solutions are going to fit in their unique context, I think that that's really important. And so we have to get better at kind of listening to people, talking to people and then making our kind of recommendations and and personalizing their health care, which of course takes time. And that's that's the challenge.
Eddie: As we begin to wrap up, I wanted to share a few ahas or things that I've learned listening to you, Beth. One of them is as a clinician, I'm a I'm a physician. I now realize as I'm thinking about patients, even that I saw this morning, that what they believe has more to do with how they're going to do and how they interpret the pain that they have and whether the pain becomes suffering, etc., and whether they're able ready and willing to listen to maybe some of the information I can give them or some advice. So I wanted to share that. I know we're here to talk about pregnancy and but your work in health beliefs is really eye opening to me, and I'm just beginning to percolate on this. And then the other part is and I'm speaking a little bit personally, I do have friends that say like, okay, like you're a doctor and like you're taking off like another afternoon to go do this podcast thing. Like, how is that, you know, what is like, why and how does that help the world? And maybe, you know, what we're trying to accomplish here is actually influencing people's health beliefs because because the, you know, the knowledge. Well, I don't know. It keeps on I mean, people question what's going on and what they're hearing and reading on the Web. But so much of it is just like believing that you do have agency, that what you do matters, that it that it aligns with your attitude. And these are just things that I'm beginning to ponder. So thank you so much for opening my eyes to that.
Juna: And yes, thank you. I feel like my impression of pregnancy before is was like, yeah, you can do whatever you want with you. And I'm like, Oh no. It's like you have to be extra healthy. You're like, All right.
Eddie: So that belief, that belief has been shattered.
Beth: Yeah, I've ruined that for you. Sorry.
Juna: Too hard. And when do I get my free for all? Thank you so much about. This was so informative.
Beth: Well, it's been my pleasure. It's been really great talking with you.
Juna: Thank you so much to Professor Beth Marie Davis. We will link to her work on our website. If you want more food, we need to talk. Head to food. We need to talk. Dot com slash membership or click the link in our show notes for weekly episodes. And the fun part about membership guys are noticing is that you can comment on the episodes that you can't do on Apple. So then like we can talk about the episode as it's happening, which also just makes it much more fun.
Eddie: It also helps us much more clearly understand what you guys want to hear and what you want episodes about.
Juna: Yes, because people can comment underneath like, Oh, I liked when you guys did this. Oh, I like I want to hear more about this, which is really, really awesome. If you want to connect with us on Instagram, you can find us at food. We need to talk. You can find me at the official Yoona and Yuna Jada on YouTube and Tik Tok. You can find Eddie.
Eddie: I'm going to be examining my health beliefs and I'll report back fully.
Juna: Oh, amazing Food We Talk is a production of PR X.
Eddie: Our senior producer is Morgan Flannery and our producers are Megan. After Matt and Samantha got sick.
Juna: Tommy Kazarian is our Myx engineer.
Eddie: Jocelyn Gonzalez is executive producer for PR X Productions.
Juna: Food We Need to Talk was co-created by Kari Goldberg, George Hicks, Eddie Phillips and me.
Eddie: For any personal health questions, please consult your personal health provider to find out more. Go to food. We need to talk e-comm. Thanks for listening.
Juna: Woohoo.
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