Nutrition During Pregnancy

Progesterone and Human Chorionic Gonadotropin are hormones in pregnancy that can suppress the immune system making you more susceptible to illnesses, colds, and viral infections. Make sure to maintain good hygiene and nutrition. Water💦 intake should be at least 1⁄2 your body weight (lbs) in ounces plus an additional 10 ounces for pregnancy.

Pregnancy is not a time to diet. Individuals with a normal/healthy pre-pregnancy weight should gain 25-35 pounds by the end of pregnancy. Underweight individuals should gain 28-40 pounds and overweight individuals should gain 15-25 pounds. The 1st trimester doesn’t require additional calories. During the 2nd trimester women require 350+ extra calories and during the 3rd trimester women require 450+ extra calories.

Carbohydrate is your baby’s preferred fuel! Consuming >175g/day helps to avoid ketosis as ketones aren’t a good energy source for your baby and can lead to neuro-psychological abnormalities in infants. Carbohydrates should be 45-65% of your total calories.

Healthy carbohydrate options include:

• Whole grains (like quinoa, brown rice, and oats🥣)

• Starchy vegetables (like sweet potatoes🍠 and squash)

• Non-starchy vegetables (like beets, broccoli🥦, and carrots🥕)

• Fruits (like apples🍎, berries🫐, and mangoes)

• Beans (like chickpeas, kidney beans🫘, and black beans)

Pregnancy🤰 requires additional protein (~25g additional per day) and micronutrients for building tissue.

▪️IRON is necessary for red blood cell🩸development and placenta growth.

- Just 1 small orange🍊 worth of vitamin C in a meal can double iron absorption! Iron sources include beans/legumes🫘, dark leafy greens/broccoli🥦, nuts/seeds🌰, meat, and dried fruits. Cooking in a cast iron pan can also be helpful.

▪️FOLATE is necessary for cell division and DNA synthesis and helps to prevent neural tube defects.

- Sources include leafy greens/broccoli🥦 and beans/legumes🫘.

- Ask your doctor about taking a folate supplement.

▪️OMEGA 3 fatty acids, particularly DHA, are important for fetal brain development.

- Sources include flaxseeds, chia seeds, walnuts, and salmon.

- Ask your doctor about taking an algae oil DHA+EPA supplement.

▪️VITAMIN A deficiency or toxicity and acne medications may cause birth defects.

- Sources include sweet potatoes🍠 , mangoes🥭, carrots🥕, and broccoli/greens🥦. Consuming organ meats may cause toxicity.

▪️VITAMIN D is important for bone🦴 and teeth formation as well as immunity.

- Ask your doctor about taking a vitamin D3 supplement as it can be difficult to obtain sufficient vitamin D from food alone.

▪️CALCIUM is necessary for bone🦴formation and blood pressure regulation.

- Plant-based sources include dark green leafy vegetables/broccoli 🥦, beans/legumes/tofu🫘, chia seeds, figs, and almonds.

▪️IODINE is crucial to produce thyroid hormones, which are important for fetal brain and nervous system development.

- Sources of iodine include iodized salt, seaweed🍙 (some are very concentrated), seafood, and eggs.

- Talk with your doctor before starting iodine supplementation, as excessive iodine intake can be harmful for those with thyroid issues and for the developing baby.

It may also be beneficial to avoid excessive caffeine☕️ intake during pregnancy to prevent blood pressure changes and any potential withdrawal symptoms from your baby after birth.

Gestational diabetes is a type 2 diabetes like condition that affects ~3-7% of pregnant🤰 individuals. In this condition the body is still producing insulin but isn’t responding as well since the body is directing nutrients to the fetus. Gestational diabetes is typically tested at 24-28 weeks gestation. Under the supervision of a healthcare provider this condition can be managed well through diet and exercise. If gestational diabetes is hard to control with lifestyle changes insulin or metformin may be prescribed.

A diet high in saturated fat (butter/ghee, whole milk, cheese, meats/sausage/bacon, coconut oil) and simple/processed carbohydrates (sugar, flour, refined grains) can increase the risk of developing diabetes by promoting insulin resistance.

Helpful tips include:

▪️Consuming regular meals & snacks with low glycemic foods: High fiber foods (like fruits🍐, veggies🥕, and whole grains) have a lower glycemic index since they take longer to digest.

▪️Exercising – activities like walking, riding a stationary bike🚴, swimming, and strength training💪 can help regulate blood glucose levels.

▪️Replacing saturated fats with unsaturated fatty acids.

- Omega 3 fatty acids are a great substitute since they have anti-inflammatory properties (sources include flaxseeds, chia seeds, walnuts, and salmon).

- Other healthy fats from whole foods include avocados🥑, nuts🌰, and seeds.

- Olive oil can be a healthier option due to its higher proportion of monounsaturated fat compared to saturated fat and omega-6 fatty acids- it’s still important to be mindful of the omega-6 to omega-3 ratio.

- I recommend avoiding cooking oils and water sauteing, steaming, or pressure cooking/using an instant pot instead.

❌This is not medical advice. Contact a healthcare provider for your individualized nutrition needs. 

Food Safety During Pregnancy

People are more susceptible to food borne illnesses during pregnancy🤰because the immune system is generally lowered. The developing fetus can be infected by foodborne bacteria crossing the placenta. If sick early on in pregnancy the baby may not fully recover.

☑️Clean and wash🧼 your hands, kitchen surfaces, and utensils regularly.

☑️Wash your produce and play close attention to separating raw meat and eggs from produce to avoid potential cross-contamination.

☑️Cook and store foods at the appropriate temperatures. It is best to immediately wash surfaces and utensils that come into contact with raw animal products with soap and hot water.

☑️In the refrigerator, meat should be placed on the bottom self in a plastic bag to prevent any leaking.

☑️It is useful to have two cutting boards: one for produce and one for meat and seafood.

☑️Beef, pork, and seafood should be cooked at 145 degrees Fahrenheit. Poultry and leftovers should be cooked at 165 degrees Fahrenheit. The use of a meat thermometer can be helpful.

☑️Never let foods stay in the danger zone (40 to 140 degrees Fahrenheit), the temperature range where the most rapid growth of bacteria occurs.

☑️Refrigerator temperatures should be no higher than 40 degrees Fahrenheit.

The following can contain microorganisms harmful to pregnancy:

▪️Unpasteurized dairy products: such as raw milk and cheeses made from raw milk

▪️Soft cheeses: feta, brie, and blue cheese

▪️Cold cuts

▪️Raw or undercooked meat, seafood, and eggs

▪️Unwashed fruit and vegetables

▪️Raw sprouts: alfalfa, clover, and radish sprouts

▪️Cross contaminated foods

▪️Cat feces – buy a self-cleaning litter box or ask someone else to clean the litter box

▪️Soil – wear protective gloves when gardening

Toxoplasma is a problematic parasite which can be found in undercooked and raw meat, unwashed produce, contaminated utensils and surfaces, dirt, and cat feces. This can cause serious health problems for a baby including blindness and mental retardation.

Listeria, a bacterium, is also a potential health risk found in ready-to-go foods such as meat and dairy, as well as soil. It can grow while in the refrigerator and, if consumed, can potentially cause miscarriage.

Avoid sushi 🍱, as it is not cooked and might contain parasites and bacteria that could be hazardous to baby as well as deli meat due to risk passing listeria to baby and ensure that meat is fully cooked.

Fish high on the food chain like halibut, tuna, and swordfish can be risky during pregnancy due to their high levels of methylmercury which can cause nervous system damage to the baby (fully cooked salmon can be a replacement). Oysters and clams may also contain high levels of mercury and arsenic. 

Swimming During Pregnancy - A Pool of Benefits

Expecting a little one? Dive into the benefits of swimming during pregnancy! From reducing pelvic pressure to strengthening your core and pelvic floor, swimming offers a world of relief and relaxation 😌

Develop swimming skills prior to pregnancy for a smoother pregnancy journey🤰Many moms to be tell me that swimming is the only thing that makes them not feel pregnant and wish they had learned to swim with proper form beforehand 🙌

✨Hydrostatic Pressure: The water’s hydrostatic pressure provides a gentle compression on the body, which can assist in venous return, reducing swelling, and promoting circulation.

✨Gravity-Defying: Swimming in water decreases the effects of gravity on the body, offering relief from the pressures of daily life.

✨Relaxing and Stress-Relieving: There’s something inherently calming about being in the water. Swimming can be a meditative and stress-relieving activity, helping to melt away tension and promote relaxation.

✨Low-Impact Exercise: Unlike high-impact activities such as running or jumping, swimming is gentle on the joints.

✨Core and Pelvic Floor Strength: Swimming engages the deep core/pelvic floor muscles 💪 This can help prevent and improve diastasis, pelvic pressure, and incontinence!

Pregnancy Tip: Perform core workouts on your fists

Dealing with wrist pain during pregnancy🤰or lactation🤱? It could be due to ligament laxity. 💫 Try performing core work on your fists or forearms instead of your hands to keep your wrists in a more neutral position and help alleviate discomfort.

Pelvic Congestion/Varicose Veins

Pelvic congestion and varicosities (distended veins) can occur when pelvic veins become lax/enlarge to the point that there is no longer just one way movement of blood flow. Blood pooling can put pressure on parts of your pelvis or nerves⚡️ leading to discomfort. The appearance can fluctuate (can look like little freckles and can go away).

Symptoms can include:

▪️Pressure in the abdomen/pelvis

▪️Pain in the legs

▪️Asymmetrical/swelling of the labias

▪️Pain with intercourse (increased blood flow can pool)

▪️Pain with periods

▪️Urinary urgency/frequency

▪️Veins in the pelvis easily visible

▪️Spider veins in the legs

Symptoms are typically worse at the end of the day, with prolonged standing, and when pressure is applied to the abdomen or when bearing down (Valsalva/straining on the toilet). Typically, there is improvement with lying down.

Increased levels of estrogen during pregnancy🤰 can contribute to the pelvic veins being lax. Women who have multiple pregnancies may be more at risk due to the increased blood volume in the pelvis. Pregnancy cradle underwear (ex: V2 supporter, The Femme Jock) applies compression and can be helpful to wear during pregnancy for varicosities, edema, and feelings of pelvic pressure. Find discount codes in the link in my bio.

Some other ideas to help relieve symptoms include:

▪️Bridge positioning while lying down (can elevate hips under a pillow)

▪️Massage labia up towards groin

▪️Compression garments/biker shorts – wearing a V2 supporter can help

▪️Apply a cold compress (ex: frozen peas)

▪️Lymphatic drainage & lymph foam pads in underwear

▪️Walk regularly & do ankle pumps

▪️Avoid prolonged sitting/standing & crossing legs

✨These tips don’t substitute pelvic floor PT. Feel free to reach out if you are experiencing symptoms✨

Foot Changes During Pregnancy Can Impact the Pelvic Floor Muscles

Estrogen, progesterone, and relaxin are dominant hormones in pregnancy🤰 that can loosen ligaments. This instability can put strain on surrounding muscles.

Ligament laxity along with the added weight of a baby👶 can affect foot🦶shape and size. Foot arches can flatten out making the foot wider and longer.

This can lead to postural changes such as:

▪️Stress to the inside of ankles

▪️Bunions on the big toes

▪️Stress to the inner knees

▪️Hip internal rotation

▪️Pelvis misalignment

▪️Leg length difference

When hips are stuck in internal rotation this can contribute to pelvic floor muscle tightness, inner thigh muscle tightness, and hip external rotator weakness.

Strengthening of the glutes and the muscles that support your foot arch along with manual therapy and education on postural alignment may help prevent and alleviate symptoms related to foot ligament laxity and muscle imbalances.

Foot and ankle pain during pregnancy may be improved with:

▪️ Performing foot and ankle strengthening exercises

▪️Wearing supportive shoes

▪️Seeing a pelvic floor physical therapist

✨Don’t hesitate to reach out if you’re experiencing symptoms✨. It is important to rule out other potential causes of foot and ankle pain during pregnancy, such as plantar fasciitis or tendinitis, which may require specific treatments or interventions.

Core and Pelvic Floor Support Garments/Bloomers

These are great to use during pregnancy and postpartum to provide a gentle compression and “lift” to the pelvic floor.

They can:

▪️Improve symptoms of pelvic pressure/pelvic organ prolapse, vulvar varicosities (varicose veins), round ligament pain, pubic symphysis pain, and C-section discomfort

▪️Provide C section scar compression/support

▪️Support diastasis recti (splitting of the 6-pack abdominals)

You still need a strong core - don’t rely on garments or bands to do all the work for you!

You may not be wearing garment or bands right if you experience increased:

- Pelvic pressure/heaviness

- Pain

- Urinary leaking

✨Consult your healthcare practitioner before wearing compression garments and don’t hesitate to reach out if you have any questions or concerns✨

Pregnancy Belly Band 

If you lift your belly🤰 and it helps wear a belly band!

Belly bands can provide abdominal, back, and hip support. This can help improve:

- Back pain

- Pelvic pain

- Hip pain

- Diastasis “6 pack ab separation”

I like the Babybellyband by CABEA (10% off with code Restored10). They also have additional straps you can add on to their original band.

✨Compression groin bands→ help relieve pelvic pressure/heaviness, varicosities and labial swelling, and prolapse

✨Shoulder straps→ extra support during exercise and prolonged standing

You can always double belt with an SI belt for extra support (see my reel on the Serola SI belt). You can also wear belly bands postpartum for diastasis or C section support. You still need a strong core - don’t rely on bands to do all the work for you. 

Wear the band:

You may not be wearing the band right if you experience increased:

Urinary Frequency & Constipation are Common during Pregnancy

Increased progesterone during pregnancy🤰slows GI motility which can contribute to constipation and hemorrhoids.

You'll likely notice increased thirst as well. Your kidneys are working extra hard due to increased fluid (40-60% more!). This along with hormonal changes and pressure on your bladder from your uterus and baby can lead to increased urinary frequency.

Try to consume a lot of liquids and fiber to reduce constipation risk. Fruits🫐, vegetables🥕, and whole grains are great sources of fiber!

Constipation💩 can cause increased pressure on your bladder leading to increased urinary frequency.

Pelvic floor muscle tension can also contribute to constipation as well as urinary frequency and urgency. It is important to learn how to fully relax your pelvic floor muscles prior to birth to help prevent trauma.

I like to see people during the 2nd trimester for a pelvic floor and core check. Around 34 weeks it’s great to have a “labor prep” session to help you find the positions where your pelvic floor is most relaxed and learn perineal massage. 

Muscle Cramps & Restless Leg Syndrome are Common During Pregnancy

Muscle cramps and restless leg syndrome often make their debut during pregnancy🤰. Weight gain, joint laxity (where muscles work harder to move the body and maintain stability), decreased blood supply to the lower body, and even imbalances in electrolytes, vitamins, and minerals can join the party, making cramps a common pregnancy woe😩. The good news? They usually bid farewell after childbirth.

Pro tip: Keep a massage gun and a strap by your bed for nighttime massages and stretches.

As for restless legs, it’s not just a muscle game; changes in dopamine levels can also be at play. This urge to move the legs is often more intense at night and can improve with activity and walking.

Birth Preparation

Pain relief during labor:

✨This is not medical advice. Contact a healthcare provider to decide what pain management is best for you✨

Relaxation Techniques during Labor

• Dim the lights💡 and play soft music🎶 

• Slow dance with your partner to improve your comfort from rhythm and music. This can also improve back pain from the pressure of a partner’s hands.

• Warm baths🛀 and showers🚿 can have a relaxation effect and can encourage pelvic floor muscle relaxation😌

• Apply essential oil on a washcloth (or something you can remove from the room if it gets overwhelming) 

• Apply a warm washcloth to the perineum 

• Keep the jaw relaxed 

• Have your partner give you a massage💆‍♀️. Some ideas include:

– Deep pressure to avoid tickling

– Avoid moving quickly from body part to body part to avoid irritation

– Apply pressure over sacrum or SI joint for support

– Squeeze hips to compress or gap the sacroiliac (SI) joint

– Contract relax techniques for progressive muscle relaxation

– Not initiating touch after contraction has started

– Once a contraction has started either release or don’t move and hold deep pressure

• Every hour of labor try to:

– Get up and use the bathroom as gravity can help baby enter the pelvis

– Change position – can encourage rotation of baby and any position held for an extended period of time can become uncomfortable

– Practice diaphragmatic breathing🧘‍♀️

– Hydrate with water💧

Labor positions to reduce perineal trauma/tearing during labor:

Positioning through labor progression:

Caution: Hip labral tears can occur due to forceful hip flexion and internal rotation during pregnancy or delivery. An example is bringing your knees to your chest with your legs blocked from moving into external rotation.

Around 34-35 weeks I like to do a “Labor Prep” session to help you find the positions where your pelvic floor is most relaxed and teach perineal massage.

If you have SI joint pain avoid deep squats, asymmetrical positions such as having one knee to your chest with the other extended, and positions where your pelvis is fixed to the bed (lying on your back). On hands and knees, kneeling, or tall kneeling can be good alternatives. 

If you have pubic symphysis pain avoid deep squats, asymmetrical positions such as having one knee to your chest with the other extended, and sidelying with legs wide/rotated outwards. On hands and knees, kneeling, or tall kneeling can be good alternatives. 

With tailbone pain avoid laboring in sitting, semi-reclining or lying on your back. If you must be lying on your back roll a pillow under your sacrum to lift the tailbone off the bed to allow freedom of movement. Good alternatives include hand and knees, kneeling, tall kneeling, and sidelying.

With spondylolisthesis or spinal stenosis avoid back extension. Take caution with laboring on hands and knees, kneeling, tall kneeling, or in standing. Good alternatives include a deep squat, supported squat, sitting, sidelying, or on your back with towel under hips to promote back flexion. 

With discogenic back pain avoid positions with back flexion such as deep squats, sitting, and lying with knees to chest. Good alternatives include hands and knees, tall kneeling, kneeling, sidelying, and lying on back with a rolled towel or pillow under your back to promote extension.

With hip pain avoid excessive hip positions. Beneficial positions include hands and knees, kneeling, tall kneeling, and sidelying with pillow support. 

With knee pain it’s best to keep the knee mid-range in positions that don’t compress the joint. Avoid kneeling, tall kneeling, and hyperflexion/hyperextension of the knee.