Positive Parenting

Craving For Sweetness During Pregnancy?
Your Unborn Child Needs Early Nutritional Care
The Healthy Mum-to-be Diet
What to eat when expecting
7 Eating habits for a healthy pregnancy
Plan what you eat
Eat right feel great

Craving For Sweetness During Pregnancy?

Watch out for a condition known as gestational diabetes.

By Dr Tan Ay Eeng, Obstetrical & Gynaecologist Consultant

Gestational diabetes is a form of diabetes that develops during pregnancy, affecting up to 3% of pregnant women. You may develop the condition even if you never had diabetes before. It typically sets in during the second trimester, and resolves after baby is born. While sweet foods do not directly cause the condition, mums-to-be should pay extra care of their diet and activity level to reduce their risk of getting it.

The cause

Gestational diabetes is essentially the result of changing hormones during pregnancy. Some of the pregnancy hormones block the regular action of insulin, a hormone responsible for regulating blood sugar levels in the body. Insulin transforms excess sugar in the blood into glycogen, to be stored in the liver for later use. By blocking the action of insulin, the mother's body ensures baby receives from the mother enough sugar, one of baby's food sources while in the womb.

However, when insulin action is blocked, this also means the mother's body is not able to utilise blood sugar efficiently. As a result, more insulin is needed to cope with the changes. If her body cannot produce enough insulin to meet this additional demand, it could lead to poorly controlled blood sugar levels, hence the diabetes.

Craving for Sweetness: Symptons & Risk Factors

How does it affect the baby?

When mum has diabetes, a high amount of sugar is transported from her blood stream through the placenta to the baby. While baby in the womb is able to produce insulin to use sugar, excessive sugar can have undesirable effects if the condition is not treated promptly.

Large baby (Macrosomia) - Baby produces more insulin that converts extra sugar into body fat, causing baby to grow larger than usual. This could pose difficulties during delivery, eg labour may be slowed down, baby is too large for vaginal delivery, increased risk of injury to baby during labour, and mum has a greater chance for a caesarean section.

Neonatal hypoglycaemia (low blood sugar) - Baby continues to produce large amounts of insulin for some time after delivery. Since maternal sugar supply is no longer present, the excess insulin will act on baby's own reserves of blood sugar, causing hypoglycaemia in the newborn. Baby can become jittery or may even have breathing problems. This can be quickly corrected once baby receives breast milk or supplemental sugar water.

Other complications - Baby may have jaundice at birth. There is also a slightly higher chance of premature labour. While baby will not be born with diabetes, there is an increased risk of baby becoming obese or developing diabetes during childhood.

Treatments

Your doctor will check your blood sugar levels during your prenatal visits. If you are diagnosed with gestational diabetes, your doctor may recommend a diet plan. If necessary, you may be given medication for blood sugar control. Your doctor will keep monitoring both you and your baby throughout your pregnancy.

Reduce your risk

If you are overweight, reduce weight to a normal range before you get pregnant to lower your risk of gestational diabetes.
During your pregnancy, eat healthy and well-balanced meals.
If you crave for something sweet, go for foods that contain natural sugars, such as fruit. Avoid foods high in simple sugar, eg ice-cream, cakes or cookies.
Exercise daily to keep your blood sugar within safe levels. Ask your doctor to recommend activities that are suitable and safe for you.

Your Unborn Child Needs Early Nutritional Care
Proper nutrition before and during pregnancy is important
for the health of your child, both at birth and beyond.

By Associate Professor Dr Tan Ay Eeng, Consultant Obstetrician & Gynaecologist.

Many women often do not pay attention to their nutritional needs, not until the time when they become aware of their pregnancy (most often, six weeks after conception). It is important for you to know that nutritional care before, during and even after pregnancy is critical for your health and that of your baby’s.

Why is nutritional care important before and during pregnancy?

A woman who has been practising sound eating habits enters pregnancy with full nutrient stores and a healthy body weight.
Good nutrition is essential for infants’ optimal growth and development, and has a critical role in determining their health later in life.

Are pregnant moms today practising good nutrition? Are you?

Unfortunately, maternal malnutrition remains a problem today, either as undernutrition or overweight. Such problems can be due to not fulfilling the body’s need for a wide range of different food requirements, or the lack of specific nutrients or vitamins needed by the mom and the baby.

Did You Know?

Malnourished women have a higher risk of giving birth to…

Babies with abnormal birth weight

Maternal underweight or undernutrition increase the risk of having babies of low birth weight. These babies are more likely to develop complications that affect the vital organs and are more susceptible to infections.
Overweight mothers have higher chance of having diabetes mellitus and big babies. These babies, on the other hand, are at greater risk of growing into overweight children and adults, and are predisposed to chronic diseases like type 2 diabetes later in life.

Babies with birth defects
One of the most common birth defects is neural tube defect, resulting from incorrect development of the brain or spinal cord due to the lack of certain nutrients before and during pregnancy.

Babies with mental and neuro-behavioural impairment
These babies are more likely to have lower IQ, and brain and sensory impairments.

Key nutrients you and your baby need Early intervention can potentially improve your health as well as your baby’s. Here’s a summary of nutrients most critical for you and your baby.
Nutrient	Why you and your baby need it	Best sources
Protein	Main building block for your baby’s cells; provides reserves for labour and delivery	Eggs, lean meat, poultry, fish, beans, milk, cheese
Calcium	For bones and teeth; muscle contraction; nerve function	Milk and dairy products, sardine, tofu, broccoli, kailan, yoghurt
Iron	Develops red blood cells needed to deliver oxygen to your baby; prevents fatigue	Anchovies, cockles, spinach, kangkung, wholegrain breads
Vitamin A	Promotes healthy skin, eyesight and bone growth	Liver, sweet potatoes, carrot, pumpkin, mangoes, papaya
Folic acid	Helps blood cell and haemoglobin formation; early in pregnancy, it prevents neural tube defects	Green leafy vegetables, beans, peas, nuts, bananas, tomatoes
Fat	Gives long-term energy for growth; is critical for the development of your baby’s brain	Lean meats, poultry, fish, eggs, seeds, peanut butter, margarine

The Healthy Mum-to-be Diet

Every pregnant mum desires a safe pregnancy
and a healthy baby. Good nutrition before,
during and after pregnancy is the key to achieving this.

You are pregnant and eating right has never been more important. By eating right, you get the nutrients you need to gain sufficient weight during your pregnancy, and your baby gets the nutrients he needs to develop well in the womb. Good nutrition increases the chances for a smooth, comfortable pregnancy by helping to alleviate common problems such as morning sickness, heartburn and constipation.

Now, what is good nutrition? It is eating a varied and balanced diet according to the Food Guide Pyramid – a good habit that should be practised regardless of whether you are pregnant or not.

Once you conceive, however, your body goes through remarkable changes and your nutrient needs increase dramatically. You can meet most of these needs not by doubling (or tripling) your portions but by continuing to eat according to the Food Guide Pyramid and choosing nutrient-rich foods. Below is a list of foods all pregnant mums should emphasise:

Grains are full of carbohydrates that give your body energy to go through the rigours of pregnancy. Many wholegrain, fortified and enriched products also contain fibre, iron, B vitamins, minerals and protein.

Fruits & vegetables are rich with vitamins and minerals and fibre. Highly pigmented, fat-soluble compounds called carotenoids are also naturally present in many yellow, orange and red fruits, and dark green vegetables.

Meat, poultry, fish, eggs & beans have plenty of protein, B vitamins and iron. Protein is crucial for your unborn baby’s growth, especially during the second and third trimesters.

Dairy products contain calcium, which helps build your baby’s bones and teeth. They also have vitamin A, vitamin D and protein.

Supplements are encouraged because most pregnant mums will not be able to meet the exceptionally high demands of iron from a normal diet alone. Folic acid supplements are absolutely necessary to prevent some birth anomalies.

Let’s Talk About Red Palm Oil

Just one tablespoon exceeds the recommended daily allowance of beta-carotene, vitamin A and vitamin E! What is red palm oil and how can it benefit you and your unborn baby?

Palm oil is derived from the fleshy portion of the oil palm fruit. Palm oil, in its natural form, is red because of its high content of beta-carotene (the same compounds found in tomatoes and carrots). It turns yellow when it goes through a boiling process, which destroys its colour and carotenoids.

GOOD FOR YOU & UNBORN BABY

Red palm oil is highly beneficial for you and your unborn baby. Did you know that it contains 15 times more carotenes than carrots and 50 times more than tomatoes? Carotenes help maintain growth and the integrity of cells and immune function in the body. In other words, it keeps your skin beautiful and helps to prevent infections!

Red palm oil is the richest natural source of tocopherols and tocotrienols, the super antioxidants of the vitamin E family. These antioxidants help fight heart disease, lower bad cholesterol levels, neutralise free radicals and even prevent cancer.

Abundant in omega-3 and -6 fatty acids, red palm oil helps to reduce the risk of heart disease, decrease triglyceride levels, lower blood pressure, reduce blood clotting and enhance immune function. It also promotes healthy brain development in the foetus.

100% NATURAL, 100% SAFE
Red palm oil is a cholesterol-free, trans-free and non-genetically modified oil. Because of its natural consistency, it does not require hydrogenation, which creates trans fatty acids.

Once the Big Day comes and baby is born, the great care you have taken with your diet so far should not change. After all, you will now be breastfeeding and the quality of breast milk is determined by what you eat! So, do continue eating a healthy diet. Make wise food choices that emphasise nutrient density ... for both you and your new baby.

What to Eat when Expecting

Dr. Tee E Siong, Nutritionist

What you eat during pregnancy, baby is ‘eating’ as well. If you eat an unhealthy diet that contains too little or too much of certain nutrients, your baby could be affected.

“I think every mother knows that she has to watch what she eats,” says Tey Wan Chee, who has her hands full with her 12 month-old baby girl and another on the way. “But to tell you the truth, I didn’t do anything drastic about my eating habits. You just have to make sure you don’t simply stuff junk into your mouth.”

“The only thing is that my mum makes me do is to drink lots of milk. If I don’t feel like drinking milk, she makes me eat cheese – I think she’s worried about my calcium!” laughs Wan Chee.

PREGNANCY WOES

Wan Chee is right. Most mothers already know that eating well is the foundation for a healthy pregnancy.

The real problem is when the ‘quirks’ of pregnancy get in the way. Nausea, cravings and old wives’ tales suddenly crowd your world of food, turning it upside down. Who should you listen to? Most importantly, what can you do? Here are some tips:

The sight and smell of food makes me throw up. All I eat is plain bread!

It will be hard to find any food that does not bring on nausea or vomiting (known as ‘morning sickness’). However, an empty stomach will make it worse. Eat several small meals throughout the day, instead of three big ones.You need low-fat, bland foods that can be digested easily, such as plain rice, toast, boiled potatoes, cereals, soft fruits and clear soups. Steer clear of fatty or fried foods. For relief, take some ginger ale, ginger tea, isotonic drinks, plain tea or cold barley water.

I want to eat sugar. All the time.

Sugar is just one example. Some women crave pickles, achar, chocolate, chilli and other foods they have never craved before. There is no harm in a little indulgence, but do not go overboard and eat only that one food at the expense of a variety of other foods.

I drink so much water, yet I’m still constipated.

Your bowel movements are bound to be affected with a baby sitting on your intestines.You’re right to drink lots of water.You can also get fluids from unsweetened juices and soups. Eating more fibrerich foods will also prevent and alleviate constipation. Foods like cereals, wholegrain bread, vegetables and fruits (particularly prunes) are good for you.

My mother-in-law keeps giving me food. She says I’m “eating for two” now.

No, you should not “eat for two”. Gaining too much weight during pregnancy causes health problems for you and your baby.You will also find it hard to lose weight after delivery. As a rule of thumb, if you were of normal weight before pregnancy, you should gain an overall of 12-16 kg.

I’ve been told to avoid ‘cold’, ‘windy’, ‘heaty’ and ‘poisonous’ foods. Is there anything left to eat?

These are traditional beliefs that have not been scientifically proven. However, if these beliefs (eg not eating chilli, pineapple or drinking coconut water) bring you a measure of comfort, following them is not likely to do any harm.Do not go to extremes and cut out foods that provide important nutrients.

Baby Needs To Eat!
Key nutrients and the roles they play:

Nutrient	For mom	For baby
Carbohydrates	Provides energy for all the changes taking place in your body.	Provides energy for processes that enable baby to grow, such as making new cells and transporting nutrients across the placenta.
Protein	Builds new tissues. Also builds new blood, enzymes and hormones.	Builds baby’s muscles, tissues, hormones, enzymes, blood and antibodies.
Vitamins (especially A, B-complex, C and D)	Builds body stores so that you have enough to nourish yourself as well as baby.	Supports many functions and processes required for baby to grow.
Minerals (especially calcium and iron)	Builds body stores so that you have enough to nourish yourself as well as baby.	Calcium builds baby’s bones and teeth. Iron builds sufficient blood supply for baby and the placenta.

Principles To ‘Eat’ By

Want to eat well, but have no idea where to start? Ask yourself some of the following questions.

Eat a balanced diet

Am I choosing foods that provide different types of nutrients?
Am I eating plenty of fruits and vegetables?
Do I have more carbohydrates, less protein and even less fat in each meal?

Try something different every day

Didn’t I have this yesterday, the day before and the day before that?
Have I tried all the different varieties of vegetables, fruits, cereals, beans, etc etc etc?
Why bore myself with the same food every day?

Plan your meals

What do I feel like eating this week?
How can I make those meals more nutritious (add more vegetables) or healthier (cook with less oil)?
Are expensive foods necessarily worth it?

Don’t give yourself food poisoning

Are my foods fresh, properly cleaned and well-cooked?
Should I eat at a roadside stall that serves uncovered food?
Could I eat a simple homecooked meal instead of eating out?

7 Eating Habits For A Healthy Pregnancy

By, Assoc Prof Dr Poh Bee Koon, Nutritionist

While you’re pregnant, baby only has one source of nourishment... and that’s you. This doesn’t mean that you need to ‘eat for two’. It does mean, however, that you need to eat sufficiently and sensibly to help keep both of you healthy throughout the pregnancy.

Habit #1: Balance your diet
As shown in the Food Guide Pyramid, your diet should consist mostly of carbohydrate foods, more fruits and vegetables, moderate amounts of protein foods as well as milk and dairy products, and finally, minimal amounts of fats, oils, sugar and salt.

Habit #2: Go for variety
Different foods provide different combinations of nutrients (energy, carbohydrates, fibre, protein, fats, vitamins, minerals and healthful food components) in differing amounts. In order to gain the goodness that different foods can offer, eat a wide variety of foods.

Habit #3: Eat according to your needs
Baby’s growth and the changes to your body call for an increase in total daily energy requirements. So it’s normal that your appetite may increase a little. However, your body also seems to make more efficient use of the food eaten. This is why many women can achieve normal weight gain during
pregnancy without eating significantly more than usual.

Habit #4: Eat regular meals
Stick to three main meals (ie breakfast, lunch and dinner) to keep you and baby going through the day and night. If your main meals are small or if you feel hungry in between, don’t hesitate to have a morning or afternoon snack of milk or yoghurt, digestive biscuits or bread, noodles or fruit.

Habit #5: Choose foods rich in vitamins & minerals
When pregnant, you need more of almost every vitamin and mineral than usual. Most of these increased requirements can be met through a carefully planned, nutritious diet. Nevertheless, you should consciously give preference to foods that are rich in calcium, iron, vitamin C, vitamin A, vitamin B12 and folate (folic acid). These micronutrients are found in foods listed in the table below as well as in processed foods, if indicated on their labels.

Habit #6: Don’t eat too much or too little
Overeating may cause you to gain too much weight in the course of your pregnancy. By the same token, now’s also not the time to go on a weight-loss diet. Both situations could do your baby a lot of harm.

Habit #7: Balance your energy intake with physical activity
Getting pregnant is one of the best reasons for leading a more active lifestyle. Whether it’s taking a walk, going for a swim, gentle stretching or whatever gentle physical activities you enjoy, just do them for at least 30 minutes (in one session or three 10-minute sessions) every day. The routine will help you burn off excessive energy from food and improve your digestion, while getting you in good shape to handle the rigours of birth and advancing pregnancies.

Are You At Nutritional Risk?

Extremely poor eating habits before or during pregnancy can harm both you and your baby. If you are under-nourished, you may lack energy or certain nutrients that might lead to complications including poor cell development in your unborn baby, low birth weight. Over-nutrition is just as undesirable. Excessive energy (from overeating or habitually taking high-fat foods) causes you to become overweight or obese. These conditions can lead to a higher risk of diabetes or hypertension in pregnancy, larger-than-normal babies, and other problems.

Over-nutrition may also occur as a result of taking certain vitamin (eg vitamin A) or mineral (eg iron) supplements without a doctor’s prescription. Such situations can lead to defects in baby’s bones, heart, nervous system, head and face.

Get specific dietary advice from your doctor or dietitian if you have any of these nutrition risk factors:

Were significantly underweight or overweight at the time of conception
Do not ordinarily consume a wide variety of nutritious foods
Take vitamin or mineral supplements without a doctor’s prescription
Have a history of chronic dieting, skipping meals or fasting
Use cigarettes, alcohol or recreational drugs; these are not only poisonous, they can also adversely affect your appetite and food intake
Are carrying more than one baby

Eating Tips

Avoid eating raw or undercooked meats, fish, eggs and soft cheeses to reduce the risk of bacterial infection for you and baby.
Artificial sweeteners are not recommended for use during pregnancy.
Limit intake of beverages containing caffeine (eg coffee, tea or cola).
If you experience nausea (morning sickness), try to eat 5 to 6 small meals per day. Eat slowly and relax after meals.

Asam boi, Kajang satay (must be from Kajang 40 km away, nowhere else!), cendol with lots of syrup, or mamak fish curry that you tasted during your honeymoon in Penang ... these and all sorts of other cravings seem to come from nowhere when you’re pregnant. If you really must, go ahead and indulge your cravings. Just remember not to eat anything that might be harmful to you and your baby.

Plan What You Eat

Your menu for a healthy pregnancy

By Pn Nik Shanita Safii, Dietitian

The key to eating well in pregnancy is to keep things simple while keeping an eye on your nutrient intake. Malaysians have a huge advantage when it comes to food: a wide variety of nutritious foods from different cultures is easily available. This gives you better chances of getting the amounts you need of each nutrient, because no one food offers all you need. Before you become pregnant, have a chat with your obstetrician or dietitian about your diet, so they can prescribe supplements to you if necessary. If you are already pregnant, it’s even more important for you to get regular nutritional advice on your diet.

Breakfast

Breakfast is the most important meal of the day. It is also the meal most frequently missed due to busy schedules. Before you go about your daily routine, your body needs food to give it energy.

The ideal breakfast should be big enough for you to feel satisfied until around noon, and light enough for you not to feel drowsy or heavy after eating. Here are some good breakfast foods:

Dry cereal (eg cornflakes, muesli)
Wet cereal (eg oatmeal) with low fat/skimmed milk
Wholemeal breads/biscuits
Noodle soup (eg kuay teow soup with lean chicken and fish cake, soto ayam, laksa asam)
Chapati/tosay with dhal
Rice porridge (eg congee or bubur)
Fresh fruits & juices

Nasi lemak and roti canai are among the popular traditional breakfast foods, but it’s not advisable for you to eat this dish more than once or twice a week because of the amount of fat in the rice and roti canai, as well as accompanying dishes.

Healthful Snacks

If you feel hungry between meals, choose nutritious snacks such as fresh fruits and vegetables, low-fat yoghurt and cereals.

Traditional desserts such as bubur gandum (wheat porridge) and tau foo fah are also good choices, as long as they are lightly sweetened and preferably without coconut milk. Quench your thirst with low fat or skim milk, fortified soya bean milk and plenty of water.

Plan Your Menus Ahead

Planning the whole week’s menus beforehand may sound like a lot of work, but it has its benefits. They include:

Ensuring that your diet over the whole week is balanced
Planning for a varied and interesting diet which covers all the essential nutrients
Knowing ahead of time what ingredients to buy
Saving time on deciding what to eat at each meal

Before you begin to plan your week’s menu, consider the following 3 steps:

Know your needs. How much of each type of food did you need before pregnancy? Did you consistently meet them? Have your needs of certain types of food increased now that you’re pregnant?
Plan to meet those needs. Write down what your needs are, including how they’ve changed in pregnancy. Then plan to eat foods that give you your daily requirement of each one.
Meet those needs. It takes some adjustment to stick to a planned menu, but this is one sure way to make sure you get exactly the nutrients that you need.

Eat Right, Feel Great!

Yes, being pregnant may be a challenging experience but
this doesn’t mean that you cannot still feel good about yourself.

By Assoc Prof Dr Poh Bee Koon, Nutritionist

To boost your energy and confidence, start eating right throughout your pregnancy. Follow these simple guidelines:

Eat sufficiently for yourself and your unborn child. But remember: you do not have to double your food portions to achieve this.
Eat a varied and balanced diet.
Emphasise on a variety of nutritious foods.

Here are some ideas:

Vitamin/Mineral	Why you need it	Where to find it
Vitamin A	Helps baby’s cells grow and stay healthy	Liver, milk, eggs, red-coloured fruits (papayas, mangoes), orange-coloured vegetables (carrot, pumpkin) & green leafy vegetables.
Vitamin B1, B2 & B3	Raise your energy levels and help you and baby have healthy skin.	Legumes, meat, fish, eggs, nuts & ortified products such as bread, cereal & biscuits, whome grains and wholemeal wheat flour.
Vitamin E	Helps baby grow and develop healthily.	Vegetable oils, seeds, nuts and cereal grains.
Calcium	Creates strong bones for baby and you.	Milk and dairy products, vegetables like spinach, watercress and broccoli, beans and bean products like tofu and tempeh.
Folate	Vital for the development of baby’s central nervous system.	Green leafy vegetables, lady’s fingers, asparagus, lentils and legumes, fortified grain products and liver.
Iron	Helps in the production of haemoglobin (blood cells) for baby.	Liver, lean meat, chicken, cockles, anchovy (whole), egg, chickpea, fried soya bean curd, fern shoots (pucuk paku), bitter gourd, spinach and kangkung.

What About Supplements?

The best way to get nutrients is by eating a varied and balanced diet. However, vitamin supplements can also be beneficial, specially if you are unable to meet the exceptionally high demands of certain nutrients, such as iron, from normal diet alone. Folic acid is the only supplement necessary from before pregnancy throughout the trimesters.

You should only take supplements on your doctor’s recommendations. Always remember that supplements do not replace a healthy diet, but rather, it ensures that you are receiving enough nutrients. In fact, supplements work best when you take it as part of a healthy diet. PP