Your Nutrition Profile

ASSESSING YOUR NUTRITIONAL NEEDS DURING PREGNANCY


QUESTIONS AND ANSWERS ABOUT THE PERSONAL NUTRITIONAL PROFILE


YOUR PREGNANCY NUTRITION PROFILE:
ASSESSING YOUR NUTRITIONAL NEEDS DURING PREGNANCY

The best time to begin doing something about pregnancy nutrition is before you become pregnant. One of the most encouraging trends in Brewer Hotline calls is the number of women now calling for nutrition information when they first start thinking about having a baby. Such inquiries are far from making up the bulk of calls, yet this appears to be the way of the future: a planned, wanted baby being born to an unquestionably well-nourished mother. If nothing else, it means not having to play catch-up with your diet after your pregnancy is under way. Mothers whose nutrition has been poor before pregnancy can turn things around and do well, but it makes life a lot easier if dietary and life-style problems can be worked out before it becomes a medical necessity to do so.

Your personal nutritional status, after all, encompasses far more than your daily food selections, important though that may be. Nutritionist Sue Rodwell Williams, Ph.D., of Kaiser-Permanente Medical Center in Oakland, California, and the University of California at Berkeley, writes in her classic textbook, Nutrition and Diet Therapy, that an individual’s state of nutrition may be significantly influenced by anatomy, biochemistry, medicine, microbiology, physics, physiology, exercise, pharmacology, anthropology, communications, economics, history, language, psychiatry, psychology, religion, and sociology.

Having plenty of the most nourishing foods available doesn’t guarantee, for instance, that you will be able to digest them properly or that you will feel like eating them if you are depressed or your doctor or midwife has told you not to gain another pound in your pregnancy. Ongoing medical problems, such as diabetes or hypertension, also present dietary problems if you’re pregnant. Or your exercise program may have tapered off to the degree that your appetite is slowing down. Your personal nutritional status at any given time is a combination of the foods and other substances (such as drugs, toxic chemicals, or vitamin pills) you ingest, how well your body uses and clears these, whether you are contending with any illnesses, your level of activity, and your own general rate of metabolism. This is one reason why two people fed exactly the same diet might, for instance, show marked variation in weight gain or loss or even laboratory analysis of their blood or urine. The foods are fundamental to your nutritional status, but they are not the whole picture.

Are you a high risk for nutrition-related pregnancy problems?

To find out, complete this Personal Nutrition Profile — an assessment tool designed to help decide if a woman has immediate food or life-style habits that need attention before she becomes pregnant. This is the tool used when women call the Brewer Hotline to evaluate their nutritional status at the time they call.

After responding to the questions as fully as possible (sometimes women have their complete medical record from past pregnancies or past illnesses, surgeries, etc., sent to Dr. Brewer for further evaluation of uncertain areas), compare your answers with the notes that follow on each item. Then you’ll have a good idea of where you stand — whether you are months away from conception or already well along in your pregnancy.

PERSONAL NUTRITION PROFILE

Step 1: Diet Record [back to top]

Write down everything you eat for three typical days. Include a note for each food or beverage about the amount you ate (1/2 cup, 4 ounces, etc.) and where you ate it (at home, on the way to work, at your mother’s house, etc.) Include all beverages (including water) and snacks — anything that passes your lips! This inventory will give you insight into your food preferences, your eating pattern, and how balanced your diet is overall.

Step 2: Comparison to the Brewer Diet [back to top]

Cross-check your diet record with one of the Brewer Pregnancy diets by seeing how closely you fulfill the required portion exchanges. Take note of which exchanges go unsatisfied. Study the list of foods for those exchanges and identify foods you like. Starting today, add these foods to your usual diet in the amounts you need.

Step 3: Physical Characteristics [back to top]

Height (without shoes) __________

Weight before this pregnancy __________

Ideal weight (see chart) __________

Pounds over or under ideal weight before this pregnancy __________

Percentage overweight or underweight before this pregnancy __________

Weight now __________

Pounds gained in this pregnancy __________

Pounds lost in this pregnancy __________

Estimated Due Date __________ Weeks left in pregnancy __________

Blood pressure (taken after 5 minutes rest) __________

Step 4: Activity Level [back to top]

Indicate approximately how often you: daily weekly seldom
work at a desk job for seven hours      
work at a desk job more than 7 hours      
walk three miles in less than an hour      
do one hour of yoga      
swim laps for 1/2 hour      
ride a bike at 10 m.p.h. for 30 minutes      
do aerobics or gym workout for 30 minutes      
work in the garden for one hour      
have vigorous sex for 30 minutes      
run 2 miles in 20 minutes or less      
iron clothes for an hour      
ski cross country or downhill for 20 minutes (minus lift time)      
play 1/2 hour of singles tennis or 45 minutes of doubles      
wash windows for 1 hour      
work on a factory assembly-line for 1 hour      
push a non-power lawn mower for 20 minutes      
wait on tables for 1 hour      
chop wood for 30 minutes      
type for 2 hours      
skip rope for 20 minutes      
stand for two hours (as in shopping or working as a sales person)      
walk a mile in 30 minutes or less with a 20-pound child in a backpack or pushing a stroller      

Step 5: Past Pregnancies [back to top]

For each past pregnancy, reply as fully as possible.

Length of pregnancy (weeks) __________

Terminated by:

surgery (tubal or abdominal pregnancy) __________
spontaneous abortion (miscarriage) __________
therapeutic abortion (reason: __________) (method: __________)
preterm (under 38 weeks) induction (reason: __________)
vaginal delivery (length of labor: __________)
Cesarean delivery (reason: __________)
postterm (over 42 weeks) induction (reason: __________)

Baby’s birth weight __________ birth date __________

Special nursing care required by baby (ICU, phototherapy for jaundice, blood transfusion, surgery, resuscitation, etc.)

Feeding problems, allergies, noted in baby or child

How long was baby breastfed?

Special nursing care required by you before or after delivery (intensive care, episiotomy care, infection therapy, post-Cesarean care, breast or nipple infection/cracking/soreness, etc.)

Childbirth classes attended (method/private instructor or hospital sponsored)

Step 6: Medical History [back to top]

Indicate whether you have been treated for any of these medical/surgical conditions, give the dates and form of therapy/medication, and note whether the condition still exists.

Condition Treated? Dates/Therapy Current?
Allergy (type?)      
Anemia (type?)      
Anorexia/bulimia      
Appendicitis      
Arthritis      
Bladder/kidney infections      
Bleeding disorders      
Breast disorders/ breast cancer      
Cancer (type?)      
Colitis/Crohn’s Disease/irritable bowel      
Costochondritis      
Depression      
Diabetes (type?)      
Ear infection      
Fibroids      
Gallbladder disease      
Genetic testing      
Gynecologic infection      
Gynecologic surgery      
Heart disease      
Hemorrhoids      
Herpes (genital)      
Hypertension      
Hypoglycemia      
Infection (type?)      
Infertility      
Kidney disease      
Liver disease      
Lupus      
Mastitis      
Menstrual problems      
Mental illness      
Migraine      
Mononucleosis      
Obesity      
Phlebitis      
Pneumonia      
Rheumatic fever      
Rubella      
Seizure disorders      
Skin disorders (type?)      
Spine/disc disorders      
Substance abuse (drugs/alcohol/sniffing)      
Tuberculosis      
Ulcer      
Varicose veins      
Venereal disease      

Have you had X-rays? Give the reasons below.

Indicate how long you have used these forms of birth control:

Oral contraceptive pills from: to:
IUD from: to:
Depo-Provera from: to:

Indicate whether you have been treated for any of these oral/dental conditions, give dates and form of therapy/medication, and show whether the condition still exists.

Condition Treated? Dates/Therapy Current?
Caries (decay): fillings      
extractions      
Missing teeth (which ones?)      
Bridgework      
Dentures      
Orthodontia      
Root canal      
Gum disease      
Bad breath      
Changes in tongue      
Cracks at corners of mouth      
Oral surgery      
Do you: yes no
bruise easily?    
have bleeding gums?    
heal slowly?    
have slow hair growth?    
have scalp problems?    
have recurrent athlete’s foot?    
become constipated often?    
have pale nailbeds?    
have more than two colds a year?    
have sleep difficulties?    
have leg cramps?    
have joint pain?    

Describe any other medical conditions or complaints you have had or now have.

Step 7: Personal Habits and Attitudes [back to top]

Indicate approximately how often you: daily weekly seldom
smoke more than 5 cigarettes      
drink more than 2 oz. alcohol      
drink more than one glasses of wine      
drink more than one can of beer      
drink more than 3 cups of caffeine- containing beverages a day (coffee, tea, cola)      
smoke a joint of marijuana      
use hashish, cocaine, heroin, or any other non-prescription drugs (which and in what amounts?)      
take prescription drugs (which and in what amounts?)      
take methadone (amount?)      
eat non-foods (starch, clay, ice, etc.)      
skip breakfast      
skip lunch      
skip dinner      
sleep less than 8 hours a night      
go all day without any exercise that gets your heart pumping      
feel too nauseated to eat      
vomit      
feel too tired for sex      
have sex with different partners      
watch television for more than 2 hours a day      
become involved in quarrels with mate, family, or associates      
wish you weren’t pregnant      
worry about money      
worry about your health      
worry about your family’s health      
worry about your unborn baby’s health      
worry about your job or school      
worry about what others think of you      
worry about your weight or figure      
worry about your neighborhood      
worry about labor and delivery      
feel ill at ease with your doctor or midwife      
worry that you won’t be a good mother      
worry that you are losing your mate’s affection      
worry about your parents      
feel as though you can’t cope any more with the pressures in your life      
find it difficult to discuss your problems with someone whose opinion you value      
face other difficult situations      

Step 8: Laboratory Tests [back to top]

Indicate if any of your current laboratory tests show anything outside the range of normal (ask your doctor or midwife to show you the test results and discuss them with you in person or provide you with a copy of the test results for your own health records). Tests marked with an asterisk (*) may not be performed routinely; you may have to request them. Those marked with two asterisks (**) would usually be performed only if you had some symptoms of disease that needed to be diagnosed, such as a gonorrhea culture.

Your blood type __________
Your RH factor __________
Your baby’s father’s blood type __________
Your hemoglobin/hematocrit __________
* Your SMA-12 values:
total serum protein __________
albumin __________
abnormal values (list) __________
Your urinalysis __________
Your rubella titer __________
Your complete blood count / differential __________
Your VDRL (blood test for syphilis) __________
* Your Pap smear __________
** Your gonorrhea culture __________
** Your quantitative urine culture and sensitivity test (urinary tract infection) __________


NOTES ON THE NUTRITION ANALYSIS

NOTES: STEPS 1 AND 2 (Diet Record and Comparison) [back to top]

A diet diary or food record, is the most accurate way to find out what you’re really eating, short of weighing and measuring each serving as would be done in a metabolic research project. It is far more likely that you will prepare a full record when you take the time to write out what you’re eating at the time you eat it, rather than trying to reconstruct from memory what it was. A reconstruction from memory is called a diet recall and is usually attempted for a twenty-four-hour period only. Obviously, if the day just past was not typical for you, a 24-hour recall might give your nutrition counselor an incorrect impression of the overall quality and adequacy of your diet. Information about where you ate your meals and snacks also gives important clues to your dietary pattern:

Do you eat well when your mother is doing the cooking and you’re home visiting, but slack off at your own home because you have to eat alone much of the time?

Do you eat well at home, but take many meals on the run because of the demands of your work or school schedule?

Do you eat extra meals every day because you feed your children at 5:30 and then eat again when your husband arrives home at 7:00?

Do you have the fast-food habit? It’s possible to make nutritious choices there, but do you?

Do you grab something sugary when you feel like you’re starting to slow down around four in the afternoon? Any number of other snack foods could give you more of the nutrients your body needs.

You get the idea: Food habits are intimately involved with our other life habits. Making the most of your pregnancy nutrition opportunities means becoming sensitive to your own patterns, finding your strengths and weaknesses, and doing something positive about them. These changes can occur gradually. Don’t become impatient or give up if you can’t transform your pattern overnight. The switch from white bread to whole wheat as a great step forward, a return to a full breakfast as a tremendous advance, and a completely filled-in pregnancy diet record as an absolute triumph!

NOTES: STEP 3 (Physical Characteristics) [back to top]

The only reason your weight is of note is in case you weigh too little for your height. Very often, medical workers come down hard on the woman who is overweight at the beginning of pregnancy (and often they use an outdated height-weight reference chart to determine this). But as mentioned earlier, the overweight mother who can eat correctly during pregnancy is not a high risk. Her underweight sister is: She lacks the calorie reserves to see her through any bouts with nausea or vomiting, the flu, or other illness, or any other kind of stress that might adversely affect her appetite. The highest-risk mothers are those who are underweight at conception and fail to gain on a good diet. If you weigh 15 percent or more under your ideal weight for your height, you would do well to try and gain those extra pounds before you conceive. That way, you won’t be in such a calorie pinch should you find that you need a few extra sometime over the course of pregnancy — or should you wind up carrying twins!

If you are 15 percent or more over your ideal weight for your height, do not go on a crash diet to try to lose weight before you conceive. You may risk depleting important stores of vitamins and minerals. If you are still six months or a year away from the time when you’d like to become pregnant (and you are not breastfeeding another baby who still relies on your milk for the bulk of the day’s nutrition), a gradual weight-loss program probably consisting primarily of increasing your amount of exercise, not cutting back drastically on good food — might make you feel more comfortable with your own body.

This point cannot be repeated too often: Even if you gained your excess weight on a nutritionally poor diet, you are not doomed to a difficult or disastrous pregnancy if you follow one of the Brewer Pregnancy Diets.

Hundreds of mothers who weighed more than 200 pounds at conception — and some over 300 pounds — have consulted the Brewer Hotline and, without exception, they did not have premature babies, difficult deliveries, or postpartum complications as long as they were able to stay on the diet detailed in this book. It is true that long-term obesity contributes to a host of medical problems, including heart disease and diabetes, and the Brewer Hotline does not advocate obesity by any means. It’s just that in terms of your pregnancy experience, excess weight at conception or excess weight gained during pregnancy on a good diet does not predispose you to obstetrical problems.

The crucial issue is whether you can manage to eat correctly for the nine months of pregnancy. All your attention needs to be placed on meeting your daily nutritional requirements as expressed in the food exchanges on the diet. Let the pounds take care of themselves. You may even be happily surprised to find that your weight stays the same or you gain only a few pounds over the course of pregnancy — once you set your sights on good nutrition as your first priority.

One other thing you could do for yourself is walk a mile or two every day. It’s good for your circulation and your frame of mind, apart from the fact that it also uses a few of those stored calories you may not really need.

If you are filling in the Profile after you’ve become pregnant, the weight issue becomes more complicated. Please read elsewhere in this book about weight adjustments in pregnancy and how they may fluctuate widely based on your activity level and metabolism. If you are more than three months along and you have not started to gain weight and you were not more than 15 percent overweight to start, it’s great that you’re doing the Profile. It may help identify what’s interfering with your nutrition and suggest some ways for correcting it, ideally with the assistance of your doctor or midwife or health worker who handles pregnancy nutrition counseling. If any of these people express pleasure that you’re not gaining, you need to find another set of consultants!

Blood pressure readings may also be affected by your weight. Volumes have been written about high blood pressure — a lengthy discussion of pregnancy in hypertensive mothers is included in Part Five of this book — and the criteria for deciding what constitutes high blood pressure. It is a routine part of a physical examination to have your blood pressure taken. And, when evaluated in relation to the many other factors that determine your state of health, a series of blood pressure readings could take on major significance. However, a single reading in and of itself is of very limited diagnostic value.

Even a perfectly normal individual can have an elevated blood pressure reading if any of the following occur:

  1. an incorrectly sized cuff is used (if you have a large arm, you need a larger cuff to compensate; otherwise, the narrow cuff cuts into your flesh, artificially producing an elevation)
  2. you are anxious about having your pressure taken, or being examined by the doctor, midwife, or health worker (many women have a particular dislike for the routine gynecological exam, and their pressures go up in anticipation of what’s next at the checkup).
  3. you are having your pressure taken while you are emotionally upset (a fight with your mate or boss, getting caught in traffic and being late for your appointment, having just been weighed and lectured for being overweight or having gained too much since your last prenatal appointment. Some people get headaches under these circumstances. Some get stomach aches or backaches. Others have their pressure go up. It is a very common stress reaction.)
  4. the person taking your pressure makes a mistake in technique, or the sphygmomanometer (blood pressure device) isn’t in good repair.

There is a good deal of controversy these days about making the diagnosis of hypertension. By some doctors’ guidelines almost everyone would have it! One reading that’s elevated does not necessarily mean that you have hypertension, but it should be taken into consideration as part of your pre-pregnancy work-up. If you have high blood pressure of long standing, your antihypertensive therapy (diet, exercise, drugs) will need to be reviewed and possibly modified to a great degree in light of your desire to have a baby. More about this appears in Part Five of this book (High-Risk Pregnancy).

NOTES: STEP 4 (Activity Level) [back to top]

Each of these activities, in the amounts described, burns approximately 200 calories. If you have five or more checks in the “Daily” column, rate yourself as a very active person — someone who might need extra calories in order to meet the demands of her lifestyle. If you do one of the activities for longer than the period of time described (say, you run six miles a day and it takes you under an hour, or you wait on tables for six hours a day), make a check for each time period elapsed. For the runner, that would make three checks in the Daily box. For the waitress, six checks (you may begin to see why so many women who work full time during pregnancy get behind on their calories and probably other nutrients as well).

Usually your appetite would signal that you need more food to meet these calorie expenditures. You’d feel hungry. However, if your life is busy, it’s easy to get into the habit of disregarding this basic signal and putting off your nutritious snack or meal until later. Also, if you’re accustomed to being very slim, you may have come to regard these empty feelings in your stomach as the status quo, your normal everyday sensation. Or, if you’ve consciously cut back on your salt lately as an experiment or because you have a medical condition that requires it, your interest in food may also have diminished since it tastes so flat now.

Completing this portion of the Profile should alert you to the fact that you need to behave differently during pregnancy. Pay attention to your body’s signals for food and satisfy them with the most nourishing selections you can make. If you have to, set an alarm clock to go off every two hours at work to remind you to have something nutritious. Bring your own lunch if there are days when you find it next to impossible to eat well on the job. If you work overtime, have a good meal sent in — or go out for it and return to work refreshed and refueled. You wouldn’t dream of ignoring your baby’s cries for food after it’s born — so don’t do so during pregnancy, either. This is not self-indulgence on your part. It is simply part of being a good mother.

If you are at the other extreme — almost all your checks are in the “Seldom” (meaning “never”!) column — you do not need less food than what’s presented in the complete Brewer pregnancy diets exchange lists. What you need is more exercise. Start today to move some of those checks into the Weekly or Daily columns. You’ll feel better, look better, and have a better appetite.

NOTES: STEP 5 (Past Pregnancies) [back to top]

Many pregnancy problems can be traced directly to the mother’s nutritional status during pregnancy. If you have had one or more pregnancies with complications either for yourself or your baby, you may finally obtain some peace of mind about what happened if you are able to think specifically about how your nutrition was managed at the time. The Brewer Hotline invests a great deal of time doing this with parents who have been advised never to attempt another pregnancy, or who have been told that they are likely to have another stillbirth or another premature, immature, or damaged baby in successive pregnancies. There are, of course, many conditions that do not have a nutritional component and for which improved maternal nutrition is not the answer; however, in talking with thousands of women, it’s clear that so often the mother’s nutrition is given little or no consideration when medical personnel are trying to advise the parents about what happened to cause the tragedy or what they might be able to do to avert it in another pregnancy. The nutritional history of the pregnancy is simply not taken.

This is a significant shortcoming in the current medical training of physicians, midwives, and most nurses, not to mention social workers, psychologists, and genetic counselors — the professionals who are most often called upon to help the parents cope with a pregnancy loss or serious disability in their child. Failure to discuss this critical aspect of prenatal management and provide appropriate information about how to correct any nutritional problems uncovered (in certain cases this may include not returning to a medical office or clinic where improper dietary advice is given) may well result in a series of unfortunate pregnancy experiences — all of which could have been prevented. Such counseling should be provided as part of the services of neonatal intensive care units across the country as one positive step toward reducing the number of repeat admissions from the same family or same set of doctors and midwives.

Dr. Brewer is asked to review hundreds of medical charts and records annually. Almost never is there a complete dietary record attached for the mother that details her pregnancy nutrition while she was under the doctor’s or midwife’s care. Certain laboratory tests give the researcher some insight into an individual’s nutritional status, the SMA-12, -20, or -24, in particular. But often even this test was not ordered: It simply wasn’t seen as pertinent to the mother’s problem!

It is impossible to reconstruct what a person actually ate or didn’t eat a year or two years or five years ago (unless she was hospitalized and comprehensive records were kept). But it is possible to remember if you were struggling to follow a low-calorie, low-salt diet and taking diuretics or appetite suppressants in order to stop gaining weight. It is possible to remember if you were hospitalized and unable to eat because the food choices were unpalatable or you had such abdominal pain or nausea that you couldn’t keep anything down. It is possible to remember if you were on medications that made you lethargic and disconnected from reality — and therefore made you uninterested in eating. It is possible to remember that you were exceedingly hungry, but all you were allowed to have were dietetic orange juice and skim milk. Record after record sent to Dr. Brewer for review document not only that these events happen once in a while, but that they have been in common practice in obstetrics across the country for decades.

If any of this happened to you in a past pregnancy, now is the time to understand what happened so you don’t go through it again. Nutritional problems can be overcome. But first they must be recognized for what they are!

NOTES: STEP 6 (Medical Record) [back to top]

All of these medical problems have nutritional components. Some are caused directly by malnutrition of one kind or another. Others have special diets associated with their medical management. The rest are possible tip-offs that your diet, while not so bad that you’re seriously ill, still isn’t everything it could be. All illness takes a nutritional toll. In fact, recovery from illness is one of the most important roles nutrition plays in your body’s ability to keep functioning over your lifespan. Writing in full detail about the interplay between nutrition and medical/surgical conditions is beyond the scope of this book, but many respected leaders in medical education are beginning to look in this direction in their research and writing. Sue Rodwell Williams’ text, Nutrition and Diet Therapy (St. Louis: Mosby, 1981), is an excellent introduction to the subject, written very clearly for a college-level audience but with immediate application to the lives of large numbers of people. An overview of pregnancy complicated by medical/surgical conditions appears in Part Six (High-Risk Pregnancy).

NOTES: STEP 7 (Personal Habits and Attitudes) [back to top]

Well, nobody’s perfect! An occasional cigarette, an occasional alcoholic beverage, an occasional late night or bad day are not going to throw your pregnancy into a tailspin — if you’re well-nourished. But a pattern of daily smoking and drinking and fatigue and emotional conflicts makes for a poor pregnancy outlook. Any hard drug use is incompatible with a healthy pregnancy and often results in a newborn baby already addicted to whatever the mother is on. Watching an adult withdraw from a drug habit is upsetting enough, but seeing a totally defenseless infant experience the convulsions, difficulty with breathing, and vomiting makes one weep. If you are involved with drugs, get off at least three months before you conceive, and get the help you need to stay off.

If you have four or more checks in the “Daily” column or eight or more in the “Weekly” column you must carefully consider your priorities as far as becoming pregnant is concerned. To give you and your baby the best possible chance, you will have to make some changes. Are you willing to make them? Will you need help to do it? Do you know where to go for the kind of help you need? Will making these changes alter your relationships with your mate or other people you care about? Would the prospect of having a strong, healthy baby compensate for any disruption of the life you’ve been leading up until now? Only you can be the judge.

Deciding to have a baby always means making some changes in your life, no matter who you are. But some of us have more difficult changes to make than others. Much of your success in seeing it through will depend on your level of commitment to your pregnancy and the support you are able to generate for the decisions you make.


QUESTIONS AND ANSWERS ABOUT THE PERSONAL NUTRITIONAL PROFILE [back to top]

QUESTION 1: WHEN TO START THE BREWER PREGNANCY DIET. [back to top]
I’ve just finished my Diet Record and Comparison and I’m close to meeting the requirements in every food group (I lack one exchange in each category), but I think my calorie intake is only about 2,000. Do I have to start on the pregnancy diet right away as soon as I’m pregnant — even though my appetite stays the same?

ANSWER 1: WHEN TO START THE BREWER PREGNANCY DIET.
A 2,000-calorie-per-day intake and a well-balanced diet when you’re not pregnant probably meet the needs of most women of childbearing age. Your calorie needs increase progressively as pregnancy goes on, even if your activity level remains the same. Growing a baby takes a lot of calories! In the first few months of pregnancy, the baby is very tiny and doesn’t require large amounts of nutrients, so your appetite may not tell you to eat more. But usually by the fourth month the 2,500-3,000-calorie range becomes more like it, and your appetite zooms. If it doesn’t, you need to find out why.

QUESTION 2: DENTAL WORK. [back to top]
Is it a good idea to have needed dental work done before conceiving?

ANSWER 2: DENTAL WORK.
If you can schedule your dental appointments prior to conception, so much the better. Often your dentist will need to take X-rays if extensive work is to be performed (bridges, dentures, fillings and extractions, oral surgery). Women should always request a shield to protect their reproductive organs (and egg supply) whether they suspect they are pregnant or not. And always make sure the X-ray is absolutely necessary before agreeing to it. Radiation accumulates in the body over our lifetimes, and the less often we are needlessly exposed, the less chance of any ill effects.

The small amounts of anesthetic substances used in dentistry appear to have negligible effects even if you are pregnant. To be on the safe side, though, whenever you have the option, avoid all drugs during the first three months when there is such rapid differentiation of fetal cells (whole limbs form in a day or two, for instance).

If you have pain from teeth or gums that are in poor shape, that in itself may interfere with your interest in and ability to chew your food. So, getting the problem corrected will benefit you in the long run. Of course, during the period of time when the repairs are being done you may have extra sensitivity in your mouth and teeth. All these reasons make it wise to see your dentist before becoming pregnant.

QUESTION 3: PESTICIDE EXPOSURE.[back to top]
We live in an area where there has been heavy spraying of forests and crop lands to control weeds and pests. What effect does this practice have on the unborn baby?

ANSWER 3: PESTICIDE EXPOSURE.
Depending on the substances used, the effects may range from devastating to nil. All environmental contaminants that make their way into the air, water, or food supply ultimately pass through or collect in our bodies. So, even though your immediate surroundings may not have been in the direct line of the sprays, there is still a possibility that you may be affected.

The well-nourished person has the best resources for clearing toxic substances from his or her body: This is one of the major tasks of your liver. A 1981 book, At Highest Risk (New York: McGraw-Hill, 1981) by Christopher Norwood, treated the issues of environmental safety and pregnancy outcome in a comprehensive way. If you have the choice, stay away during spraying season, especially if it’s during the first three months of pregnancy or you suspect that you might be pregnant. Contact your local town hall to find out what substances are being used in your area and do all you can to influence local decision makers to use the least toxic substances that will achieve the desired goal.

QUESTIONS 4: CURRENT MEDICATIONS. [back to top]
How can I find out if medications I’m taking are safe to continue during pregnancy?

ANSWER 4: CURRENT MEDICATIONS.
An excellent place to look up your medications is the standard text, The Pharmacological Basis of Therapeutics, current edition (New York: Macmillan), by Louis S. Goodman and Alfred Gilman. It’s objective in its appraisals (whereas the Physician’s Desk Reference is just a compilation of what the drug companies have to say about their products).

Today’s dynamic era of drug development means in most cases that a talk with a well-informed pharmacist might be your best bet. From him or her you can request the package insert that accompanies your medication, and which must be provided to you if you ask for it. Ask the pharmacist to explain it. Often the pharmacist is the health care professional most aware of dangerous drug reactions and drug interactions and so may be able to suggest alternative medications to your doctor that will treat your condition effectively but have fewer side effects in pregnancy.

The American Academy of Pediatrics publicizes its position that no drug has been proved safe for the unborn baby and urges every expectant mother — indeed, every woman who has the capacity to become pregnant — to avoid every possible medication unless it must be taken for some urgent medical reason. Perhaps the medication you’re taking could be stopped altogether. For specifics of drugs used in common diseases during pregnancy, see Part Five (High-Risk Pregnancy).

QUESTION 5: INFERTILITY. B> [back to top]
My husband and I have been through a complete infertility work-up (I’ve been trying for three years to get pregnant). Nothing seems to be wrong with either of us, except that I’m very thin (at 5′ 6″ I weigh 102). I am seriously considering taking drugs to force ovulation but I’d like to know of any nutritional approaches to our problem before I do.

ANSWER 5: INFERTILITY.
You are decidedly underweight, probably enough so to have had your body’s fat stores fall below the 15 percent of total body weight researchers have identified as the critical percentage to support ovulation and manufacture enough female hormones to sustain a pregnancy in the early stages. This information was obtained after women in large numbers began running long distances for sport and fitness and engaging in strenuous weight training as part of athletic competition. Professional dancers have known about the problem for a much longer time, but little was written about the phenomenon: Many of these women not only stop ovulating, but their menstrual periods cease altogether. When they let up on training and gain back some weight in the form of fat stores, their fertility returns.

Taking pills to force ovulation when you are in such calorie deficit is not a good idea. Many times such pregnancies turn out to be multiples — resulting in an overwhelming nutritional stress in a woman who has obviously been turned off to eating for some time. It would be far less hazardous for you and your unborn if you could gain the pounds you need to reach a standard weight for your height and enjoy a spontaneous conception. Your chances of having a twin or triplet pregnancy would be significantly reduced, and you’d have enough of a calorie reserve to tide you over if you should go through a period in pregnancy where your appetite falters.

Put yourself on one of the Brewer Pregnancy Diets today — you may have to force yourself to eat even when you don’t really feel like it at first — and see what happens. Tell your fertility specialist what you’re doing. If you’re still not pregnant six months from now and you’ve reached your ideal weight for height, try the drugs. At least then you’ll be in better nutritional shape in case you do become the mother of two or more at once!

QUESTION 6: AFFORDING GOOD PREGNANCY NUTRITION. B> [back to top]
I would like to have a baby, but I don’t think I can afford the kind of diet you’ve stressed is so important. Are there any financial aid programs for pregnancy nutrition?

ANSWER 6: AFFORDING GOOD PREGNANCY NUTRITION.
The federal government funds a program called WIC (pronounced “wick”), or Women, Infants, and Children. It distributes coupons for certain specified foods (fruit juices, cereals, eggs, milk, and cheese) that can be redeemed at retail supermarkets in the same way as promotional coupons for many other types of products. WIC is available nationwide, and information about the program office in your area is available by calling your local health department about the location of the WIC office. Sometimes it’s in the prenatal clinic of a hospital. Sometimes by itself in a social service agency in another building. Pregnant women are enrolled in WIC preferentially. In a given area where there are spaces left over after all pregnant women have been served, WIC can also be extended to children up to the age of five. Financial criteria and medical criteria must be met by all WIC participants. For details of how to enroll in WIC, ask your caregiver, contact your hospital clinic or dietetics department, or call your county or municipal health department.

One closing comment: The Brewer Pregnancy Diet was developed in the course of twelve years’ work with the lowest-income mothers in the United States — in the days before WIC was introduced. When mothers understood the life-and-death importance of their pregnancy nutrition, they gave up colas, packaged snack foods, and sugary desserts and instead spent their limited funds on the foods that gave them the most nutrition per dollar spent. Nobody is giving away six-packs of carbonated beverages or imitation punch. They cost a great deal: $3.30 a gallon for a nationally advertised brand of cola, versus $2.29 a gallon for whole milk (New York prices). The cola is a nutritional zero, except for calories in the non-diet varieties. The milk is a bountiful source of protein, vitamins, minerals, essential fats, and calories. There’s just no comparison. No single food is perfect or capable of supporting human life all by itself. But milk and eggs come close. If they are used as the foundation of your diet (they are still the best buys in the market) and you obtain your other needed protein from beans, peanut butter, and the less expensive cuts of meat and poultry, you can do exceptionally well in pregnancy, even on a very limited budget. A professional dietitian or home economist could be very helpful to you in identifying which foods in your area are the best seasonal buys. Request an appointment to see the dietitian as part of your first prenatal clinic visit.


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