Are You Really Eating for Two? Food and Nutrition During Pregnancy

By: St. Louis Children's Hospital

Hey welcome to belly to baby i keep transposing the words baby to baby but we’re belly to baby. This is our third week that we're doing the show live on Facebook. We’re so excited that everyone is joining us again. Today we are joined by Dr. Shelby Dickinson.

Thank you so much for joining us we are going to be talking about I think the all important topic when you're pregnant… Food! Yummy— gotta eat it. Oh my gosh— Gotta eat it is the right words to use because i don't think i've ever experienced hangry, the likes of which I will now. I was in meeting it was a new meeting the other day and if a co-worker is watching this, I swear I don't hold it against any one of you, but it was a noon meeting and the pizza that was supposed to be at the meeting was late and I walked in a couple minutes— uh no! Where I truly thought I was going to burst into tears before one o'clock when it arrived and all was fine with the world again, but I’m here with all of these executives and co-workers and colleagues and bringing together bringing together. Yeah but didn't you say that's pretty normal um Yes twice you can ask my husband about hangry.

He’ll be like Shelby’s hangry again. There may have been some food in the center console we'd be driving and he’s like “oh do you need to eat?” oh yeah where's that food. Oh yes not always keep snacks handy that is not one thing I have learned.

If last week I just so happened to have a slim jim, which it is not my snack of choice it was a random, random… Good protein! I'm sure it has protein in it, but usually there is not a sort of prepackaged snack in the purse which brings me to my first question about you when we first, everybody wants to be as healthy as possible during pregnancy but yes I have Cheez Its in my purse and is that okay? or you should you have the apple instead? and is it. You’re never ever going to fault yourself by eating the Apple first. Okay? Fruits and vegetables should be a mainstay pregnant or not, but every now and again you need a carb and I think some of those cravings will lead you towards more carbohydrate based foods.

Are You Really Eating for Two? Food and Nutrition During Pregnancy

Some of that may have to do with the increase hormones in pregnancy, but if you have an apple go for the apple. If you’re so hungry you can go for the cheese's because your caloric intake or how many calories you need to take in does increase during pregnancy and how much does it increase because we've all heard the you're not really eating for two exactly not affecting the quality that you people need but not necessarily the quantity. So what is the change in caloric need that your body experiences? You really only need an extra 300 calories per day to support a pregnancy to be honest with you. A little bit more when you're breastfeeding them 500 maybe skip that work out— just kidding Nice! I was going to say that just made that decision so much easier for so many of us But no, you just need an extra 300 calories a day, so you're not really eating for two. And is that throughout pregnancy? That's throughout pregnancy so even in the third trimester I thought I thought it went up again, but it doesn't go up again? Well it kind of does so in general that's how much I shouldn't say that's how much extra but that’s how much extra you'll burn okay? I was about that do you burn— your larger, so do you burn more? So it's typically 300 calories a day that you burn. In the first trimester, you want to eat about total for yourself and for your baby about 1,800 calories a day.

It does go up like you— in the second trimester 2200 calories and then the third trimester about 2,400 calories okay and not all on ice cream I’m guessing? You can rack that up really fast! Yes, you can So the recommendation for weight changes in pregnancy kind of depend upon how much you weighed when you got pregnant to be honest with you. Yeah and it is interesting because i was just, I have read so much about this, which is probably dangerous and I should also say right now I always forget the introductions part aside from giving names, Shelby you are a doctor or I should say Dr. Dickerson you're a physician with Wash U— call me Shelby it’s fine everybody else does too. Dr. Shelby Dr. Dickerson I respond! oh no Dr. Shelby I'm game.

But you are a Wash U physician you deliver babies and take care of women at Barnes-Jewish. Ah yes I do and I work at St. Louis Children's Hospital in a non-clinical role, so I don't actually take care of the babies, but I see where they are all cared for very well on daily basis and some of your little ones wind up there as well. Yeah uh-huh make They sure do! Terrific! Well and I'm not the only one who's allowed to ask questions here either, by all means please send us your questions we will so we will get as many of them answered as we can live and if there are any that we need to take off line we can certainly do that as well so keep that in mind as we're going and back to the topic at hand on weight gain like I have been so paranoid just about how much because there are some apps and the websites all the time out there that give you pretty strict guidelines as to as far as we can go and I will say I’m 17 weeks now and i am nine and a half to ten pounds higher than where i was at my first doctor's appointment which was around seven eight weeks, so i was fortunate never sick in the first trimester.

I know a lot of women first of all who sometimes lose weight in the first trimester. They can. And then do they gain it back? They do? A lot do gain it back they do they do gained it back so typically what happens you either in the first trimester have no weight gain or maybe just a little bit like five pounds.

The second and third trimester you can increase that or what we see I should say is that on you may gain a half a pound to a pound a week throughout the second and third trimester. What we really really care about is making sure you don't gain too much weight because there are some bad outcomes associated with that and you're gaining enough weight so that your baby doesn't grow small okay because we have seen like in third world countries where starvation is an issue there's an increased risk of small babies a lot of it having to do with malnutrition. In this country, we don't see them as often. It's more on the other other spectrum of things where too much weight can actually be a problem too. And what does that does that cause— I’m trying to think of this it’s a multi-part question I mean as far as weight gain goes right now and I'm not carrying 10 pounds of baby.

No you're not what where is that all. I can tell you where it's going. But what what is that why does this, I mean why does your body need or want to gain that weight? Well a lot of it has to do with the fluid Even in the first trimester, the amount of fluid your body retains significantly increases and the reason why is we have to circulate all the micronutrients and then also the calories to the baby and we do that via our blood volumes and so a lot of what you're experiencing is a volume of fluid and essentially at this gestational age. Okay and so then as you can just go on with pregnancy because is that something that you need to worry about with the baby growing small but also growing large with waking Yes, you’re right! So there are some risks associated with too much weight gain and pregnancy. They include the following: blood pressure conditions of pregnancy gestational diabetes or diabetes of pregnancy, large babies which have different outcomes.

Okay such as c-section, so there is an increased risk of c-section associated with too much waking. Those are the big ones. The other one that I think we don't think about— we're always so focused on the pregnancy. Postpartum— I mean a postpartum period, there is a lot of literature that shows that if you gain too much weight during a pregnancy that you tend to hold on to that woman's afterward, which has long-term complications such as cardiovascular disease so heart attack stroke diabetes you got to be alive to take care of everybody, right mom’s? Yeah. Now you come in handy after the pregnancy too. It’s not just carrying. You do forget that that's funny that you bring that up and it I guess it's called the fourth trimester for a very good reason and you all see that all the time that you don't stop and my doctor went over that was last week too was your care does not stop the day that you deliver the baby you know as your maternity care goes well past that.

We say six weeks post pardom but there's developing literature all the time that physiology extends 3 months after delivery, six months after delivery. It's kind of been a focus field over the past several years all right we'll get into the whole how you're supposed to eat when you're breastfeeding and postpartum and all of that eventually yeah right now we’ll go back to while pregnant. Did you see the eating pattern? Did you experience that you're eating pattern changed a whole lot? Oh my goodness! Yeah sometimes that's the first clue you're pregnant Yeah— where are those pickles? They’re not custom made?! They actually taste delicious! Oh they do They’re so salty. You know some of that— a lot of them are myths as to why we crave what we crave.

Okay I think personally it has a lot to do there’s some physiology behind that. Your hormone levels really really rise during pregnancy, so I think that is a trigger. The other thing too is that salty foods will help your body reabsorb water but it's not a hundred percent. People create different things depending on the pregnancy too I should say. Were yours different? Oh completely different really! I wonder if my husband will try to do Facebook. Ed if you're listening please please say something nice. Just be nice that is all. I am still a little sensitive seven months out in month out hazardous postpartum.

So on my first pregnancy qdoba this is no plug for qdoba very bad. We have a history of plugging different things accidentally so keep going. Okay okay okay good! Um pickles on everything and they had to be Schnucks pickles sliced dill the big jar yeah.

That was first my pregnancy. That was my first pregnancy Then my second pregnancy which is very odd umm fruit, so hey I know! I think I have a shirt that says “I want fruit, but the baby wants cake” or something yeah yeah it’s awesome the baby wanted fruit too Babies a little smaller of a guy but Drew was my big one in the second trimester and the other interesting thing is I can’t drink coffee during pregnancy. Really I'm a coffee drinker.

I have to have at least two cups of coffee a day, but when it comes to pregnancy— that's the other clue. Shelby doesn't want coffee you better check a pregnancy test. Oh my god how funny! And I don't really know that unless there's some sort of inherent aversion to bitter tastes associated with coffee but that's the only time though and this is sort of a side note but did you get if you're a 2 cup of day drinker did you get headaches whenever you went I wouldn't suddenly didn't like it anymore I did initially. Yeah I had some withdrawal headaches, but the aversion to it didn't matter you really get over pretty quickly. It was literally a couple of days and they're probably back way you're feeling like you don’t know what made it to begin with You don’t feel good, so you're eating other stuff and you honestly don't notice it and I will say I had a very similar experience come to think of it I would stick at the time I had a cold just a nasty nasty cold at the time I found out I was pregnant. I am a coffee first thing in the morning person and it was really easy to decrease it down to half CAF well last because it was it just was completely unappealing.

The other thing I found that was that, I don’t know if I’m allowed to mention it, but I love red wine and the second, I mean it was minutes after I found out I was pregnant I really Thank God I mean it was a nice thing to not want it because can have it yes but the smell even bothered me, the smell of alcohol in general and it was only in the first trimester. Oh Shelby your husband just chimed in! Oh no mm-hmm. You should have bought stock in Schnucks sliced pickles. He was right! Stock in Schnucks fried pickles The best pickles— I wonder if they've got that we’ll have to look into it We’ll tag Schnucks in this after this Oh yeah Schnucks pickles, they're cheap Schnucks brand. Oh yes yeah hey it works out it works out works just fine. My standards i said my thing is that my standards are no longer high I love food I look for me food. Now, I want all random things— fried chicken but and not on the bone to describe like chicken fillet and umm I was eating it with mustard and pickles the other day and I thought it was the most delicious thing in the world and everyone at the table was looking at me like I had lost my sanity and still doesn't sound weird to me it sounds delicious and what are we having for lunch today? I don't eat fried chicken every day, but I did eat the doughnuts this morning I feel like I need to get the truth out okay finally finally thank you okay in summer you'll be all right It was green it was for Saint Patrick’s day so someone brought them into the office it was her fault come on but the in chocolate ice cream was the other thing, which I couldn't care less. Oh where did those ten pounds come from? I know exactly where do they come from? Where did they go? No I don't buy for the purpose if it’s in the fridge or in the freezer I will eat it and then fried chicken is there or if it’s not because I know it's bad for you but if I we were we were out gallivanting sounds delicious and it was! Oh cinnamon toast crunch that was the second one.

I knew there was it was my second pregnancy. One I was driving home and one day it came to me like an epiphany uh-huh cinnamon toast crunch! I'm serious oh my god I had to have it routinely, routinely and then after delivery not none interested anymore. Okay I oh you'll get over that we have a question but I won't mind what women out there to text us or go ahead and tell us too what they've been craving because your husband also wrote it again. Stop writing in! Oh this was very nice he didn't mind going out at 3am to have to get them for you. Oh so sweet show really nice husband ah okay Jocelyn has a question about red meat she said when it comes to steak, can I have it medium-rare. My husband who was a chef says yes.

He says the bacteria lies on the surface of the steak and not inside. Yeah so what she's alluding to is getting concerned about listeriosis and eating raw meat and I think it's okay as long as just like with her husband says that is if it if the bacteria is inside of the meat there's only something wrong with the meat, so I think it's completely safe Now as long as it's cooked I wouldn't do rare, but I think a medium steak is fine medium-rare? It depends on the temperature and every place is different. Okay, so maybe if she’s eating out she should get it medium, but if in home with a chef husband we're good yeah and even better understand do medium rare? It’s probably fine overall but yeah. And this is a great segue into the whole what you can and can’t eat. And we had talked previously with Dr. Robin you can eat the turkey mm-hmm. Do you feel the same way? I mean it's the listeriosis that's the problem with all of the foods or a great many of the foods that we're told It’s because of that risk which is actually really really rare to be honest with you. It's the uncooked meat it's the unpasteurized dairy so that's the other thing because I really like Gouda or not gouda or not gouda— feta! Gouda’s fine because it's that extra Feta’s the problem? Well it’s packed— you have to make sure it's packed okay.

I was going to say it came out of a plastic thing is that is pasteurized pasteurized uh-huh uh-huh you're right! The FDA's gotten a hold of it somewhere. I know I know. It's all good make sure it's pasteurized. There is some not pasteurized cheese in whole foods. Yeah right generally so and now is the other thing I would we were told very early is that you just have to check and make sure. I met a lot of restaurants most restaurants you're fine but it's worth checking at some of the nicer places are more adventurous places let’s say just to confirm that they are safe. You're right I'm sorry it was the unpasteurized cheese’s, deli meat, what else are the things that are worthy of concern or at least if I have look at the label? Yeah uncooked sushi is the other one for the same reasons as mentioned above.

Just make sure that it's cooked Okay yes Liz Rodin she's having cravings for Smacks Cereal it's a daily staple she hasn't had it in 20 years, but now its daily. Smacks wow! I forgot about that I remember those commercials from when I was a kid they were funny! That’s amazing isn't it the Frog I think it's the Frog guys gotta go to the frogs it's amazing that's amazing. That is so weird a girlfriend of mine also had the cinnamon toast crunch thing and I thought that sounded like a brilliant idea i gots some for myself and I was like man it’s okay okay it wasn't for you it wasn't it wasn't fried chicken with pickles in here.

So that is so those are the foods you can’t eat as far as amount that you eat in this day. I've noticed it's like a different pattern I mean I used to be able to be just fine eating breakfast lunch and if I was busy in the afternoon I make it to dinner just fine yeah now it is every two hours. You need that constant caloric source okay. A lot of patients will get real nauseated if they don't have a little something on their stomach.

Yes. And honestly if you eat big meals like a big breakfast, a big lunch, and a big dinner that can also be a little unsettling on your stomach as well. Well and that was the thing that I learned just about myself early on was that if I don't know that you're running out of space or if it's heartburn or what exactly, but I couldn't I was raised with three brothers, so I eat meals quickly because you eat protected it I think there's a whole psychology behind this, at least one that I developed with absolutely no authority But I have continued that unfortunate pattern to this day and I will say I can't do it right now. Like I can eat a certain amount and know that I just have to stop because two hours later okay First of all going to be really uncomfortable very quickly and then two hours later I'm going to want something else yeah this is the way it is.

So there are two factors to that. In the beginning and now you're GI system slows because of the progesterone. I think that's a component of that now, but then as your pregnancy progresses and your uterus grows and that baby's grows I mean literally there's only so much room in there. So that starts playing a bigger part as your pregnancy progresses. So it's a factor of two things and your GI system slows your metabolism speed up? How’s that impacted? Now your metabolism does speed up ok. I don't know I think in my mind I think it slows you can get as much chloric intake as you can from the foods that you eat.

It seems that way from like an evolutionary or anthropologic perspective, but the your metabolism does increase and hence the extra 300 calories a day that you need to help support the pregnancy okay and just to put 300 calories in perspective I was looking up different 300 calories snacks and it's like an apple with 2 tablespoons of peanut butter and that's it in a day I mean that's pretty remarkable I mean that's so many calories remember you also gain fluid which is from the water that you trained to help circulate the nutrients and the oxygen and the pregnancy. And is there do you and I have only had this experience a couple of times myself but did you experience any point with your pregnancy did you wake up at night hungry? Apparently there was a 3am run to the grocery store. But yeah yeah that other than for cinnamon toast crunch that one time that well that wasn't my big thing but i have many patients and many women who will wake up hungry in the middle of the night and then they start looking what can i eat what can i eat? And it was the first I do it's only happened to me a couple of times yeah first time I did it was so bad I was like oh my gosh it was first trimester and I can't figure out there's something wrong with my stomach and I thought oh my gosh I'm hungry I don't think I've been hungry enough since I don't know 1992 I don't let myself get hungry I know I know yeah usually. It's just so funny it's such an odd sensation but I mean I went up went down the stairs, got a sandwich and made a peanut butter and jelly sandwich went back to bed but was totally fine. Yep. So wild. Okay so your food pattern intake changes a little bit. Do you expect that things will evolve over the course of a pregnancy? Do you see that? yeah how do they change? I would say first trimester patients fall into a couple of categories I feel fine, I don't feel pregnant and then you have those that feel terrible can't tolerate food they need a little bit more extra support and then you have others that have to eat all day, all the time just small meals constantly otherwise they start feeling sick, so it's kind of the opposite.

They need food to prevent them from feeling sick whereas you have some patients that can’t even eat food because then they’ll get sick. It was so interesting and I think we're three for three on me bringing up my sister-in-law or one of my sisters-in-law and these episodes but she was sick and I just do it because I look back at this now I think she has got to be some sort of saint for having gone through what she did, but she was sick from week six to week 36, but she was saying the other day that she's still gained more than she wanted to in the pregnancy and I was like how is that possible you were sick the entire time and she said all I could eat was carbs and cheese yeah and so I did and so you do what you have to do, I do agree with that you do what you have to do. Are there any things any any restrictions you would put on people just in the sense that okay say you come in with unique dietary situations being with vegetarians, vegans yeah people who have gluten aversions, whether they are physical versions or just prefer not to eat gluten what are the regulations that you give them We should probably take them one by one yeah they're a little bit different. Yeah so vegetarians can you be a vegetarian through pregnancy? Yes you can be a vegetarian through pregnancy. Here are the micronutrients you need to really focus on and make sure you get enough of. So calcium okay calcium is very important for developing babies they have bones, they have teeth that needs that calcium. They will take it that they will take it for it.

So make sure you get enough calcium on but a lot about your vegetarians will still have dairy the problem is when you take out that dairy and we'll talk about vegans here in a second, but calcium is very important. The next is iron so which is probably even bigger for vegetarians, but iron is really important that there are foods that aren't meats that you can get your iron stores from because you need about twenty seven milligrams a day of iron in pregnancy, which is about the double of somebody who's a not pregnant okay. Some things that they can eat like beans and legumes. And can just get that from a vitamin? You can. I mean is it the same quality that you're going to get from food? No foods tend to you tend to tolerate it better from foods than you do from a vitamin, but vitamins are helpful. One of the things I recommend is taking vitamin taking foods with vitamin C in them like orange juice if you're trying to supplement with iron.

Or if you're eating foods that are high in iron that are plant-based to help really absorb that iron that's in those foods. Red meat our bodies have a really great ability of absorbing the iron in them and so that's not as problematic for people who eat meat. Now we’ve talked about vegan, vegetarian. Vegans so sorry Vegans I get a little bit more concerned about because they lack that calcium and the iron that they need and so I really think it add something that their diet and sometimes we have to coordinate with a dietician to help them do that. Even supplementation would be sufficient.

And so that's something whenever you see a patient to the pretend it's not a good idea to bring up with your doctor if you have any I mean if you are a vegan if you are a vegetarian oh yeah I definitely would find that right away yeah I definitely would. Every now and again ACOG doesn't recommend routine testing of vitamin D in all women, but if you have somebody who's at risk of having low vitamin D that's something that is a part of the history we could get from you that would be important we could check to see supplementation is an option. And ACOG is? American College of Obstetrics and Gynecologists. They tell me what to do. Yes I was going to say I know the American Academy of Pediatrics so they really want to do yet but so you are you are they up dating regularly their recommendations and what they see out there is best practices? Yes yes definitely. So the third one I think we were going to talk about was gluten-free. Gluten-free shouldn't be a problem. Avoiding gluten a lot of carbs we don't need it any way.

We have a little bit too much in our diet, so a gluten free diet generally are not a problem. We need that iron and that calcium. In terms of what kinds of food you're eating in a breakdown of carbs, protein and fat in a day. Do your needs change? Throughout pregnancy? Yeah. Um I would say that you may need more because that caloric intake increases. But proportionately one more than the other? Not necessarily. Okay, so it's just whatever gets it through to the end of the day? Mhm.

Alright so that's the food which it is an all important topic. The next one that is also just as important though not much fun to talk about is exercise. Oh before we go to exercise though, I forgot one important micronutrient— folic acid. Oh my god! How did we leave that out? I'm so sorry We’re talking about yummy foods and you know what it's so funny this last appointment was the one where my doctor was asking about the spina bifida testing, so the reason is for folic acid and could you tell us a little bit about what it is and why we need it? Yeah yeah so folic acid has done a lot of green leafy vegetables and prenatal vitamins the biggest thing there are a couple things that are different for prenatal vitamins and multi violence, but the biggest thing is amount of folic acid they have in it which is more than just a regular multivitamin. Typically prenatal vitamins have about one milligram of folic acid, which is a little bit more than what you need which is fine. The guidelines include taking in 600 micrograms of folic acid a day, so by taking a prenatal vitamin you'll get that supplementation. You need it because there's an increased risk of spina bifida or spinal cord malformations in people who lack folic acid and so that's why we do encourage women to supplement with it even before pregnancy because that spinal cord forms before you find out you're pregnant.

Oh my gosh! Yeah so which is pretty pretty some interesting embryology, regardless three months before you attempt pregnancy should be taken a multi vitamin at least three months. Is there any harm in women taking a folic acid supplement in addition or involved in folic acid and their daily vitamin intake before they ever even think about getting pregnant or is it something that you just that is just for. You can take it, but a lot of what happens a lot of times people get sick of taking more and more pills. But yeah if you want to take it whenever you're not contemplating pregnancy that's completely safe and completely fine and reproductive women who aren't using any form of birth control should consider taking enough folic acid in case they do become pregnant.

That's so interesting I didn't I didn't realize I the spinal cord was formed long before you ever knew you were pregnant We don't see it until later, but a lot of those things have already happened in that time period. There have been other things that have shown an increased risk of the spinal cord mouth forming, so like hot tubs like hot like not like my showers hot, but like a hot tub it's a hundred degrees that you get into that's been associated with it as well. And women who have a history of this, so let's see if you had a pregnancy with some sort of spinal cord malformation or if they're on anti-seizure meds because that can lower the amount of folic acid in your body. They should actually take even more. They should take about four milligrams and is that something you recommend people talk to their own doctors about right away Oh definitely! Oh how interesting. Alright so that is now that's an even better segue because when you mention the hot tubs I think this does fall there are so many things that we can talk about the idea of exercise. What can we do? What can we not do? Under the heading of especially of exercise And no sitting in a hot tub is not exercise, but 762 00:29:50,179 -- 00:29:54,889 it’s related to exercise for example if you go skiing and then you get in the hot tub afterwards, first of all can you ski pregnant? No sorry. Why is that? Well there are two reasons.

The first reason is you want to avoid contact sports and skiing as kind of a physically demanding contact sport— not necessarily physically demanding part of it, but it's a part of trauma or injury you could easily fall over and hurt your abdomen or your belly I will say I’ve only been skiing one time and skiing is a loose word I only went to the ski school for one day and I was asking the group i was with on the way up the slope how do you stop? What do you mean how do you stop? I mean if you're going to come at something how do you stop and and they’re like you’ll stop you'll figure it out they will teach you how to stop and trust us you'll figure it out. Yes you’ll figure it out you throw yourself into the side of the mountain. It's just the bunny slopes It was not anything by any chance but there were 18 month olds that slid right by me on ski’s but I'm you just might intentionally knock yourself to the ground and I don't know I mean at what point the become a real problem and it isn't a huge problem now but I will say I bump into things more often because i think as your body starts to change and you're not fully aware of. Oh you're totally right yeah and I mean this is the center of gravity it changes Yeah let me show you I need to know you can I show them? Yes I do need a second demo are we going to watch them afar? As well alright I will watch from afar. So I had kind of bad posture but um typically when you're not pregnant you have this posture where you're spine is a little bit curved on both up here and back here. What happens with pregnancy your center of gravity changes you're starting to carry what's going to become a watermelon you develop what we call lordosis so it’s physiologic, it’s normal, but basically this curve right here really accentuates and that's why sometimes pregnant women looks like they're waddling. They have to change their center of gravity back here because they're carrying a watermelon here. And so this curvature and their spine changes and your ribs will also move up, their heart will move up as loads of pregnancy progresses, if by that center of gravity changes and so because of it they walk a little funny they made waddle side to side, but in addition to they're prone to falling.

They're really prone to falling, so having good shoes. These are not good shoes, but I'm not pregnant. They're very cute! They're very cute shoes but having a nice solid tennis shoe of trying to avoid flip-flops as you can we're getting on summer now— everyone loves their flip flops, but a nice supportive shoe like a tennis shoe is really helpful because you're prone to falling and if you're prone to injuring your belly, so that's essentially why skiing for two aspects isn't helpful because you're prone to you're moving very fast and prone to hitting your belly, but also your center of gravity changes you don't have as good of a balance and you really need that to ski. But what about seeing another sport though is like riding a bike? You could fall riding a bike, is that is hazardous? Sorry sorry yeah yeah it is ok because once again riding a bike you have your own center of gravity, which you're going to have to change and in addition to it balancing on a bike. So if anything I’d recommend a stationary bike where you have a little bit more support and you're not likely to have a dog roll through or a squirrel right? Oh and then oh and then your yeah and they are going at higher rates of speed But exercise is good we're talking and I do know that I shouldn't have started with the one you can't do.

Yeah I did all of the things you can’t you should always start with a positive. So um I won't be a have friends who was on a spin bike from I mean up until she was eight months pregnant. Okay. She said my doctor said I can keep doing what I did before. I mean is that the general rule? Is there what would you recommend for? Spin bikes like a stationary? Yeah.

Yeah oh sorry, sorry. Yeah so I was amazed because it's intense when you're not pregnant and I get really winded now. I can't even imagine trying to keep up the intensity of a sport like that yeah for any duration of time, but I mean she was she was incredibly fit to be oh yeah and would do that on a routine basis and said I just kept going and I never needed to stop. Yeah so I guess I should have I didn't quite understand what you're asking me before. A bicycle. I was asking about my okay okay i was asking about something you could fall off.

Yes yes it makes me really I just sorry. In my mind i moved to stationary bikes but.. I ok ok so a stationary bike is fine. There are a couple of things though. Do what you can so you shouldn't be able to sing when you exercise, but you should be able to talk ok making sure it's not too hot, so I don't know they use but like the hot yoga hot pilates I don't know if they do hot spinning I don't think so but just just like pilates you're pretty hot and gross so you know making sure that you're in a temperature-controlled work which you generally are when you're spinning or on a stationary bike i should say um The only thing I get a little concerned about is because of our anatomy and our pelvis, you may notice increase pelvic floor pain from that position From what position? Riding a stationary bike. Okay but if you don't it should be fine and when you say pelvic floor pain you know what is what is it? Yeah I would you just know when you feel it and you know but you don't know? Ask your doctor if you experience it? yeah no not really let’s back up what is it? So you're pelvis the bottom part of your hips basically has an intricate musculature that sometimes with stationary bikes leaves us a little restricted and can cause a little bit more strain on those muscles that they attach to your hips.

They attach to the front of your pelvis. They get a lot of pressure on them from a growing pregnancy. In addition, they can cause your vagina hurt! Oh my goodness! And I can say vagina right? Alright good good okay yes so you say I mean if you experience that kind of pain what do you do you need to call the doctor check on it? What exactly are the symptoms that you need? Yeah so I would just discuss with your doctor. Is it because of the pressure of the growing pregnancy in general or could it be some pelvic floor dysfunction? And there are physical therapists out there that can work with patients that you have some problems with their pelvic floor muscles. And that is what specifically yeah that I mean those physical therapists specifically work with women with pelvic floor issues i did not realize that. Yes there yes it is a thing it is a thing ok So we talked about it with different kinds of classes, but general rule want to you tell patients when they come in to you for their first appointment and they say well I mean I'd like to keep exercising what is your response? Continue ok.

Do what you're doing just nothing hot too hot, um no contact sport, do what you can and you're going to notice as a pregnancy changes you may feel a little bit limited ok and that's okay but continue to exercise. Exercise is super important it's helpful for the labor process and it's also helpful in keeping you from gaining too much weight during the pregnancy. That's so interesting that you talk about helping during the labor process I know that there has there has been at least the perception in the world at some point or another that you should be very calm and laid back and not doing any major activity when you're pregnant.

However, it does seem a little counterintuitive when really you are nine months gearing up for one heck of a game. Oh that's true and you're body needs to be prepared and are there things that you can do to best prepare your body to be an optimal physical shape for labor? Is that a thing? So we don't have a lot of research into it but anecdotally I can tell you that women stay physically fit during their pregnancy tend to tolerate labor much better than women that don't because if you don't you tend to gain weight and you put yourself at risk of other complications that we talked about earlier but I would say just keeping your overall health and not feeling like you have to be a bump on the log it's most important. And we can touch I know Dr.

Robinson mentioned previously Pilates is fine. I do a workout called bar and it's a combination of yoga and pilates it’s not very low-impact yeah and I had asked one of the instructors early on to avoid anything just a little you know you're not supposed to be flat on your back after 20 weeks, but really your body is going to tell you what it can and cannot do otherwise you're fine and there are certain I mean you can't it definitely already awkward to twist certain ways, but it's so so it's so true that you're right your body does kind of give you some indication. You're totally right. You'll know when you can't do something or you don't feel good so if you lay on your back for a long period of time, you may feel nauseated you may feel a little dizzy, you may start breathing heavier and if you stand for long periods of time you may feel a little dizzy as well and sometimes fluid can collect in your legs and it needs to come back up so. So one question that was submitted earlier in advance for this is what about like CrossFit and lifting weights and sit ups and pull ups? Oh that's a good question and CrossFit and there are some those what is a high-intensity interval training type work those that are really hot right now hot as in trendy not temperature hot with air conditioning uh-huh.

The one thing I get concerned about lifting heavy weights would include I'm dropping something on your belly, losing any sort of balance um Pull ups should be fine, sit ups should be fine, but they're going to become harder to do at that pregnancy progresses. I was asked my next question too about it it just seems counterintuitive that you could do a crunch when you're pregnant. Yeah uh huh you kind of can you kind of can yeah um you may not be able to towards the end because your rectus muscle really get stretched out. In the beginning you can and it's perfectly safe and are there I've seen people who wear support bands underneath is what is that and do you recommends that? Oh do they help? oh yeah even without exercise it’s really really helpful. You can imagine like I showed you guys earlier you start carrying this watermelon and your muscles and your ligaments have to accommodate this watermelon.

So you can imagine everything gets stretched out and as everything starts leaning forward a pregnancy belt can really help you support that extra weight— especially whenever you're exercising. It's just like the weightlifters, only a little bit different. It's just and the the thing you're talking about the bat curving and is that what leads to back pain early on too? Okay yeah yeah. In addition to that, your pelvis is made of three different bones that relax because of hormones that your body makes and that relaxing of those hips can also cause pain too, but you're right. And does exercise can it hurt that? Can aggravate it further or does it help? Tends to help it and get it to help be honest with you ,depending on what you're doing though. Everybody’s body's a little bit different. A friend of mine was saying it was first trimester and so a little bit now of being so exhausted and trying to avoid that late afternoon caffeine run um some just go for a walk it'll help and it does. I mean… it doesn't help as much of coffee people.

I'm sorry it just doesn’t. But it does get your blood moving a little bit better and that seems again on the counter intuitive scale to be kind of on there. As did because I started to experience a little bit of lower back pain. It's not it's not horrible it's not unbearable just annoying. Oh yeah is it ain’t.

It's going to get worse oh yes at all oh yeah I was told if you think it hurts now you ain’t seen nothing yet. I mean so many of my complaints now if I was very just people yeah. But it's very important you and your feeling at now. And I feel bad even though I said this in our first episode to you feel bad complaining about it and like I say I'm not complaining though. I realize that you're experiencing it! Especially when we're talking like this every week and I feel compelled to highlight every single minute experience so please— no I don't mind all the time I try and just save that for my husband um so that and the ice cream runs.

Um but the just a little bit of exercise can help boost your energy yeah yeah definitely definitely and if you need a little topper with a coffee it's okay yeah that is it I've heard the same thing as well and I bear news there has been coffee in my life a couple of days I cannot tell a lie. Are there any other tips or tricks that you would give women as it relates to diet and exercise in pregnancy? Well balanced diet we talked about a little bit of the nuances, but a well-balanced diet okay. Weight— too much weight gain can be not as good as too little, so that's equally as important. Where do you draw the line where it’s too much? I know it’s where somebody starts. Yeah it does depend on where somebody starts. So if you're looking at somebody who's underweight um typically they can gain up to 40 pounds in a pregnancy okay we're from 28 to 40.

If somebody who's obese typically their weight gain should goal would be like 11 to 20 pounds. Really? Yeah and your body can sustain just based on what it has there? And then your average pregnancy is what? Your average pregnancy for somebody who’s of normal weight is 25 to 35 pounds. So eat the apple. Yeah but these are for patients who have just one singleton pregnancy yeah. Very very smart to point that out because there are some that carry two or more! Oh we see many multiples Yeah yes you do I can't even imagine.

I don't even want to imagine that’s terrifying right now. But for all of you who are experiencing the joy of getting ready to welcome two, three, or four babies we’re really excited for you! Yeah. So is there any other anything else you? Just stay healthy exercise is okay, eating a well-balanced meal, make sure you're getting plenty of water, and plenty of sleep and this will really tip you off to the rest of enjoying the time enjoying your baby. Keeps you healthy for well not only the duration of the pregnancy, but for that time period after the kid comes when you want to at least be present and physically able to enjoy this much as possible. Exactly well Dr. Shelby thank you for joining us and your husband as well Yeah! Thanks Adam. I failed to look at the topic list, but i think next week we're talking about what tests to expect in the duration of a pregnancy. So there is one of the— Sorry i cannot hold a sentence together today.

The gestational diabetes test is which one? The glucose is the one you were drinking the syrup? Yeah yeah so that one is typically 24 to 28 rate weeks and if you have risk factors they may do it in the first trimester. Okay, so there's a preview of the fun in store for next week join us next Friday Thanks so much!.

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