New guidelines around eating and activity during pregnancy and breastfeeding

The female body is amazing. It can grow a baby for nine months and breastfeed it for many more, and it’s important that women support their body, and their baby, by eating well and exercising regularly.

A nutrient-rich diet, healthy weight and active lifestyle all helps to optimise health outcomes for mums and bubs, and in recognition of this, the Ministry of Health has revised its Eating and Activity Guidelines for New Zealand Adults to include updated recommendations for pregnant and breastfeeding women.

Here, we see how women can maintain good health with a baby on board or at the breast.

What do the Eating and Activity Guidelines prescribe for New Zealand adults?

The Guidelines contain six Eating Statements, one Body Weight Statement and five Activity Statements for ages 19 to 64 years, with specific information for pregnant and breastfeeding women.

The Statements are as follows:

Eating Statement 1	Enjoy a variety of nutritious foods every day, including: Plenty of vegetables and fruit, Grain foods, mostly whole grain and those naturally high in fibre, Some milk and milk products, mostly low and reduced fat, Some legumes, nuts, seeds, fish and other seafood, eggs, poultry and/or red meat (with the fat removed).
Eating Statement 2	Choose and/or prepare food and drinks: With unsaturated fats (canola, olive, rice bran or vegetable oil or margarine) instead of saturated fats (butter, cream, lard, dripping, coconut oil), With little or no added sugar, That are low in salt (sodium); if using salt, choose iodised salt, and That are mostly ‘whole’ and less processed.
Eating Statement 3	Make plain water your first choice over other drinks.
Eating Statement 4	If you drink alcohol, keep your alcohol intake low. Stop drinking alcohol if you could be pregnant, are pregnant or are trying to get pregnant. When breastfeeding, it is best to be alcohol-free.
Eating Statement 5	Buy or gather, prepare, cook and store food in ways that keep it safe to eat. Take extra care to protect yourself from foodborne illness if you are pregnant.
Eating Statement 6	Encourage, support and promote breastfeeding.
Body Weight Statement	Making good choices about what you eat and drink and being physically active are important to achieve and maintain a healthy body weight. When you are pregnant, talk to your midwife or doctor about the right amount of weight to gain during pregnancy. This amount is different for each person. Being a healthy weight: Helps you to stay active and well, and Reduces your risk of developing type 2 diabetes, heart disease and some cancers. If you are struggling to maintain a healthy weight, see your doctor and/or your community health care provider.
Activity Statement 1	Sit less, move more! Break up long periods of sitting.
Activity Statement 2	Do at least 2 ½ hours of moderate or 1 ¼ hours of vigorous physical activity spread throughout the week. Pregnant women should aim to do 2 ½ hours of moderate-intensity physical activity spread over at least 3 days per week (preferably some activity every day).
Activity Statement 3	For extra health benefits, aim for 5 hours of moderate or 2 ½ hours of vigorous physical activity spread throughout the week. Pregnant women should seek advice from a health care professional with specialist knowledge about the impact of vigorous-intensity activity if competing in event or if exercising significantly more than Activity Statement 2.
Activity Statement 4	Do muscle strengthening activities on at least two days each week. Pregnant women may also benefit from doing stretching and pelvic floor muscle training daily.
Activity Statement 5	Doing some physical activity is better than doing none. All pregnant women without serious health conditions should be regularly physically active through a variety of aerobic and resistance activities.

The government says these evidence-based recommendations are, ‘Based on nutrient intakes and activity levels that are consistent with good physical health,’ and the advice for pregnant women applies to, ‘Uncomplicated pregnancies involving just one baby.’ Women who are pregnant with multiples should seek specialist advice.

You can read more about the body weight and activity guidelines here, and below, we explore the eating guidelines for pregnant and breastfeeding women in more detail.

Why is a healthy diet so important for expectant and breastfeeding mums?

The government says, ‘Healthy eating patterns are particularly important before conception, during pregnancy and while breastfeeding, because pregnant and breastfeeding women have extra nutrient requirements.’

At this time in a woman’s life, diet has an influence on two people instead of one, and eating well during pregnancy can:

• Lower the risk of high blood pressure-related pregnancy disorders (such as pre-eclampsia and eclampsia) and gestational diabetes,
• Improve birth outcomes, and
• Improve the long-term health of the child.

Why is it particularly important for pregnant and breastfeeding women to eat a variety of fruit and veg?

The government says eating plenty of fruit and vegetables can provide important nutrients and help to establish healthy taste preferences in the infant (e.g. eating bitter vegetables while pregnant/breastfeeding can improve a child’s acceptance of vegetables in early childhood).

During pregnancy, it’s important for women to get enough:

• Folate, which can help prevent birth defects of a baby’s brain and spine (neural tube defects), like spina bifida. Folate is found naturally in green leafy vegetables (e.g. spinach, broccoli, bok choy and pūhā) and citrus fruits, as well as in cooked dried beans and peas, wholegrain bread and breakfast cereals.
• Vitamin C, which helps in absorbing iron. Vitamin C is found in foods like kiwifruit, oranges, broccoli, red capsicum, berries, kūmara, tomato and silver beet.

As well as eating plenty of fruit and veg, pregnant and breastfeeding women should also choose foods that are high in iodine, like eggs, milk and milk products, cooked fish, red or green seaweed and most breads.

The government says iodine is important because it’s, ‘Part of thyroid hormones that are needed for growth and development and is essential for normal fetal brain development during pregnancy.’

What supplements are recommended for women who are planning a pregnancy, pregnant or breastfeeding?

The government says women should:

• Aim to take one 800 µg folic acid-only tablet daily for at least four weeks before pregnancy and until the end of the first 12 weeks of pregnancy (the first trimester). If a pregnancy’s unplanned, the daily folic acid tablet should be commenced as soon as possible.
• Take a 150 µg iodine-only tablet daily from the start of pregnancy until the end of breastfeeding.
• Only take other supplements on the advice of a doctor or midwife. For example, women with low iron levels or a vitamin D deficiency may be advised to take a supplement.

What fluids should pregnant and breastfeeding women drink and not drink?

The government says, ‘Pregnant and breastfeeding women need plenty to drink because their blood volume increases during pregnancy and they need fluids to produce breast milk.’ Drinking plenty of plain water can also help to reduce constipation during pregnancy (along with a high fibre diet and an active lifestyle).

In terms of volume:

• Pregnant women should drink 2.3 litres (or 9 x 250ml cups) of fluid each day (including plain water and milk).
• Breastfeeding women should drink 2.6 litres (10 x 250ml cups) of fluids per day.

Women are advised to limit caffeine intake to less than 200 mg per day during pregnancy. This equates to:

• Four cups of black tea, or
• One cappuccino, or
• Two cups of plunger coffee and one cup of black tea over the course of the day.

Pregnant women shouldn’t drink energy drinks.

They’re also advised to use herbal teas with caution, and avoid these types: Aloe, buckthorn bark, chamomile, coltsfoot, comfrey, juniper berries, Labrador tea, lobelia, pennyroyal, sassafras and senna leaves (alpine tea).

Alcohol should also be avoided by women who could be pregnant, are pregnant or are trying to get pregnant. Alcohol can harm the developing baby (such as by causing fetal alcohol spectrum disorder), and the government says, ‘There is no safe level of alcohol use at any stage of pregnancy.’

When breastfeeding, the government says it’s best to be alcohol-free. Drinking alcohol can cause delays in the ‘let-down’ of milk, decrease milk production and negatively impact the baby’s behaviour.

Although it doesn’t recommend alcohol while breastfeeding, the government says women who choose to drink:

• Should avoid drinking alcohol during the first month of breastfeeding and at least until breastfeeding is well established,
• Consider expressing milk before drinking to ensure there’s alcohol-free milk available for the bub,
• Wait at least two hours after one standard drink before breastfeeding again (the FeedSafe app can estimate when the alcohol is out of your breastmilk)
• Ensure the baby always has a sober care-giver, and
• Never fall asleep on a bed or sofa with the baby after drinking alcohol.

Fermented drinks (like kombucha, kefir and kvass) should be carefully chosen or avoided, because they can contain low levels of alcohol.

Should pregnant or breastfeeding women avoid certain foods (like peanuts, soy, eggs or seafood) to prevent their babies from developing an allergy?

No. The government says, ‘Recent international guidelines encourage pregnant and breastfeeding women to eat foods associated with allergies, unless they have an allergy to the food themselves. Avoiding foods while pregnant or breastfeeding is not associated with the prevention of allergies in infants.’

How can pregnant women guard against food poisoning?

Pregnant women need to take extra care to protect themselves against foodborne illness.

The government says that mums-to-be have lower levels of immunity, which puts them at a higher risk of foodborne illness, and as well as experiencing the usual symptoms of food poisoning, there’s also the risk of miscarriage, stillbirth or premature birth.

To protect against foodborne illness, pregnant women should:

• Make sure food is not past its use-by date,
• Avoid foods with broken packaging,
• Choose undamaged and unripe (or just ripe) fruit and veg,
• Wash gathered food (like pūhā and watercress) before eating, and check for ‘marine biotoxin alerts’ before gathering shellfish or other seafood,
• Keep the fridge at or below four degrees Celsius,
• Store raw meat away from other food,
• Follow storage advice on labels,
• Cover leftovers and put them in the fridge within two hours of cooking, then use them within two days, making sure they’re steaming hot before eating,
• Always thoroughly wash hands with soap and water, then dry them, before handling food (and after handling raw meat),
• Prepare food on clean surfaces with clean utensils, and
• Take extra care storing and cooking foods that are at a higher risk of being contaminated with bugs that cause illness, like raw meat, milk products, fish/shellfish and sprout. ‘If in doubt, throw them out.’

Pregnant women should also wash their hands well with soap and water, ‘After being around animals, protect themselves against exposure to cat litter and wear gloves while gardening.’

Listeriosis and toxoplasmosis are two food-related infections that are rare, but can be dangerous to pregnant women. You can read more about them here.

The government says breastfeeding women should take the same food safety precautions as for non-pregnant adults.

What do pregnant women need to know about heavy metals?

Lead may be present in old housepaint; there’s mercury in certain types of fish and seafood; and there might be cadmium in Bluff and Pacific oysters and queen scallops.

It’s important for pregnant women to limit exposure to these kinds of heavy metals, so it’s recommended that care be taken around pre-1965 paint, the oysters and scallops shouldn’t be eaten more than once a month, and there’s guidance about eating fish like shark, deep sea perch and swordfish here.

How long should mums breastfeed for?

The Guidelines reinforce the idea that, ‘Breastfeeding is the ideal and optimal way to feed a baby,’ but they also acknowledge that, ‘We all need to do our part to create an environment that supports women to breastfeed’ and support those who can’t breastfeed.

The government recommends that babies are:

• Breastfed exclusively to around six months of age, then
• Continue to breastfeed up to two years of age.

This has health benefits for both bub and mum, and if breastfeeding isn’t possible, the government says that infant formula is the only suitable alternative in a baby’s first year (not cows’ milk).

All in all, there’s a lot of helpful advice in the updated Eating and Activity Guidelines, including advice for vegetarian and vegan mums.

You’re encouraged to read the New Zealand Dental Association’s advice around oral health during pregnancy, as well, and the NZ Nutrition Foundation is a great place to learn about healthy eating before, during and after pregnancy.