Pregnancy and Nutrition

What is nutrition, and why is it important during pregnancy?

Nutrition is about eating a healthy and balanced diet so your body gets the nutrients that it needs. Nutrients are substances in foods that our bodies need so they can function and grow. They include carbohydrates, fats, proteins, vitamins, minerals, and water.

When you're pregnant, nutrition is more important than ever. You need more of many important nutrients than you did before pregnancy. Making healthy food choices every day will help you give your baby what they need to develop. It will also help make sure that you and your baby gain a healthy amount of weight.

Do I have any special nutritional needs now that I am pregnant?

You need more folic acid, iron, calcium, and vitamin D than you did before pregnancy:

• Folic acid is a B vitamin that may help prevent neural tube defects.
  • Before pregnancy, you need 400 mcg (micrograms) per day.
  • During pregnancy and when breastfeeding, you need 600 mcg per day from foods and/or vitamins. It is hard to get this amount from foods alone, so you will most likely need to take a supplement that contains folic acid.
• Iron is important for your baby's growth and brain development. During pregnancy, the amount of blood in your body increases, so you need more iron for yourself and your growing baby. You should get 27 mg (milligrams) of iron a day.
• Calcium during pregnancy can reduce your risk of preeclampsia. It's a serious medical condition that causes a sudden increase in your blood pressure. Calcium also builds up your baby's bones and teeth.
• Pregnant adults should get 1,000 mg (milligrams) of calcium a day
• Pregnant teenagers (ages 14-18) need 1,300 mg of calcium a day
• Vitamin D helps the calcium to build your baby's bones and teeth. All women, pregnant or not, should be getting 600 IU (international units) of vitamin D per day.

Keep in mind that taking too much of a supplement can be harmful. For example, very high levels of vitamin A can cause birth defects. Only take vitamins and mineral supplements that your health care provider recommends.

You also need more protein when you are pregnant. Healthy sources of protein include beans, peas, eggs, lean meats, seafood, and unsalted nuts and seeds.

Getting enough fluids is another special nutritional concern during pregnancy. When you are pregnant, your body needs even more water to stay hydrated and support the life inside you. So it's important to drink enough fluids every day.

How much weight should I gain during my pregnancy?

How much weight you should gain depends on your health and how much you weighed before pregnancy:

• If you were at a normal weight before pregnancy, you should gain about 25 to 35 pounds
• If you were underweight before pregnancy, you should gain more
• If you were overweight or had obesity before you became pregnant, you should gain less

Check with your provider to find out how much weight gain during pregnancy is healthy for you. You should gain the weight gradually during your pregnancy, with most of the weight gained in the last trimester.

Do I need to eat more calories when I am pregnant?

How many calories you need depends on your weight gain goals. Your provider can tell you what your goal should be, based on things like your weight before pregnancy, your age, and how fast you gain weight. The general recommendations are:

• In the first trimester of pregnancy, you probably do not need extra calories
• In the second trimester, you usually need about 340 extra calories
• In the last trimester, you may need around 450 extra calories per day
• During the final weeks of pregnancy, you may not need extra calories

Keep in mind that not all calories are equal. You should eat healthy foods that are packed with nutrients - not "empty calories" such as those found in soft drinks, candies, and desserts.

What foods should I avoid during pregnancy?

During pregnancy, you should avoid:

• Alcohol. There is no known amount of alcohol that is safe for a woman to drink during pregnancy.
• Fish that may have high levels of mercury. Limit white (albacore) tuna to 6 ounces per week. Do not eat tilefish, shark, swordfish, marlin, orange roughy, or king mackerel.
• Foods that are more likely to contain germs that could cause foodborne illness, including
  • Refrigerated smoked seafood like whitefish, salmon, and mackerel
  • Undercooked meat, poultry, eggs, and seafood
  • Refrigerated meat spreads
  • Store-made salads, such as chicken, egg, or tuna salad
  • Unpasteurized or raw milk
  • Unpasteurized juices or cider
  • Unpasteurized soft cheeses, such as unpasteurized feta, Brie, queso blanco, queso fresco, and blue cheeses
  • Raw sprouts of any kind (including alfalfa, clover, radish, and mung bean)
  • Raw cookie dough
  • Unwashed fruits and vegetables
• Too much caffeine. Drinking high amounts of caffeine may be harmful for your baby. For most people, it's best to limit caffeine to less than 200 mg per day during pregnancy. But first check with your provider about whether you should have caffeine at all.

Prostate Cancer

What is prostate cancer?

Cancer is a disease in which cells in the body grow out of control. Prostate cancer begins in the cells of the prostate. The prostate is a gland in the male reproductive system. It lies just below the bladder. It makes fluid that is part of semen.

Prostate cancer is one of the most common types of cancer. It often grows very slowly. If it does not spread to other parts of the body, it may not cause serious problems. But sometimes prostate cancer can grow quickly and spread to other parts of the body. This kind of prostate cancer is serious.

What causes prostate cancer?

Researchers don't know for sure what causes prostate cancer. They do know that it happens when there are changes in the genetic material (DNA).

Sometimes these genetic changes are inherited, meaning that you are born with them. There are also certain genetic changes that happen during your lifetime that can raise your risk of prostate cancer. But often the exact cause of these genetic changes is unknown.

Who is more likely to develop prostate cancer?

Anyone who has a prostate can develop prostate cancer. But certain factors can make you more likely to develop it:

• Age. Your chance of developing prostate cancer increases as you get older. Prostate cancer is rare in people under age 50.
• Family health history. Your risk of prostate cancer is higher if you have a parent, sibling, or child who has or has had prostate cancer.
• Race. African Americans are more likely to get prostate cancer. They're also more likely to:
  • Get prostate cancer at a younger age.
  • Have more serious prostate cancer.
  • Die from prostate cancer.

What are the symptoms of prostate cancer?

Prostate cancer doesn't always cause symptoms, especially at first. If it does cause symptoms, they may include:

• Problems urinating (peeing), such as:
  • A urine stream that's weak, hard to start, or starts and stops
  • Suddenly needing to urinate right away
  • Urinating often, especially at night
  • Pain or burning when urinating
  • Blood in your urine or semen
• Pain in your lower back, hips, or pelvis that does not go away
• Painful ejaculation (the release of semen through the penis during orgasm)

But many of these symptoms may be from other common prostate problems that aren't cancer, such as an enlarged prostate.

You should discuss your prostate health with your health care provider if you:

• Have symptoms that could be prostate cancer
• Have a high risk for developing prostate cancer
• Had a screening test that suggests you could have prostate cancer

What are prostate tests and how is prostate cancer diagnosed?

Tests which check for prostate cancer include:

• A digital rectal exam (DRE). In this exam, your provider feels your prostate for lumps or anything unusual by inserting a lubricated, gloved finger into your rectum.
• A prostate-specific antigen (PSA) blood test. A high PSA blood level may be a sign of prostate cancer. But many other things can cause high PSA levels, too.
• Imaging tests. These tests may use ultrasound or MRI to make pictures of your prostate.

If these tests show that you might have prostate cancer, the next step is usually a prostate biopsy. A biopsy is the only way to diagnose prostate cancer.

During a biopsy, a doctor uses a hollow needle to remove some prostate tissue. The tissue is studied under a microscope to look for cancer cells.

What are the treatments for prostate cancer?

Your treatment options usually depend on your age, your general health, and how serious the cancer is. Your treatment may include one or more options:

• Observation,which is mostly used if you are older, your prostate cancer isn't likely to grow quickly, and you don't have symptoms or you have other medical conditions. Your doctor will keep checking on your cancer over time so to see whether you will need to start treatment for the cancer. There are two types of observation:
  • Watchful waiting means having little or no testing. If symptoms begin or change, you will get treatment to relieve them, but not to treat the cancer.
  • Active surveillance means having regular tests to see if your prostate cancer has changed. If the tests show the cancer is starting to grow or if you develop symptoms, then you will have treatment to try to cure the cancer.
• Surgery to remove your prostate gland may be an option if your cancer hasn't spread outside of your prostate.
• Radiation therapy uses high energy to kill cancer cells or prevent them from growing.
• Hormone therapy blocks cancer cells from getting the hormones they need to grow. It may include taking medicines or having surgery to remove the testicles.
• Chemotherapy uses medicines to kill cancer cells, slow their growth, or stop them from spreading. You might take the drugs by mouth, as an injection (shot), as a cream, or intravenously (by IV).
• Targeted therapy uses drugs or other substances that attack specific cancer cells. This treatment causes less harm to healthy cells than radiation therapy or chemotherapy.
• Immunotherapy helps your own immune system to fight cancer.

Can prostate cancer be prevented?

Making healthy lifestyle changes may help to prevent some prostate cancers. These changes include:

• Being at a healthy weight
• Quitting smoking
• Getting enough exercise
• Eating healthy foods

NIH: National Cancer Institute

Rickets

Rickets causes soft, weak bones in children. It usually occurs when they do not get enough vitamin D, which helps growing bones absorb the minerals calcium and phosphorous. It can also happen when calcium or phosphorus levels are too low.

Your child might not get enough vitamin D if he or she:

• Has dark skin
• Spends too little time outside
• Has on sunscreen all the time when out of doors
• Doesn't eat foods containing vitamin D because of lactose intolerance or a strict vegetarian diet
• Is breastfed without receiving vitamin D supplements
• Can't make or use vitamin D because of a medical disorder such as celiac disease

In addition to dietary rickets, children can get an inherited form of the disease. Symptoms include bone pain or tenderness, impaired growth, and deformities of the bones and teeth. Your child's doctor uses lab and imaging tests to make the diagnosis. Treatment is replacing the calcium, phosphorus, or vitamin D that are lacking in the diet. Rickets is rare in the United States.

Sickle Cell Disease

What is sickle cell disease (SCD)?

Sickle cell disease (SCD) is a group of inherited red blood cell disorders. If you have SCD, there is a problem with your hemoglobin. Hemoglobin is a protein in red blood cells that carries oxygen throughout the body. With SCD, the hemoglobin forms into stiff rods within the red blood cells. This changes the shape of the red blood cells. The cells are supposed to be disc-shaped, but instead they are crescent, or sickle, shaped.

The sickle-shaped cells are not flexible and cannot change shape easily. Many of them burst apart as they move through your blood vessels. The sickle cells usually only last 10 to 20 days, instead of the normal 90 to 120 days. Your body may have trouble making enough new cells to replace the ones that you lost. Because of this, you may not have enough red blood cells. This is a condition called anemia, and it can make you feel tired.

The sickle-shaped cells can also stick to vessel walls, causing a blockage that slows or stops the flow of blood. When this happens, oxygen can't reach nearby tissues. The lack of oxygen can cause attacks of sudden, severe pain, called pain crises. These attacks can occur without warning. If you get one, you might need to go to the hospital for treatment.

What causes sickle cell disease (SCD)?

SCD is caused by a variant (change) in a gene that has instructions for your body to make one part of the hemoglobin. This changed gene is sometimes called a sickle cell gene. People with SCD are born with two sickle cell genes, one from each parent.

If you are born with one sickle cell gene, it's called sickle cell trait. People with sickle cell trait are generally healthy, but they can pass the defective gene on to their children.

Who is more likely to have sickle cell disease (SCD)?

In the United States, most of the people with SCD are African Americans:

• About 1 in 13 Black or African American babies are born with sickle cell trait
• About 1 in every 365 Black or African American babies are born with sickle cell disease

SCD also affects some people who come from Hispanic, southern European, Middle Eastern, or Asian Indian backgrounds.

What are the symptoms of sickle cell disease (SCD)?

People with SCD start to have signs of the disease during the first year of life, usually around 5 or 6 months of age. Early symptoms of SCD may include:

• Painful swelling of the hands and feet
• Fatigue or fussiness from anemia
• A yellowish color of the skin (jaundice) or the whites of the eyes (icterus)

The effects of SCD vary from person to person and can change over time. Most of the signs and symptoms of SCD are related to complications of the disease. They may include severe pain, anemia, organ damage, and infections.

How is sickle cell disease (SCD) diagnosed?

A blood test can show if you have SCD or sickle cell trait. Genetic tests can tell if you have one or two copies of the sickle cell gene. Genetic tests can help confirm an SCD diagnosis if the results from blood tests are not clear.

All states now test newborns for SCD (as well as many other treatable conditions) as part of their screening programs. These programs help find the conditions early, so treatment can be started right away.

Health care providers can also diagnose SCD before a baby is born. That test uses a sample of amniotic fluid (the liquid in the sac surrounding the baby) or tissue taken from the placenta (the organ that brings oxygen and nutrients to the baby).

People who are thinking about having children can have the test to find out how likely it is that their children will have SCD.

What are the treatments for sickle cell disease (SCD)?

There are many ways to manage sickle cell disease. Your medical team will probably include a hematologist, a doctor who specializes in blood diseases. You will work with your medical team to set up a treatment plan. Possible treatment options may include:

• Treatments that can help relieve symptoms and lessen complications, including:
  • Hydroxyurea, a medicine to reduce sickling of red blood cells. This can help prevent serious symptoms of sickle cell disease. This medicine can be used in adults and in children as young as 9 months old. But this medicine is not safe during pregnancy.
  • Voxelotor, another medicine to prevent the sickling of red blood cells. It can be used in adults and children ages 4 years and older.
  • Pain relievers for acute or chronic pain.
  • Antibiotics to try to prevent infections in younger children.
  • Blood transfusions for severe anemia. If you have had some serious complications, such as a stroke, you may have transfusions to prevent more complications.
  • Other treatments for specific complications, such as medicines to lower blood pressure and vitamins to treat a vitamin deficiency.
• Bone marrow or stem cell transplantation, which can cure SCD. Because these transplants are risky and can have serious side effects, they are usually only used in children with severe SCD. For the transplant to work, the bone marrow must be a close match. Usually, the best donor is a brother or sister.
• Gene therapies to treat SCD in people who are 12 years and older and have had repeated sickle cell crises. These new therapies involve taking some of your blood stem cells and either adding new DNA to them or changing their existing DNA. Then these cells are given back to you, and they can make a type of hemoglobin that is healthy. This can reduce the complications of SCD, including the SCD crises.

Complementary and alternative medicine (CAM) seems to help some people deal with pain caused by SCD. These types of CAM may lower your pain, especially if it is not well managed with medicines::

• Cognitive behavioral therapy (a type of counseling)
• Acupuncture
• Exercise or movement programs, such as yoga
• Massage
• Meditation and mindfulness practices
• Virtual reality, a computer-generated 3D environment you can see with special goggles

It's also important to take steps to keep yourself as healthy as possible:

• Get regular medical care
• Get your routine vaccinations
• Live a healthy lifestyle
• Avoid situations that may set off a pain crisis

NIH: National Heart, Lung, and Blood Institute

Stomach Cancer

The stomach is an organ between the esophagus and the small intestine. It mixes food with stomach acid and helps digest protein. Stomach cancer mostly affects older people - two-thirds of people who have it are over age 65. Your risk of getting it is also higher if you:

• Have had a Helicobacter pylori infection
• Have had stomach inflammation
• Are a man
• Eat lots of salted, smoked, or pickled foods
• Smoke cigarettes
• Have a family history of stomach cancer

It is hard to diagnose stomach cancer in its early stages. Indigestion and stomach discomfort can be symptoms of early cancer, but other problems can cause the same symptoms. In advanced cases, there may be blood in your stool, vomiting, unexplained weight loss, jaundice, or trouble swallowing. Doctors diagnose stomach cancer with a physical exam, blood and imaging tests, an endoscopy, and a biopsy.

Because it is often found late, it can be hard to treat stomach cancer. Treatment options include surgery, chemotherapy, radiation or a combination.

NIH: National Cancer Institute