Pregnancy Pathway, Pregnancy — Nutrition

Fresh fruit = vitamins & minerals!!

Fresh fruit = vit­a­mins & minerals!!

Ques­tion:

How many extra calo­ries do you need in each trimester to off­set the meta­bolic cost of pregnancy?

Answer:

First trimester — 0; Sec­ond trimester — 300; Third trimester — 500 (source: Insti­tute of Medicine).

Keep in mind that you may also need calo­ries for any fit­ness pro­gram you are doing. If you are con­tin­u­ing a pro­gram, the only change is due to the pregnancy.

If you begin or increase your activ­ity, you need to take that into account. One yoga class = 100 — 150 calo­ries. One aer­o­bics class = 200–400 calo­ries. Walk one mile = 100 calories.

1 slice whole grain bread = 50-100 calories

1 slice whole grain bread = 50–100 calories

Be sure you read food labels so that you can bal­ance your food intake and your calo­rie out­put. A small woman (under 5’3″ & 130 lbs.) prob­a­bly needs about 1200 calo­ries per day as a base. A medium sized woman needs about 1400, and a large woman (over 5’9″ & 160 lbs.) prob­a­bly needs 1600 to 1800 calo­ries. Add your activ­ity and preg­nancy needs to your base amount.

Ques­tion:

What foods are nec­es­sary for a healthy pregnancy?

Answer, part A:

PROTEIN. Lean pro­teins like turkey and those with omega 3 fats like ocean fish and eggs.…yes! EGGS!

Turkey is a good protein

Turkey is a good protein

Ocean fish 1 or 2 times/wk = good protein & omega 3 fat

Ocean fish 1 or 2 times/wk = good pro­tein & omega 3 fat

Eggs are a perfect pregnancy food!

Eggs are a per­fect preg­nancy food!

70–90 grams of pro­tein are nec­es­sary each day, along with  ade­quate water.  These are needed to make an extra 40% blood vol­ume required to sup­port the placenta.

Answer, part B:

WATER. Two (2) quarts of water…more if you are very active…are needed to make extra blood and to pre­vent dehydration.

Ques­tion: What else?

Fresh vegetables also provide fiber

Fresh veg­eta­bles also pro­vide fiber

Answer: CARBS. Fresh, col­or­ful fruits & veg­gies pro­vide nec­es­sary vit­a­mins and min­er­als, as well as fiber. Eat 5 serv­ings a day from all the col­ors:  yel­low, orange, red, pur­ple and green, and you will get live vit­a­mins all day long that help your baby develop prop­erly! Fruits, veg­eta­bles and whole grains are low glycemic index car­bo­hy­drates — the good ones!

Dairy provides calcium

Dairy pro­vides calcium

Ques­tion:

Do I need dairy prod­ucts and red meat? Can I get the needed min­er­als in other ways?

Answer:

Cal­cium is needed in ade­quate amounts for bones and teeth. It is most eas­ily obtained by drink­ing milk or eat­ing cheese, yogurt or cot­tage cheese. Soy, dark green leafy veg­eta­bles and cal­cium for­ti­fied juice are alternatives.

Iron is nec­es­sary for red blood cells to take up oxy­gen. It is found in high amounts in beef,  and lesser amounts in raisins, spinach, and prune juice. Pre­na­tal vit­a­mins are your insur­ance against defi­cien­cies of these essen­tial minerals.

Ques­tion:

Any­thing else that’s essential?

Answer:

Yes! Healthy FAT!!

Avocado is an excellent source of omega 6 fat

Avo­cado is an excel­lent source of omega 6 fat

In addi­tion to omega 3 fats found in fish, wal­nuts and flax seeds, you need also need omega 6 fats, which are found in avo­ca­dos, olive oil and other veg­etable oils. Healthy fats help bal­ance car­dio­vas­cu­lar con­stric­tion and dila­tion, reduc­ing the risk for hypertension.

Last Ques­tion:

What is a healthy weight gain?

Answer:

In 2009, the National Acad­emy of Sci­ences revised its rec­om­men­da­tions. It now bases desir­able weight gain on pre-pregnancy BMI (Body Mass Index…google this!).

BMI less than 18.5 (low) — 28 to 40 lbs.; BMI between 18.5–24.9 (nor­mal) — 25 to 35 lbs.; BMI 25.0 to 29.9 (high) — 15 to 25 lbs.; obese women (BMI over 30.0) — 11 to 20 lbs.

Com­ing Next: Avoid­ing Risks.

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Pregnancy Pathway — Exercise

How lucky is this? Just a few days ago, yet another study was released and has been cir­cu­lat­ing on Med­scape and other med­ical sites that indi­cates exer­cise is ben­e­fi­cial in preg­nancy, whether the mother is a pre­vi­ous exer­ciser or not. Just in time for this entry!

Behavior Affects Pregnancy Outcome

Behav­ior Affects Preg­nancy Outcome

Phys­i­cal exer­tion (we call it “exer­cise” nowa­days) is a nor­mal state for healthy humans. Only in the last cen­tury has the desire to rest or the need to store extra calo­ries as fat become more pos­si­ble to achieve than our need to move about to survive.

Preg­nancy is a state in which both of these fac­tors (rest­ing and stor­ing calo­ries) are enhanced through organic changes in body chem­istry, adap­ta­tions that favor fetal sur­vival. The cur­rent seden­tary lifestyle exag­ger­ates these meta­bolic changes and results in syn­dromes that increase the risk for a num­ber of meta­bolic, car­dio­vas­cu­lar and immuno­log­i­cal dis­or­ders of pregnancy.

When con­fronted by the idea that it is coun­ter­in­tu­itive to think exer­cise in preg­nancy might be safe (let alone ben­e­fi­cial) I am dumb­founded. To me, it is coun­ter­in­tu­itive to think that a seden­tary lifestyle in preg­nancy might be safe!

Burning Calories in Pregnancy Improves Outcomes!

Burn­ing Calo­ries in Preg­nancy Improves Outcomes!

What is the evi­dence that exer­cise in preg­nancy is ben­e­fi­cial? Keep in mind that some stud­ies have been exe­cuted more expertly than oth­ers. But, what is com­pelling is that numer­ous well-respected researchers have sought to test the hypoth­e­sis that exer­cise is not safe, but come away with results that indi­cate the opposite!

Here are some of the major findings:

• The pla­centa is larger and has more trans­port sur­face in exer­cis­ers than seden­tary women

• The fetuses of (aer­o­bic) exer­cis­ing moth­ers make ben­e­fi­cial car­dio­vas­cu­lar adaptations

• Women who do aer­o­bic exer­cise are less likely to develop severe preeclamp­sia or ges­ta­tional dia­betes, and the long term health prob­lems that accom­pany these disorders

• Women who are aer­o­bi­cally fit recover from birth 10 times faster than seden­tary women (as mea­sured by time needed to metab­o­lize free rad­i­cals pro­duced in labor)

• Women who exer­cise in preg­nancy are more likely to be phys­i­cally fit in midlife

• Babies of aer­o­bi­cally fit women are at reduced risk for pre­ma­tu­rity and low birth weight
DTP_mover2
So, we have arrived at the take-home mes­sage: MOVE!! Preg­nancy works best when you move and burn calo­ries in a mod­er­ate to vig­or­ous fash­ion. But, alter­nate this activ­ity with rest and good nutri­tion, and be sure to stay well hydrated.
If you want more specifics and resources on this topic, try these:
“Women and Exer­cise” in Varney’s Mid­wifery.
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American College of Nurse Midwives updates

Two updates on the ACNM web­site of interest:

• the value of exer­cise in pregnancy

• health care reform

Check out the ACNM site!!

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Pregnancy Pathway, Pregnancy — Maternal Immunological Response

Today: Mater­nal Immuno­log­i­cal Response…or…the Mother/Fetus Dance!

Maternal Immune Response During Pregnancy

Mater­nal Immune Response Dur­ing Pregnancy

Back to work! Thank you for your fore­bear­ance while we wrote a chap­ter for a nurs­ing textbook!

Dur­ing the course of preg­nancy, the mother/fetus dance is ongo­ing. The mater­nal immune sys­tem and the tro­phoblast cells con­tinue to influ­ence each other even beyond the implantation.

Because the mother’s immune response mod­u­lates near the start of each trimester, the fetus is affected to some degree and mounts a response, as well. For a long time it was thought that mater­nal and fetal DNA mate­r­ial was not exchanged across the pla­cen­tal mem­brane, how­ever recent find­ings indi­cate that there is some exchange of mate­r­ial. Thus, we all carry some por­tion of our mother’s DNA and our mother car­ries some of ours.

What is the impact of this chimeric effect? It depends on how well our DNA gets along!

How does this affect the fetus in utero? The fetus may be affected by clot­ting issues. Depend­ing on mater­nal health sta­tus s/he may be sub­ject to a stronger or weaker immune system.

How does this affect the mother? Women are more likely than men to develop autoim­mune dis­or­ders (preg­nancy play­ing a role here), and those who bear male off­spring are more likely than those who only have girls to have these disorders.

The maternal/fetal dance goes on.…

Be Prepared for Birth!

Be Pre­pared for Birth!

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Pregnancy Pathway, Pregnancy

Time for an entre: Preg­nancy!!

Up for discussion…

Health Influences in Pregnancy

Health Influ­ences in Pregnancy

Let’s start at the begin­ning…in the first trimester you feel sick and tired, right? Three things:

1) your immune sys­tem is pro-inflammatory (caus­ing nau­sea and fatigue), 2) your body is pro­tect­ing your fetus from some tox­ins (if you eat some­thing not so great for the fetus, you throw up), and 3) you have extreme swings in blood sugar lev­els so that after you eat, the level soars and you feel sick.

Num­ber 3 can be fixed with behav­ior, but you may have to wait out 1 & 2. To fix num­ber 3 eat very small meals fre­quently (6 or 8 times a day) and be sure to eat pro­tein, that is, eggs, meat, fish, fowl, cheese, nuts, rice & beans, soy, etc. with each small meal. This sta­bi­lizes blood sugar and pre­vents dra­matic ele­va­tions that can cause nausea.

In most healthy preg­nan­cies, the immune sys­tem will rebound in the sec­ond trimester so that you feel good; it is pro­tect­ing you again!  But, those wicked tox­ins and infec­tions are still out there in the envi­ron­ment, so the mes­sage is beware bad air (smog, smok­ing, indus­trial air pol­lu­tion), highly processed foods (lunch­meats, things with names you can’t pro­nounce), any drugs or meds not pre­scribed or okayed by your ob or mid­wife, alco­hol, and dan­ger­ous bac­te­ria, viruses and other microbes!

Exer­cise wisely…no sky-diving or scuba div­ing! Eat healthy food and get enough sleep. De-stress through relax­ation and med­i­ta­tive tech­niques. Don’t take risks with your health, but do stay active and start to pre­pare for birth and bring­ing home a baby (or two?).

Third trimester & the immune sys­tem goes on the fritz again — can’t keep this baby in here for­ever; must expel! You may feel sick and tired again. BUT, keep your pre­na­tal care appoint­ments, keep mov­ing, get good nutri­tion, rest and stay focused. Before you know it the real work begins, not to men­tion the 18 years of sleep deprivation.

Get­ting from here…

Being Fully Present in Your Pregnancy...

Being Fully Present in Your Pregnancy…

…to here..

Being Fully Present as Mom

Being Fully Present as Mom.

…is a jour­ney like no other. The adap­ta­tions of your body to the demands of preg­nancy are amaz­ing. If you pay atten­tion, you will learn more about the mean­ing of exis­tence from this than from any­thing else.

BE HERE NOW!!

Sign up for this Blog (top tool­bar, click blog info and sub­scribe)!! Learn from our more than 30 years of help­ing make healthy moms & healthy babies.

Visit our web­site:  www.dancingthrupregnancy.com

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Pregnancy Pathway, Conception — Review & Small Rant!

REVIEW: Evi­dence is clear - pre-pregnancy mater­nal health sta­tus, includ­ing phys­i­cal fit­ness, healthy nutri­tion and an uncom­pro­mised immune sys­tem affect the health and well-being of both mother and off­spring, in both short and long term.

This is the mes­sage sum­mary from our first two areas of dis­cus­sion:  Pre­con­di­tions and Con­cep­tion — the green and sand col­ored sec­tions on the chart below.

pregnancy_pathway

COMING ATTRACTIONS: We are about to move on to the blue sec­tion — Preg­nancy!!  So, book­mark this Blog for future reference!

Also, you can sub­scribe to this Blog by click­ing on Blog Info in the upper right cor­ner and then click­ing on Sub­scribe in the drop down menu.

But, yes, you guessed it, first we have a small rant!

SMALL RANT: When we note that fit­ness, nutri­tion and a healthy immune sys­tem play sig­nif­i­cant roles in the out­come of preg­nancy and the future health of mother and child, we are appeal­ing to young peo­ple of child­bear­ing age to be care­ful about your bod­ies. The alliance of egg and sperm shapes the world. With 6.5 Bil­lion egg/sperm com­bi­na­tions (yes, peo­ple) presently liv­ing on earth, our resources are stretched. With time, either we get more picky about doing this, or the 3rd rock from the sun (remem­ber that show?) is cooked.

Humor­ous incur­sion: In case you need fur­ther enlight­en­ment on this whole area, there is a great web­site that will help you out. Be pre­pared to be amused and amazed!

The Truth about Eggs and Sperm

Hope­fully, this gets you in the right mood and keeps you smil­ing. After all, once you actu­ally are preg­nant, we have more seri­ous mat­ters to discuss.

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Pregnancy Pathway, Conception — Health Status

Today: How the mother’s health sta­tus at the time of con­cep­tion affects the pregnancy.

For com­plete graphic, see Feb. 5 or 23 post.

The Impact of Health Status at the time of conception.

The Impact of Health Sta­tus at the time of conception.

When a woman becomes preg­nant, her health can be a major fac­tor how her preg­nancy will pro­ceed. If she has been exposed to a vir­u­lent infec­tion, it may have an impact on how well the implan­ta­tion goes. If she has meta­bolic syn­drome, she is at risk for com­pli­ca­tions such as ges­ta­tional diabetes.

On the other hand, if she has taken care of her­self, is phys­i­cally fit and well nour­ished, is well rested and has not been exposed to ill­nesses that induce dra­matic changes in her immune sys­tem, she has done her best to cre­ate a sit­u­a­tion in which her body is best pre­pared for the rig­ors of pregnancy.

There are still genetic and envi­ron­men­tal fac­tors that can affect the course of the preg­nancy, but behav­ior is the one fac­tor that women have con­trol over. At Danc­ing Thru Preg­nancy we are fond of the notion that if you know a cer­tain behav­ior is the best for a sit­u­a­tion, it is smart to chose that behav­ior; if you do not, you are sab­o­tag­ing yourself.

So, if preg­nancy is in your head­lights, eat right, exer­cise, and be cau­tious about expo­sure to ill­ness and infec­tion. Wash your hands, use one of the hand cleansers, prac­tice safe sex (okay, so if you are try­ing to get pg, this may change, but in the meantime!).

We wel­come com­ments on what you are doing to be healthy for pregnancy!

Curl-up! Strong abs are part of physical fitness!

Curl-up! Strong abs are part of phys­i­cal fitness!

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Pregnancy Pathway, Preconditions — Behavior

Please refer to Feb­ru­ary 5 entry for entire graphic. Today:  Behav­ioral Pre­con­di­tions to Preg­nancy.
bubblus_preconditions-behavior

Why do you sup­pose the Amer­i­can Col­lege of Nurse Mid­wives and the Amer­i­can Col­lege of Obste­tri­cians and Gyne­col­o­gists rec­om­mend the min­i­mum time between preg­nan­cies to be two years? Why is it crit­i­cal to eat foods high in B vit­a­mins (includ­ing folic acid) and cal­cium dur­ing the child­bear­ing years? How does your exer­cise reg­i­men in the six months prior to con­cep­tion affect your risk for some dis­or­ders of preg­nancy, such as preeclampsia?

Answer:  Your pre­con­cep­tion or inter­con­cep­tion behav­ior affects the course and out­come of your preg­nancy. As it turns out, it takes about two years for a mother’s body to replen­ish her stores between preg­nan­cies. Prior to a first preg­nancy, behav­ior in the six months lead­ing up to con­cep­tion has been shown to affect outcome.

Dur­ing preg­nancy, nutri­tional and func­tional resources must sup­port two beings in one body, one of whom is grow­ing at a very fast speed by bio­log­i­cal stan­dards (think cell time NOT com­puter time). Essen­tial vit­a­mins and min­er­als (such as B vit­a­mins and cal­cium) are taken from the mother’s body — already in meta­bolic stress due to demands on the kid­neys and liver to clear tox­ins and fil­ter meta­bolic waste from the fetus as well as the mother.

Insur­ing that mater­nal stores of valu­able nutri­ents are ade­quate to pro­vide for both fetus and mother is a job that only the poten­tial mother can do. By eat­ing a bal­anced and col­or­ful diet of pro­teins, fruits and veg­eta­bles, whole grains and essen­tial fatty acids (omega 3’s and 6’s — fish, wal­nuts, olive oil, ava­cado, eggs), as well as ade­quate aer­o­bic exer­cise lead­ing up to and dur­ing preg­nancy, a woman improves her odds for a healthy infant. Smart behav­ior reduces her risk for con­di­tions that cause immune sys­tem and car­dio­vas­cu­lar dis­or­ders that dis­turb implan­ta­tion, blood pres­sure and blood flow to essen­tial organs.

Fur­ther, avoid­ing risky behav­iors that may lead to sys­temic infec­tions, meta­bolic syn­dromes or mal­nu­tri­tion lead­ing up to con­cep­tion is an aspect of behav­ior known as “risk-aversion” -  the abil­ity to avoid behav­iors that have neg­a­tive con­se­quences. Infec­tion at the time of con­cep­tion (to be dis­cussed in a future post), an extreme lifestyle (either seden­tary or anorexic), toxic food choices, drugs, tobacco and alco­hol are all behav­iors that incur risk for poor preg­nancy out­comes, includ­ing pre­ma­tu­rity and low birth weight — out­comes  on the rise in the U.S.

dtp_mover22As dis­cussed in the pre­vi­ous two posts, behav­ior is inter­twined with genet­ics and envi­ron­men­tal influ­ences. Hav­ing a cer­tain gene muta­tion or an envi­ron­men­tal risk may pre­dis­pose a woman to pos­si­ble prob­lems in preg­nancy or the devel­op­ment of cer­tain can­cers, but some behav­iors — espe­cially exer­cise — may mit­i­gate this poten­tial or reduce the sever­ity or course of dis­ease. Behav­ior is the area in which we have the great­est con­trol. Exer­cise, healthy nutri­tion and risk aver­sion are the three areas in which women can exert con­trol over their des­tiny as moms-to-be. It’s a dif­fi­cult set-up. We live in a time of instant grat­i­fi­ca­tion of per­sonal acts. But, moth­er­hood is a long-term com­mit­ment to the bio­log­i­cal and psy­chic well­be­ing of a new human who is — and is not — us.

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Pregnancy Pathway, Preconditions — Environment

Please refer to Feb­ru­ary 5 entry for entire graphic. Today: Envi­ron­men­tal Pre­con­di­tions to Preg­nancy.
bubblus_preconditions-environment
Our envi­ron­ment is with us all the time. Even if we think we are pre­vent­ing or con­trol­ling envi­ron­men­tal fac­tors that impinge on our bod­ies and minds, they are lurk­ing here, there, every­where, and they are myr­iad. Our envi­ron­men­tal influ­ences are every­thing from the air we breathe to the per­sons who raise or teach us, from the food avail­able to our hous­ing, from our job stresses to cul­tural forces or even the weather in our part of the world. These things help shape who we are phys­i­cally and men­tally, over the long term and from moment to moment.

08-4Are you pre­pared to become a par­ent? One way to tell is to look at your environment…is it healthy? Are you liv­ing in a sit­u­a­tion that you can count on? What about clean air, safe paint or safe food? What about water? What about peo­ple around you? Are they sup­port­ive? Does your envi­ron­ment help you stay healthy?

What about your body? Fac­tors in the envi­ron­ment that affect fer­til­ity (or lack of it) may deter­mine if  you can even become preg­nant, or when you can become preg­nant. Think about this:  Women who work together often cycle together. What if you work alone, say at home…does this affect your ovu­la­tion? One fac­tor iden­ti­fied in the low­er­ing age of men­stru­a­tion in girls is the increas­ing num­ber of hor­mones in var­i­ous meats. Another fac­tor is the pres­ence of non-biologically related older males in the house­hold. If these things are known, imag­ine what is not known about sit­u­a­tions, chem­i­cals or peo­ple in our envi­ron­ment that affect our reproduction!

There is not an absolute sep­a­ra­tion of genet­ics, envi­ron­ment and behav­ior. If we are genet­i­cally pre­dis­posed to cer­tain dis­or­ders, for exam­ple, we may or may not develop them, depend­ing on envi­ron­ment. Some per­sons are inclined toward autoim­mune dis­or­ders, but they may do well or poorly depend­ing on the air pol­lu­tion where they live. Some indi­vid­u­als may develop immune dis­or­ders. And, this sit­u­a­tion may adversely impact inflam­ma­tory responses dur­ing implantation.

Peo­ple who strive to take care of them­selves even if they live in hor­ri­ble con­di­tions can use their behav­ior to improve their chances for suc­cess in every­thing from a healthy preg­nancy to a mean­ing­ful exis­tence. Even if genet­ics and the envi­ron­ment are against the process, behav­ior can some­times over­come the odds. Granted, it’s not likely you can pro­duce 6’5″ off­spring (see last post on genet­ics!) if the egg per­son is 5’2″ and the sperm per­son is 5’7″, but much is pos­si­ble beyond that.

So, what do you do about your envi­ron­ment if you are think­ing about becom­ing preg­nant? Take stock. Ask your­self what, if any­thing, might have to change. Ask what you can or can’t accept for your off­spring, if you know there are envi­ron­men­tal fac­tors that aren’t per­fect. Fetuses are amaz­ing crea­tures; the pla­cen­tas that sup­ply and defend them are ruth­less and will pro­tect a fetus at all costs. But, you can give your body and poten­tial baby a good chance to do well by pro­vid­ing a six month span of a healthy envi­ron­ment lead­ing up to con­cep­tion. And, healthy for mind as well as body.

When your baby comes into the world, a door opens in your heart to a room you didn’t even know was there. In that room is a cer­tain kind of love and car­ing that can­not be described. It is love for this being who is and isn’t you. As a mother, you have been her/his envi­ron­ment for nine months or how­ever long you have shared. The womb is a small, pro­tected, orga­nized envi­ron­ment, one that reflects your larger envi­ron­ment. So, take stock now, ahead of time.

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Pregnancy Pathway, Preconditions

Please refer to Feb­ru­ary 5 entry for com­plete graphic. Today we turn to the ques­tion of pre­con­di­tions to preg­nancy and how they might affect mater­nal and off­spring health.

Preconditions

Pre­con­di­tions

Pre-existing fac­tors that can influ­ence health out­comes include genetic fac­tors (fam­ily risk for heart dis­ease, for exam­ple), envi­ron­men­tal fac­tors (liv­ing in a build­ing with mold, for exam­ple), and behav­ior (eat­ing well and exer­cis­ing, for exam­ple). In each cat­e­gory, fac­tors will con­tribute to the health of the mother and even­tu­ally to off­spring health.

It is impor­tant to under­stand what major genetic fac­tors may affect your off­spring and whether the envi­ron­ment or behav­ior can help off­set neg­a­tive fac­tors. For exam­ple, there may be a his­tory of preeclamp­sia dur­ing preg­nancy in your fam­ily, but vig­or­ous aer­o­bic exer­cise in the six months prior to preg­nancy pro­vides a high degree of pro­tec­tion from this risk. Preeclamp­sia puts both mother and off­spring at risk for complications.

Other genetic fac­tors that may be of con­se­quence include autoim­mune dis­or­ders, aller­gies, and meta­bolic syn­dromes. For exam­ple, so-called “thrifty genes” may pre­dis­pose you to a high weight gain in preg­nancy. But, you may be able to off­set health prob­lems asso­ci­ated with this by stay­ing active and eat­ing well.

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