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Ob-Gyn

Answers to Questions About Nutrition During Breastfeeding and Pregnancy

By on 04/24/2017

On April 20, 2017, we held a live chat with Einstein Healthcare Network lactation consultant Karen Meade, RN, and Einstein OBGYN dietitian Leeanne Lawrence, RD. They answered a range of questions from the audience about nutrition during pregnancy and breastfeeding. Here is a transcript from the chat.

Do preemie growth spurts go along with chronological age or adjusted age? Or neither?

This is a great question for your child’s next physician visit. Your doctor can likely share a growth chart and explain how it pertains to your child specifically. – KM

I’m interested in taking DHA while breastfeeding. What supplements are big no-no’s?

As an International Board Certified Lactation Consultant (IBCLC), I use The Infant Risk Center as my go-to resource on the safety of medications and supplements while breastfeeding. They assign DHA an L3 lactation risk category and say that DHA “is probably compatible.” Given that DHA is in prenatal vitamins and breast milk, it would seem to me that it would not be problematic for breastfeeding moms to take. You can contact the Infant Risk Center yourself for more detailed info. http://kellymom.com/nutrition/vitamins/vitamin-d-and-breastfeeding/ – KM

There seems to be such conflicting advice about drinking alcohol while breastfeeding. How can I safely consume a glass of wine now and then?

That is a great question. It’s one I often get asked as an IBCLC. The American Academy of Pediatrics says that moderate alcohol consumption is compatible with breastfeeding. That glass of wine you’re craving will get metabolized in your body just as anything else you ingest would. If you don’t feel drunk, you’re fine to breastfeed. And even if you feel a little buzzed, you don’t need to “pump and dump.” Just pump and save that milk to mix in with milk pumped from another time. -KM

Is it safe to consume whey protein (powder or protein bars) while pregnant? I’m specifically referring to the brand Quest protein powder and Pure Protein bars.

Whey protein is considered a safe product in pregnancy. Be careful of other ingredients added such as artificial sweeteners. Great protein sources in pregnancy come from real foods such as eggs, meat and low mercury fish like sardines and salmon. They are less processed and usually contain more nutrition than protein bars. -LL

How long will my doctor let me go past my due date before inducing?

Your question is a common one that moms often ask in the Preparing for Childbirth classes at Einstein. Whether to induce labor is a decision both you and your care provider should feel comfortable making together. The American College of OB/GYNs currently recommends against inducing labor prior to 40 weeks for nonmedical reasons. A term pregnancy can safely last up to 42 weeks, provided mom and baby are being monitored closely and not showing any signs of distress. If your provider suggests an induction you can ask him/her to help you fully understand why so that you can make an informed decision about it together. Here is more information from Lamaze International that you may find helpful: http://www.lamaze.org/induction – KM

What is the importance of folic acid when pregnant?

Thanks for joining us. Folic acid is important to help prevent neural tube defects in the fetus and is important usually before mom knows she is pregnant. If you are thinking about becoming pregnant, ask your doctor about taking a prenatal vitamin. Folic acid is naturally found in many green vegetables. -LL

Is it necessary to give a breast-fed baby vitamin D when it is warmer out and we are spending more time outside in the sun? A lot of breast feeding mom’s stop eating dairy to help with spit up and reflux. What are the real signs of a dairy allergy in a breast fed baby?

Dairy is found in many foods and food products. If you wanted to remove dairy from your diet, you would also have to avoid many other foods such as bread for this to be a true elimination diet. –LL

The American Academy of Pediatrics currently recommends that all children from birth through adolescence get 400 IU of vitamin D daily. This includes breastfed babies. However, there is also research that shows moms of exclusively breastfed babies who prefer not to give supplemental Vitamin D to their babies can supplement themselves with 6400 IU of Vitamin D daily instead. You can read more about Vitamin D and breastfeeding here: http://kellymom.com/nutrition/vitamins/vitamin-d-and-breastfeeding/

To answer your second question, these are some signs to look for in a breastfed baby who may have a true dairy allergy: rash, hives, eczema, sore bottom, dry skin, cold-like symptoms, wheezing, GI upset including vomiting and diarrhea, or green stools with mucus or blood. Babies can be fussy for lots of reasons other than a dairy sensitivity or allergy. Breastfeeding moms who think dairy in their diets is causing digestive problems for their babies may want to consider eliminating all cow’s milk products from their diets for at least two weeks to see if it seems to help with baby’s signs of discomfort. But it’s best not to take that step before reaching out to an IBCLC first. You can talk to one at our weekly free Tuesday Tea with the IBCLC group at 11 a.m. at the Einstein Women’s Resource Center in Plymouth Meeting, Pa. – KM

I would like to know how your NICU babies are fed when not at breast? Is syringe/cup/spoon feeding utilized?

When working with NICU families, the IBCLCs at Einstein help each family determine which supplemental feeding method will work best toward helping that family achieve their breastfeeding goals once home from the hospital. -KM

How many cups of milk should I drink at the second trimester?

Thank you for the question! Milk can keep us hydrated and give us calcium and possibly vitamin D in pregnancy. However, other drinks such as water can keep us hydrated, as well. Calcium and Vitamin D can be found in foods. We do not have a daily amount of milk in pregnancy we need since we can get the same nutrition from other foods. A balanced diet with lots of water is recommended in pregnancy. -LL

Does Einstein have PCP doctors for me to choose?

Yes! We have a large network of primary care physicians in Philadelphia and Montgomery Counties. Here is a list of all our PCP locations: https://www.einstein.edu/locations/listing.aspx?locationtype=4  You can call a location to make an appointment, or use our online form: https://www.einstein.edu/appointmentrequest

My husband and I are currently on an active adoption list. What tips do you have for us expecting mothers who may have an infant who may have some level of maternal drug exposure or little to no prenatal care? Should we have a pre-adoption interview with a pediatrician?

Congratulations on your pending adoption. You may certainly find a pre-adoption interview with a pediatrician helpful. I’ve also had numerous adoptive parents attend the Newborn Care and Parenting Classes we teach at the Einstein Women’s Resource Center. If you’re local, I’d love to see you and your husband in one of my classes! You can find information about our classes and services at our Women’s Resource Center: http://www.einstein.edu/obstetrics-and-gynecology/obstetrics/maternity-care-montgomery-county/womens-resource-center -KM

I am presently nursing my almost 3 month old 8 to 10 times a day and often find myself super hungry in between nursing sessions. Do you have any healthy, filling snacks that are especially good for breastfeeding moms? Thanks!

The best breastfeeding snacks are ones you can get in your mouth while breastfeeding 🙂 !! Try foods that you can eat with one hand and do not require a knife and fork. Some ideas are nuts and seeds, fresh fruits, cheese, half sandwich, raw veggies and dip. Avoid convenience, processed foods like chips as they will not be as filling or nutritious. Do not forget your glass of water before breastfeeding. –LL

I am a type 1 diabetic, expecting my second baby. I am hoping to have a much calmer experience this time around. However, what I am really looking for is some good, solid tips on breastfeeding for diabetics. I know every person is different so what worked for some may not work for me, but I would like to try to be successful with it this time around because it is supposed to be so much better for the baby, especially babies of diabetic moms. Thanks in advance for your time!

Thanks for the question. In our Diabetes in Pregnancy clinic here at Einstein, our goal is that mom is discharged on the right amount of insulin in pregnancy. Often, we see our type 1 diabetics having hypoglycemia postpartum. My suggestion is to make sure you keep up with your blood sugars and keep in touch with your endocrinologist after pregnancy. You might also find it helpful to attend a prenatal breastfeeding class and schedule a prenatal visit with an IBCLC to discuss strategies to help you be more successful with breastfeeding this time around. Some diabetic moms also choose to hand express colostrum during the end of pregnancy (but not before 37 weeks) to bring to the hospital with them in case the baby needs to be supplemented for low blood sugar. Contact us at our Women’s Resource Center and we can help you. 484-362-6133. –LL

Thanks to everyone for attending! We appreciate all your great questions.

To learn more about Einstein’s Obstetric Services or to request an appointment: http://www.einstein.edu/obstetrics-and-gynecology/obstetrics

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Perspectives highlights the expertise and services provided by the physicians, specialists, nurses and other healthcare providers at Einstein Healthcare Network. Through this blog, we share information about new treatments and technologies, top-tier clinical teams and the day-to-day interactions that reinforce our commitment to delivering quality care with compassion. Here, you will also find practical advice for championing your health and wellness. The Einstein Healthcare Network "Terms of Use" apply to all content on this blog.