Nutrition for a Healthy Pregnancy - National Guidelines for the Childbearing Years

Appendices

1. Canada's Food Guide to Healthy Eating
2. Canada's Food Guide to Healthy Eating - Healthy Eating Checklist
3. Food Guide Facts: Background for Educators and Communicators
4. Dietary Sources of Calcium, Iron and Folate
5. Canadian Guidelines for Healthy Weights - Body Mass Index (BMI)
6. How to Take Accurate Weight and Height Measurements
7. PARmed-X for PREGNANCY, physical activity readiness medical examination
8. Canada Prenatal Nutrition Program
9. Health Canada Update on Reducing the Risk of Neural Tube Defects

Appendix 1:

Canada's Food Guide to Healthy Eating

Appendix 2:

Canada's Food Guide to Healthy Eating - Healthy Eating Checklist

This checklist can be used in conjunction with the Food Guide Tearsheet or the Food Guide booklet to help you quickly assess in a very general way, the quality of your eating pattern*. At the day's end think about:

1. How many food groups did I eat from? What groups are missing? (Grain products and Vegetables & Fruit should be included in most meals/snacks if the number of daily servings are to fall within the recommended range.)
2. How many servings from each food group did I get?
   1. between 5 and 12 Grain Products
   2. between 5 and 10 Vegetables Fruit
   3. between 2 and 4 Milk Products
   4. between 2 and 3 Meat Alternatives
3. Of the Grain Products chosen, were most whole grain or enriched foods?
4. Have I included dark green of orange vegetables or orange fruit?
5. Are my meals/snacks low or high in fat? What makes it so?
6. How many caffeine-containing foods or beverages did I have today?
7. How many alcoholic drinks have I had today?
8. Did I enjoy eating today?
9. Was I active today?
10. Lastly, what should my meals/snacks look like over the next day or next several days to balance what I have recently eaten?

*For more specific, locally adapted tools to generally assess the quality of the diet during pregnancy and the childbearing years, contact dietitians/nutritionists through your local public health office or health centre. They can also provide you with other available resources related to this area.

Appendix 3:

Food Guide Facts: Background for Educators and Communicators

Appendix 4:

Dietary Sources of Calcium, Iron and Folate

The following tables list foods that have been classified according to excellent sources, good sources and sources of the above nutrients. Reference amounts used to classify these foods were taken from the Guide to Food Labelling and Advertising produced by Agriculture and Agri-Food Canada, revised 1997. They represent usual serving sizes.

View the Dietary Sources of Calcium (based on usual serving size)

View the Dietary Sources of Iron (Based on usual serving size)

View the Dietary Sources of Folate (Based on usual serving size)

Appendix 5:

Canadian Guidelines for Healthy Weights - Body Mass Index (BMI)

Appendix 6:

How to Take Accurate Weight and Height Measurements

The following points will help you take accurate height and weight measurements when assessing pre-pregnancy body mass index (BMI) and monitoring gestational weight gain. Height should be measured as early in pregnancy as possible to avoid errors caused by vertebral compression which may affect measurements by the 20th week of gestation. Measured heights and weights are always preferable to those that are self-reported or recalled. Where possible, obtain pre-pregnancy weight from the patient's medical chart.

Weight:

• Use a platform beam balance with non-detachable weights or an electronic scale, placed on a hard flat surface.
• The balance or scale should be graduated to the nearest 100 grams, checked for zero-balance before each measurement and calibrated periodically.
• The woman should be weighed wearing only lightweight clothing and no shoes.

Height:

• Ensure the woman is standing erect for these measurements. Her legs should be straight with her knees together, feet flat with heels close together. When physically possible, the woman's buttocks, shoulder blades and heels should touch the wall.
• Ask the woman to look straight ahead and take a deep breath.
• Use a headboard that can be placed at a right angle to the wall and lowered along the tape measure until it touches the woman's head.

Resource

Gibson, R.S. Principles of Nutritional Assessment. New York: Oxford University Press; 1990.

Appendix 7:

PARmed-X for PREGNANCY, physical activity readiness medical examination

Appendix 8:

Canada Prenatal Nutrition Program

The Canada Prenatal Nutrition Program (CPNP) is a comprehensive program designed to provide food supplementation, nutrition counselling, support, education, referral and counselling on lifestyle issues to pregnant women who are most likely to have unhealthy babies.

There are approximately 400,000 births every year in Canada. Of these, an estimated 10 percent of births are at risk due to poor health and malnutrition of the mother. Poor nutrition is a risk factor for low birth weight (less than 2500 grams). Low birth weight is the determining factor in about two-thirds of all deaths among newborns, and those that survive are at a greater risk of developing serious and lifelong disabilities.

The Program delivered through Health Canada regional offices, funds community groups to establish and deliver services that address the needs of low-income pregnant women. Long-term financial assistance is provided through contributions to support these services.

The Canada Prenatal Nutrition Program supports comprehensive community-based services, especially designed to build upon existing prenatal health programs across Canada. It offers resources, based on population (number of births) to provinces and territories to expand prenatal nutrition programs, and in cases where they do not exist, to assist in setting them up. The program establishes and enhances services but does not duplicate or replace other government services.

Target groups:

• pregnant women living in poverty
• pregnant adolescents
• youth at risk of becoming pregnant
• pregnant women who abuse alcohol or other substances
• pregnant women living in violent situations
• First Nations, Métis and Inuit women
• refugees
• pregnant women living in isolation or without access to services.

The Canada Prenatal Nutrition Program is jointly managed by the federal government and provincial/territorial governments. Administrative protocols, established through the Community Action Program for Children, set out the terms and conditions of how the program will be managed in each province/territory. Contact the appropriate national and regional office to find out about local CPNP-funded programs.

NATIONAL CONTACT

Senior Program Consultant, Canada Prenatal Nutrition Program
Health Promotion & Programs Branch, Health Canada
Jeanne Mance Building, AL:1909C2
Tunney's Pasture
Ottawa, Ontario K1A 1B4
Telephone: (613) 952-0240
E-mail: capc-cpnp@www.hc-sc.gc.ca

REGIONAL CONTACTS

Newfoundland Region
CPNP Consultant, Health Promotion and Programs Branch, Health Canada
Sir Humphrey Gilbert Building, 5th floor
PO Box 1949
165 Duckworth Street
St. John's, Newfoundland A1C 5R4
Telephone: (709) 772-2880
Fax: (709) 772-2859

Nova Scotia
CPNP Consultant, Health Promotion and Programs Branch, Health Canada
Suite 709, 1557 Hollis Street
Halifax, Nova Scotia B3J 3V4
Telephone: (902) 426-2742
Fax: (902) 426-9689

Prince Edward Island
CPNP Consultant, Health Promotion and Programs Branch, Health Canada
97 Queen Street, Suite 324
Charlottetown, PEI C1A 4A9
Telephone: (902) 566-7857
Fax: (902) 566-7860

New Brunswick
CPNP Consultant, Health Promotion and Programs Branch, Health Canada
Government of Canada Building, 1st floor, 10 Highfield Street
Moncton, New Brunswick E1C 9V5
Telephone: (506) 851-7008
Fax: (506) 851-3197

Quebec
CPNP Consultant, Health Promotion and Programs Branch, Health Canada
Guy Favreau Complex, East Tower, Suite 212
200 West, René-Levesque Boulevard
Montréal, Québec H2Z 1X4
Telephone: (514) 283-0757
Fax: (514) 283-3309

Ontario
CPNP Consultant, Health Promotion and Programs Branch, Health Canada
55 St. Clair Avenue East, 3rd Floor
Toronto, Ontario M4T 1M2
Telephone: (416) 973-5649
Fax: (416) 973-0009

Manitoba
CNCP Consultant, Health Promotion and Programs Branch, Health Canada
391 York Avenue, Suite 420
Winnipeg, Manitoba R3C 0P4
Telephone: (204) 983-7690
Fax: (204) 983-8674

Saskatchewan
CPNP Consultant, Health Promotion and Programs Branch, Health Canada
Room 320 - 1975 Scarth Street
Regina, Saskatchewan S4P 2H1
Telephone: (306) 780-5355
Fax: (306) 780-6207

Alberta/Northwest Territories
CPNP Consultant, Childhood and Youth Section, Health Promotion and Programs Branch,
Health Canada
Suite 815, Canada Place
9700 Jasper Avenue
Edmonton, Alberta T5J 4C3
Telephone: (403) 495-7362

Yukon
CPNP Consultant, Health Promotion and Programs Branch, Health Canada
#100-300 Main Street
Whitehorse, Yukon Y1A 2B5
Telephone: (867) 393-6777
Fax: (867) 393-6772

British Columbia
CPNP Consultant, Health Promotion and Programs Branch, Health Canada
#440 757 West Hastings Street
Vancouver, British Columbia V6C 1A1
Telephone: (604) 666-2729
Fax: (604) 666-8986

Regional Contacts, First Nations and Inuit Component

Alberta Region
Regional Nutritionist, Alberta Region, Health Canada, MSB
Canada Place, Suite 730, 9700 Jasper Avenue
Edmonton, Alberta T5J 4C3
TEL: (403) 495-5418
FAX: (403) 495-2687

Saskatchewan Region
Regional Nutritionist, Saskatchewan Region, Health Canada, MSB
1911 Broad Street
Regina, Saskatchewan S4P 1Y1
TEL: (306) 780-5427
FAX: (306) 780-6026

Manitoba Region
Regional Nutritionist, Manitoba Region, Health Canada, MSB
303 Main Street, Room 500
Winnipeg, Manitoba R3C 0H4
TEL: (204) 983-3637
FAX: (204) 984-7458

Yukon Region
Managing Director, First Nation Health Programs, Medical Services Branch
#103-300 Main Street
Whitehorse, Yukon Y1A 2B5
TEL: (867) 393-6770
FAX: (867) 393-6772

Québec Region
Directrice, Épidémiologie et spécialités de santé communautaire
Svcs de santé des Indiens Région du Qc, Santé Canada, DGSM
Place Guy Favreau, Tour est, pièce 202
200, boul. René Lévesque ouest
Montreal, (Québec) H2Z 1X4
TEL: (514) 283-1576
FAX: (514) 283-8067

Ontario Region
Regional Nutritionist, Ontario Region, Health Canada, MSB
1547 Merivale Road
Nepean, Ontario K1A 0L3
TEL: (613) 952-8377
FAX: (613) 952-1144

Nova Scotia
Atlantic Coordinator, Nutrition Programs, Indian and Inuit Health
1557 Hollis Street, Suite 634
Halifax, Nova Scotia B3J 1V6
TEL: (902) 426-4118
FAX: (902) 426-8675

Ottawa
Senior Nutritionist, Health Programs Support Division (HPSD), First Nations and Inuit Health Programs Directorate (FNIHP)
Tunney's Pasture, 19th Floor, Jeanne Mance Building, Postal Locator 1920A
Ottawa, Ontario K1A 0L3
TEL: (613) 954-7757
FAX: (613) 954-8107

Affiliated:
Northwest Territories
Infant/Child Nutrition Consultant, Child Family Support Division, Government of NWT
Department of Health and Social Services
P.O. Box 1320
Yellowknife, NWT X1A 2L9
TEL: (867) 920-8032
FAX: (867) 873-7706

Appendix 9:

Health Canada Update on Reducing the Risk of Neural Tube Defects

October, 1998

Information Update from Health Canada
On Reducing the Risk of Neural Tube Defects

Neural tube defects, such as spina bifida and anencephaly, are serious birth defects that occur in about one out of every 1000 births in Canada. These defects occur very early in pregnancy, often before a woman knows that she is pregnant. It is becoming increasingly apparent that preparing for pregnancy increases the chances of a safe and successful pregnancy outcome. A striking example of this is the potential for reducing the risk of neural tube defects with the consumption of a supplement containing folic acid around the time of conception.

Women can help reduce the risk of their baby having a neural tube defect.

Research has found that the risk of babies having a neural tube defect was reduced when women consumed a daily multivitamin/multimineral supplement containing folic acid (a form of folate, a B vitamin) beginning before becoming pregnant and continuing through the early weeks of pregnancy.

Taking the evidence as a whole, a daily supplement containing 0.4 mg. of folic acid together with the amount of folate found in a healthy diet is expected to reduce the risk for women who have not previously had a pregnancy affected by a neural tube defect. Although the focus has been on folic acid, it is unclear from the results of research completed to date whether folic acid alone will have the same proven beneficial effects for these women as folic acid taken as a component of a multivitamin or multivitamin/multimineral supplement.

Taking a supplement containing folic acid does not preclude the need to eat a healthy diet according to Canada's Food Guide to Healthy Eating.

Note: Women taking folic acid in a multivitamin or a multivitamin/multimineral supplement should be advised not to take more than 10,000 IU per day of Vitamin A. This could increase the risk of birth defects.

Women are advised to consult a pharmacist or other health care provider about the supplement that is best for them.

Some women are at greater risk

1. Women who have had a previous pregnancy affected by a neural tube defect are at increased risk of having another affected pregnancy. They should be advised to consult their physician who may prescribe an amount of folic acid higher than 0.4 mg daily.
2. Women who have a family history of neural tube defects, have diabetes, or are taking anticonvulsant drugs may also be at increased risk. They should be advised to consult their physician about appropriate folic acid supplementation.

Remember: A woman's own health from the beginning of pregnancy is very important for the healthy development of her baby. Pregnancy may not always be planned; therefore, health professionals are encouraged to promote awareness among women who could become pregnant of the importance of good health habits to the healthy development of their babies.

Note: This update will be followed by a companion document. It will help professionals provide patients and clients with more personalized advice and answers to questions they have. It will be posted on Health Canada's website http://www.hc-sc.gc.ca/nutrition.