Part 1: Understanding what occurs during the 1st trimester
The 1st trimester is a time of radical growth and transformation for both mom and baby. Within the first 13 weeks of conception, baby’s major organs and systems have been formed and the heart is beating. The amniotic sac, placenta and umbilical cord have all been created and are taking on their roles in the process of baby’s development. Mom’s uterus is already growing, cardiac volume increases and hormones surge. Mother’s BMR begins to increase, her thyroid begins to grow, and her body prepares for changes to the pelvic floor, abdominal wall, and respiratory system. Overall, the first trimester brings with it the most dramatic changes which is why a nutrition coach can be vital in helping a new mom transition into pregnancy.
Due to the intense nature of these changes, optimal choices should be made in terms of food, exercise, rest, posture, core to breath work and hydration. The baby is most susceptible to damage early on, and the mother’s body is working hard to create a new life. However, due to rising hormones, many new symptoms can come about that create a challenge in prioritizing healthy intake, exercise, and overall wellness. So how does a woman navigate this time in a way that allows healthy choices to be made for baby, while also honoring her journey through the first 13 weeks?
First, it’s important to explore some of the common 1st-trimester concerns that impact healthy choices, and the reasons many of these symptoms arise. Food aversions, morning sickness, fatigue, acid reflux, and constipation are all common complaints of pregnant women, beginning early on in their pregnancy. These specific issues can make it difficult to hit certain caloric or macronutrient goals, increase intake of micronutrients, keep up with an appropriate exercise regimen (relative to what they were doing before and what’s been approved by their practitioner) or maintain a positive and adaptable mindset.
Considering some of the most common aversions center around quality foods such as protein and vegetables, and many women experience ongoing morning or all-day sickness, many women feel they are limited in what they can eat and keep down. They may also feel they must eat frequently in an effort to not increase sickness with an empty stomach. Overwhelming fatigue (because the body’s systems are all working hard to create a new life!) can decrease motivation to go to the gym or prioritize movement, mobility or breath work as a daily regimen. With this often comes guilt, frustration and body image issues for many women, especially those who aren’t used to their changing body, losing control over their nutrition and exercise, or having factors that limit their ability to participate in their routine.
The likely culprit behind many of these changes is hormones. Many of our hormones, produced by the ovaries first and then the placenta during pregnancy, begin changing right away. However, in an effort to highlight those that most impact 1st-trimester symptoms, we must most consider rises in estrogen, progesterone, and human chorionic gonadotropin (hCG). All 3 of these hormones rise dramatically during pregnancy, and the fluctuations could contribute to many 1st trimester symptoms. For example, the strong rise in hCG through the 1st 12 weeks can bring a shift in mom’s taste and perception of smell, leading to food aversions. In similar fashion, many link the rise of hCG, as well as estrogen, to increased nausea and morning sickness. The increase in progesterone can impact the contractions of the muscles (including the intestines), increasing constipation and heartburn.
As we can see, often there is a physiological reason a woman is experiencing many of her symptoms, and a simple emphasis from a nutrition coach to “have more will power” or to “try anyway” won’t warrant success. Instead, mindset coaching can help increase motivation for clients by providing education, explore ways to work with and around 1st-trimester symptomology, and, if nothing else, remain empathetic and supportive.
Part 2: Implementing effective nutrition coaching during the 1st trimester
In the case that a client is able to incorporate certain foods into her diet or participate in exercise and simply needs additional reinforcement and motivation from her hired coach, coaches should be reminded that education drives compliance. As stated before, the 1st trimester is the period when the majority of baby’s vital systems are developed, and therefore the most damage can be done. This isn’t to scare clients who made less than ideal choices before knowing they were pregnant, but more to increase the desire or willingness to make more optimal choices now that they have the knowledge. Clients can be reminded that the goal of prenatal nutrition is not solely to create a healthy baby, but also to ensure mom has a healthy pregnancy, minimizes pregnancy-related symptoms, and has a better healing and recovery process postpartum.
Food quality should be emphasized from day one (if it has not already been discussed during the preconception period). This does not mean a nutrition coach simply instructs on what should be avoided or minimized, but also encourages intake of the micronutrients that are vital at this time. A mother deficient in nutrients will become even more deficient as her pregnancy progresses and baby takes what it needs first for development. A mother who is vitamin deficient from the onset of pregnancy will not only be impacted by the deficiency herself but also increases the risk of birth defects or improper development of baby.
If a client is open to supplementation (especially if increasing intake through food is difficult due to nausea, vomiting or food aversions) clients can be encouraged to explore supplementing with B Vitamin, Magnesium, Vitamin D, Choline, Folate, and a probiotic to get started (all with the guidance of their practitioner). Other supplements can be incorporated if needed. If a client isn’t experiencing nausea or aversions or isn’t in a position to add additional supplements to her routine, she should be encouraged to eat whole foods including high-quality proteins (organic and hormone-free when possible), vegetables high in fiber and in an array of colors (especially leafy green, orange, and red), fruits, healthy fats (especially unsaturated and sources of Omega 3), and complex carbohydrates.
As for exercise, clients should be encouraged to move and remain active and mobile throughout their pregnancy. Some of the benefits of exercise during pregnancy (especially in the 1st trimester) include: potential reduction in symptoms (including nausea and fatigue for some women), increased pliability of tissue and ligaments, decreased back pain, decreased risk of excessive weight gain, and maintaining of lean mass and physical fitness. Studies also show that exercise in pregnancy can increase the rate of placental growth, meaning more oxygen, blood and nutritional delivery to baby and overall improved fetal development. However, exercise will look different for every pregnant woman. Clients should consider their exercise intensity pre-pregnancy and coaches should encourage clients to listen to their bodies, stop if they experience any pain, discomfort or signs of pelvic floor dysfunction (including urinary leaking), and can empower clients to begin slowly and increase as appropriate. Coaches should also feel comfortable referring to other professionals (including the client’s medical care team) to determine an appropriate regimen.
Should a client need more than motivation and coaching to move through the first trimester, and instead need guidance on how to work around symptoms and limiting factors, coaches can consider exploring the following:
Food aversions and sickness:
- Try different food choices, cooked different ways, with different seasonings. For example, perhaps chicken cooked in a crockpot is more appealing than grilled chicken, or perhaps cold chicken sounds better than hot. Different seasonings or sauces may help with taste, or perhaps eating the food very bland is the best approach.
- Pair food aversions with a food source that is more palatable. For example, if a client is struggling with protein or vegetables, opting for meals such as a stir fry or tacos where the undesirable food is paired with a carbohydrate or a more appealing food may allow intake to increase.
- Trial different meal sizes, food combinations, and meal timing. Small complete meals throughout the day may work better than 3 large meals of just a protein and/or fat source, for example.
- Some women find certain foods to help with nausea, including ginger, peppermint, and citrus.
- Be aware that food aversions and morning sickness may come and go. Capitalize on good days, and see if any trends can be linked to determine what can help reduce symptoms.
Acid Reflux:
- Acid reflux could be attributed to certain foods even more than hormonal fluctuations. Foods that trigger acid reflux should be minimized or avoided altogether. Common food triggers include caffeine, sugar, spicy foods, citrus, carbonated beverages, and chocolate.
- Acid reflux can be worse if a client has an empty stomach for too long and then eats, or eats a trigger food on an empty stomach.
- While antacids such as Tums may be a quick fix-all to some, overly relying on it can potentially neutralize stomach acid and alters a mother’s pH balance (when pregnancy alone is already shifting her pH levels). This doesn’t mean that antacids can’t or shouldn’t be used, it just means that they should be used sparingly and after a client has tried changing things within her nutritional protocol. Clients can be encouraged to first explore non-medication options, including the use of apple cider vinegar, lemon water, ginger, some herbal supplements, decreasing meal size, and increasing meal frequency, not lying down immediately after eating and limiting fluid consumption during meals. Any supplements should be approved by a medical professional. Some women will be unable to address acid reflux with lifestyle changes due to hormone fluxes and should feel supported in their decision to discuss medical interventions with their practitioner if needed.
With all symptoms:
- They are all temporary, and many come and go throughout pregnancy.
The art of coaching the pregnant client comes in finding the ability to remember that “this too shall pass” for our clients, while also recognizing that a pregnant client may not be quite as tolerant of her symptoms or able to always see the bigger picture (especially if symptoms are particularly severe). Nutrition and Wellness Coaches must remember that the client is the one living with her symptoms and continually dealing with the discomfort, while often also trying to balance work, home, and managing other children. Pregnant clients should be provided continual encouragement and support, and coaches should remain adaptable and flexible, willing to meet clients where they are at. Sometimes this means throwing rules, numbers and timelines out the window, and prioritizing what works in the moment. Mindset can continually be emphasized, especially as concerns arise regarding body image, loss of control, and fear of the unknown. And above all else, empathy should remain high throughout the coaching process.
References
Clapp, JF. “Influence of endurance exercise and diet on human placental development and fetal growth.” Placenta 27.6-7 (2006): 527-534. NCBI. Web Aug. 2018.
Coaching and Training Women Academy. Pre- & Postnatal Coaching Certification Manual. Girls Gone Strong.
John’s Hopkins Medicine. Pregnancy: The First Trimester. Retrieved from https://www.hopkinsmedicine.org/healthlibrary/conditions/pregnancy_and_childbirth/first_trimester_85,P01218
Maternity Institute. (Producer). (2018). Maternity Nutrition Coach. [Certification].
