Educational instrument for intervention in the lifestyle of overweight pregnant women

Manochio-Pina, Marina Garcia; Crivellenti, Lívia Castro; Sartorelli, Daniela Saes; Diez-Garcia, Rosa Wanda

doi:10.1590/1806-9304202200020011

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Brasil

Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 22 (2) • Apr-Jun 2022 • https://doi.org/10.1590/1806-9304202200020011 copy

Educational instrument for intervention in the lifestyle of overweight pregnant women

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to conduct the semantic validation of the images and text in educational material about eating and lifestyle for overweight women in different stages of pregnancy.

Methods:

qualitative, descriptive, analytical, cross-sectional study with focus groups for adapting and semantically validating the messages and images of educational material for women in three moments of the pre-natal period, as well as the support scripts for healthcare providers. The Consolidated Criteria for Reporting Qualitative Research (COREQ – Portuguese acronym) were considered.

Results:

participants of this study were seven pregnant women aged 21 to 40 who were in pre-natal care and 17 nutritionists aged 25 to 51. The folder was validated over seven meetings with the focus group, with one-week intervals between the groups. For each folder there were at least two meetings with focus groups, and one meeting for each script. The language was adjusted for the messages, and two images were changed to improve the self-identification of pregnant women. Technical and didactic adaptations were suggested for the scripts.

Conclusion:

images and text were semantically adapted; the instrument is easy to use in primary and secondary healthcare, providing support for pregnant women and healthcare providers on the subject of eating habits and lifestyle for overweight women in different stages of pregnancy.

Key words:
Pregnancy; Eating and nutritional education; Qualitative research; Validation studies

Folder 1 (message number)
Original message	Justification for change	Final message
(3) Eat cooked meals every day for lunch and dinner.	Change the “cooked meals” term used to facilitate comprehension regarding homemade food.	Eat homemade food every day for lunch and dinner.
(5) Before eating, wash fruits and vegetables well.	Detail the step-by-step process of cleaning fresh products.	Before eating fruits, vegetables and legumes: wash, leave to soak (1 tablespoon of bleach for 1 liter of water) for 15 minutes and rinse.
(6) Drink plenty of water. Sodas and juices do not replace water.	Specify the amount of water.	Drink at least 8 glasses of water a day. Soda and juice do not replace water.
(7) Soda, artificial juice, crackers and savories harm your health. Avoid eating these products.	Exemplify other industrialized food options and set a consumption limit per week.Note: in this message, the consumption limit suggestion was not accepted. In the focus group with nutritionists, the professionals suggested that setting a limit could encourage the consumption of these foods.	Limit the consumption of processed foods (sodas, artificial juices, cookies, savories). These foods harm your health and that of your baby.
Folder footnoteWarning: in special cases of health problems, talk to your doctor.	Replace the term “warning” with “attention” to better emphasize the message and include this footnote information in all the folders.	Attention: in special cases of health problems, talk to your doctor.
Folder 2 (message number)
(5) Drink water. Water is essential for your life.	Add the information that water is also important for the baby’s health. With this, the guidance is emphasized more.	Drink water. Water is essential for your life and that of your baby.
(6) Image	Change the image to indicate what to avoid and prioritize, according to the content of the message.
Folder 3 (message number)
(1) Image	Change the image to make it easier to see the whole body, highlighting the belly, to identify the image with the body of a pregnant woman.
(5) Preferentially eat seasonal fruits, vegetables and legumes.	Emphasize the need to consume a variety of fruits and vegetables.	Consume different types of vegetables, legumes and fruits every day.
(6) Drink water throughout the day to remain hydrated.	Add the information that water is also good for the baby, giving more emphasis to the guidance.	Drink water throughout the day to remain hydrated and for your baby’s health.
(7) Avoid consuming products such as cookies, snacks, noodles®, sausages, soda and artificial juice.	Include more examples of processed foods.	Avoid consuming industrialized products, such as: cookies, savories, instant noodles, sausages, sodas, artificial juices and fast foods.
Script 1 (message number)
(1) For you, it is recommended to gain a maximum of 11.5kg during your entire pregnancy. It is more common for this weight gain to be greater towards the end of the pregnancy, so don’t be anxious to gain a lot of weight in early pregnancy. Stay tuned and track your weekly weight gain, if possible using the same scales. Remember that inadequate weight gain, if greater or less than recommended, can be harmful to your health and that of your baby.	Explain that this weight gain recommendation is specific to the BMI classification of overweight. Do not indicate that pregnant women weigh themselves weekly to avoid an increase in anxiety about weight gain and highlight the harmful effects of inadequate weight gain on the health of mother and baby.	According to your weight and height, it is recommended that you gain 7.0 to 11.5kg throughout your pregnancy. It is more common for this weight gain to be greater towards the end of the pregnancy. If possible, monitor your weight gain regularly, preferably using the same scales, which does not necessarily have to be done at the Primary Health Unit. Remember that inadequate weight gain, greater or less than recommended can be harmful to your health, increasing the risk of diabetes, obesity and high blood pressure. It can also harm your baby’s health, increasing the chance that they will be born with inadequate weight, prematurely and develop diseases in later life.
(2) This is the recommended frequency of physical activity during pregnancy, if you don’t have any contraindications and respecting your doctor’s guidelines. If you don’t have this habit, start slowly, walking 10 minutes a day and increase the time until you reach 30 minutes 5 days a week or a total of 150 minutes a week according to your availability. Regular physical activity, such as walking, will help control your weight gain, reduce swelling in your legs, and reduce stress. In addition, it can also improve the functioning of your intestines.	State that the activity should be pleasurable. Explain better the indication of time per week of physical activity and exemplify other options for physical exercises.	This is the recommended frequency of physical activity during pregnancy, if you don’t have any contraindications from your doctor. If you don’t have this habit, start slowly, performing some physical activity that is pleasurable for you for 10 minutes a day and increase the time until you reach 30 minutes 5 days a week or a total of 150 minutes (2 hours and 30 minutes) per week according to your availability. Regular physical activity, such as walking, dancing, cycling or other activities, will help you control weight gain, reduce swelling in your legs, reduce stress and improve the functioning of your intestines.
(3) Always give preference to homemade food. If you are in the habit of cooking, keep it this way; if you don’t have this habit, start small, ask your family and friends for help and share some recipes. To make your day to day easier during pregnancy, it is important that you plan shopping and food preparation, also consider the possibility of freezing some prepared foods. Homemade food is healthier and rich in nutrients that are important for your pregnancy and the proper development of your child.	Include what food should be chosen when it is not possible to prepare food at home. In the guidance on freezing, remove the term “prepared foods”, as they could understand that these are industrialized foods. In addition, emphasize what would be considered homemade food and that it is a pleasure to eat.	Always give preference to homemade food. If you are in the habit of cooking, keep it this way. However, if you don’t have this habit, start small, ask your family and friends for help and share some recipes. To make your day to day easier, it is important that you plan your food shopping and preparation. Know that you can freeze the food you have prepared. If you are going to eat out, look for a place where you recognize the food as being homemade. Homemade food, such as rice and beans, in addition to being tasty, is healthier and rich in important nutrients for you and your child.
(4) To increase variety, you can consume fruits, vegetables and legumes that are cheaper. A tip is to buy these foods at street markets and greengrocers. These foods are rich in several important vitamins and minerals to reduce the risk of high blood pressure, prematurity and fluid retention and strengthen your defense system and that of your child.	Add that the consumption of fruits, vegetables and legumes can also favor good intestinal functioning.	To increase variety you can consume fruits, vegetables and legumes that are cheaper, that is, in season. A tip is to buy these foods at street markets and greengrocers. These foods are rich in several vitamins and minerals that can lower the risk of high blood pressure, prematurity and swelling and can improve bowel function and strengthen your defense system and that of your child.
(5) If you are going to consume these foods raw, first wash under running water to remove dirt. Soak in a mixture with 1 tablespoon of bleach in 1 liter of water (4 cups) for 15 minutes, and then rinse the food in drinking water. Bleach is suggested to sanitize these foods. When buying this product, look for the brands that say on the label “Can be used to disinfect fruits and vegetables”. Some brands that have this information on the label are: Qboa, Chemix, Cândida, Tá Boa and Triex. If you prefer, there is an option on the market for hypochlorite from the Pury Vitta or Hidroesteril brands. In this case, follow the same steps, but replace 1 tablespoon of bleach with hypochlorite (according to the package recommendation) in 1 liter of water.If you have been advised by your doctor not to consume these foods, remember that if you sanitize properly when you consume them at home, there will be no problems. However, if you are going to consume them in a place you don’t know, it is better not to eat this food raw.	In the cleaning stage, adapt the message in the folder according to the explanation in the script, replacing chlorine with bleach. Add a step-by-step illustration of the cleaning to be clearer and do not mention the information that you may receive different guidance from the doctor, but that it would be safe to consume these foods, as long as they are properly sanitized.	If you are going to consume these foods raw, first wash them under running water to remove dirt. Soak in a mixture with 1 tablespoon of bleach in 1 liter of water (4 cups) for 15 minutes, then rinse the food in drinking water. Example of step-by-step cleaning (Figure 1). Bleach is suggested to sanitize these foods. When buying this product, look for the brands that say on the label “Can be used to disinfect fruits and vegetables”. Some brands that have this information on the label are: Qboa, Chemix, Cândida, Tá Boa and Triex. If you prefer, there is an option on the market for hypochlorite from the Pury Vitta or Hidroesteril brands. In this case, follow the same steps, but replace 1 tablespoon of bleach with hypochlorite. If you have been advised not to consume these foods, remember that if you sanitize them properly when you consume them at home, there is no problem. However, if you are going to consume them in a place you don’t know, it is better not to eat this food raw.
(6) Drink plenty of water throughout your day. A tip is to have a bottle of filtered water with you always. Water hydrates the body, maintains the proper functioning of the organs, reduces the swelling of the legs, and should not be replaced by soft drinks and artificial juices, as they contain a lot of sugar and this can cause weight gain.	Exemplify the equivalent measure of a bottle of water. Add examples of artificial juices and better emphasize the benefits of water intake.	Drink plenty of water throughout your day. A tip is to always have a bottle of filtered water with you (1 bottle of 500ml is equivalent to 2 glasses). Water hydrates the body, maintains the proper functioning of the organs, improves the functioning of the intestine and decreases the swelling of the legs. Water should not be replaced by soft drinks and artificial juices (boxed or powdered), as these contain a lot of sugar, which can cause excess weight gain and complications for your health. If your feet are very swollen or if you are very thirsty after meals, cut down on salt, but not water.
(7) Generally, these foods are sold in very colorful packages and are often ready to eat, simply by heating. Other examples are: box cake, packet soup, instant noodles, frozen dishes, ham, bologna, sausage, mayonnaise and other ready-made sauces. These products are rich in fat, salt and sugar, so if you are going to consume them, choose only two types twice a week, as their consumption can lead to excess weight gain, increase the risk of gestational diabetes, high blood pressure, swelling in the legs, and can compromise your child’s development.	Adjust the text to emphasize that the consumption of processed foods is harmful to health and mention what their problems are. Better direct the maximum consumption limit and exemplify the quantities to facilitate understanding.	Although these foods are apparently attractive, they are harmful to health, as they are low in nutrients and very high in fat, salt and sugar, which can increase the risk of excess weight gain. If you are going to consume these products, make it a maximum of 2 servings per week. Some examples of 1 serving are: 1 200ml glass of soda or boxed juice or powdered juice; 2 filled cookies; 5 water and salt crackers or cream crackers; 1 cup (tea) of chips; 1 bonbon; 1 popsicle; 1 scoop of ice cream; ½ packet of instant noodles.
Script 2 (message number)
(1) To track your weight gain during pregnancy, remember to weigh yourself regularly, preferably using the same scales. Adequate weight gain decreases the risk of complications in your pregnancy, such as gestational diabetes, high blood pressure and prematurity, as well as inadequate birth weight of the baby.	Add the guidance that if the weight gain expected in pregnancy had already been achieved, not to continue gaining weight.	To track your weight gain during pregnancy, remember to weigh yourself regularly, preferably using the same scales. If you have already achieved the weight gain expected throughout the pregnancy (11.5kg), the important thing is not to continue gaining weight. Accordingly, you should opt for healthier eating habits.Adequate weight gain decreases the risk of complications in your pregnancy, such as gestational diabetes, high blood pressure, prematurity and inadequate birth weight of the baby.
(2) During pregnancy, it is recommended that you do a physical activity such as walking, dancing, cycling or another activity of your preference, habit and according to your limit for about 30 minutes 5 days a week. If you have any contraindications, always follow your doctor’s instructions. Regular physical activity decreases your risk of developing gestational diabetes, high blood pressure and excess weight gain. In addition, it helps your child to be born with the proper weight.	Remove the types of exercises, just guide that it is regular exercise, respecting the limit. State other benefits of the practice of physical activity.	During pregnancy, it is recommended that you do a physical activity such as walking or another activity of your preference, habit and according to your limit for about 30 minutes 5 days a week. If you have any contraindications, always follow your doctor’s instructions. Regular physical activity helps at the moment of the birth and lowers your risk of developing gestational diabetes, high blood pressure, swelling and excess weight gain. In addition, it helps your child to be born with the proper weight.
(3) When preparing meals for your family, you should ensure that everyone eats fresh food. Do not substitute homemade food (rice, beans, meats, salads, stir-fried vegetables, pasta, vegetable soup, among others) for foods that are not culinary preparations, such as instant noodles, packet soup, frozen lasagnas and pizzas, and fast foods). Home cooking is tasty, rich in nutrients, and healthy for you, your baby, and your family.	Clarify the harmful effects of consuming processed foods and include more examples. Add more information about home cooking.	When preparing meals for your family, you should ensure that everyone eats fresh natural food. Do not substitute homemade food (rice, beans, meats, salads, stir-fried vegetables, pasta, and vegetable soup, among others) for processed foods, such as: instant noodles, packet soup, frozen lasagna and pizzas, soft drinks, filled cookies and fast foods. These foods are high in calories and low in nutrients and contain excess sugar, salt, fat, preservatives and coloring. Give preference to roasted and grilled preparations instead of frying and use natural seasonings. Home cooking is tasty, rich in nutrients, and healthy for you, your baby, and your family.
(4) The colors of fruits and vegetables represent different types of vitamins and minerals, for example: orange tones are related to the presence of vitamin A and vitamin C, while the dark green of vegetables is related to the minerals iron, calcium and to the vitamin folic acid. To maintain food variety, remember to consume at least 3 fruits and 3 types of vegetables every day. The vitamins and minerals present in fruit, vegetables and legumes are very important for your health and that of your baby (vision, hair, nails, and body resistance).	Simplify information about the benefits of fruit and vegetable consumption to facilitate comprehension.	To maintain food variety, remember to consume at least 3 fruits and 3 types of vegetables every day. The more colorful your plate, the more vitamins and minerals it has. For example, for a five-color dish, you can include rice, beans, meat and/or eggs and vegetables. The vitamins and minerals present in fruit, vegetables and legumes are very important for your health and that of your baby (vision, hair, nails, and body resistance) and prevent malformation of the baby.
(5) Most of our body is made up of water. Throughout the day, it is important that you drink at least 8 glasses of water to keep your body well hydrated. Water maintains the proper functioning of the entire body, such as digestion, transport of nutrients, circulation, body temperature balance and elimination of impurities.	Add the information that water intake is also important to prevent urinary tract infection.	Most of our body is made up of water. It is important that you drink at least 8 glasses of water throughout the day to keep your body well hydrated. Water maintains the proper functioning of the entire body, such as digestion, transport of nutrients, circulation, body temperature balance and elimination of impurities and helps prevent urinary infection.
(6) Avoid replacing natural foods and homemade food with industrialized products, such as: instant noodles, packet soups, sausage, crackers and packaged cookies, chips, artificial juices (powdered or boxed) and sodas. Natural foods are better for you and your baby’s health as they lower the risk of you gaining excess weight.	Justify the reasons that processed foods are harmful to health and emphasize that natural foods are beneficial to health if consumed in a balanced way. Add other complications that can be avoided through a balanced diet.	Avoid replacing natural foods and homemade food with industrialized products, such as: instant noodles, packet soups, sausages (sausage, ham, salami, bologna), hamburgers, nuggets, chips, crackers and packaged cookies, sweets, cereal bars, artificial juices (powdered or boxed) and sodas. These foods contain a lot of preservatives, colorings and flavorings and are high in sugar, salt and fat. Natural foods, consumed in a balanced way, are better for you and your baby’s health, as they reduce the risk of you gaining excess weight and other complications such as gestational diabetes, high blood pressure, swelling, prematurity and inadequate weight of the baby.
Script 3 (message number)
(1) Remember that according to your weight and height, it is recommended that you have a total weight gain of 7kg to 11.5kg. Be extra careful about weight gain in the last trimester of pregnancy. Excessive weight gain during pregnancy can interfere with your health and that of your child, from baby to adulthood.	Emphasize that weight gain is greater in the last trimester and that, for this reason, greater attention should be paid. State what the complications of excessive weight gain are for the mother and baby.	Remember that, according to your weight and height, it is recommended that you have a total weight gain of 7kg to 11.5kg. Throughout pregnancy, weight gain occurs and in the last trimester this gain is greater, so be more attentive at this stage. Excessive weight gain during pregnancy can interfere with your health and that of your child, from gestation to adulthood. For you, complications can be: obesity, high blood pressure, swelling and diabetes. For your baby, the possible complications are: being born with low weight or overweight, diabetes, and obesity, among others.
(3) Don’t go too long without eating throughout the day. It is better for you to eat less more times a day. Eat vegetables and legumes at lunch and dinner. Fruits, in addition to being tasty, are great options to eat for breakfast and between meals. Having these as snacks during the day is healthier and helps to reduce heartburn, a very common symptom during pregnancy.	Include the information that adequate consumption of fruits also helps in the proper functioning of the intestine.	Don’t go too long without eating throughout the day. It is better for you to eat less more times a day. Eat vegetables and legumes at lunch and dinner. Fruits, in addition to being tasty, are great options to eat for breakfast and between meals. It is essential to have these snacks during the day, reducing the chance of having heartburn and constipation, which are very common symptoms in pregnancy.
(4) Do not substitute homemade food, such as rice, beans, meats, vegetables and legumes, for snacks and/or savories. Homemade food is healthier, nutritious and has fewer calories. Snacks and savories are more caloric, have more fat and salt, increasing the risk of you gaining excess weight and having greater fluid retention in the body.	Include fast foods as an example of processed foods and add that increased blood pressure can also be a risk of consuming processed foods.	Do not substitute homemade food, such as rice, beans, meats, vegetables and legumes, for snacks, savories and fast food. Homemade food is healthier, nutritious and has fewer calories. Snacks, savories and fast food are more caloric and have more fat and salt, increasing the risk of you gaining excess weight and having greater fluid retention and high blood pressure in the body.
(5) You can consume the fruits and vegetables that are cheaper, so you maintain the variety of these foods. These foods are important for your health and that of your baby, as they reduce the risk of high blood pressure, fluid retention, excess weight gain and prematurity, and protect your defense system and that of your child.	Emphasize more the benefits of maintaining a variety of fruits and vegetables.	You can consume the cheapest fruits and vegetables, so you maintain the variety of these foods and ensure an adequate amount of vitamins, minerals and fiber in your diet. These foods are important for your health and that of your baby, as they reduce the risk of high blood pressure, fluid retention, excess weight gain, prematurity, and protect your defense system and that of your child.
(6) Throughout the day, you should drink at least 8 glasses of water to maintain adequate hydration. Adequate consumption of water will help to reduce leg swelling a lot.	Emphasize more clearly the benefits of adequate fluid intake.	Throughout the day, you should drink at least 8 glasses of water. Adequate water consumption can decrease leg swelling and constipation and keep your body hydrated.
(7) These products are harmful to your health as they are high in fat and salt and have few vitamins and minerals. In addition, they can harm your child’s development. Always favor homemade food: in addition to being tasty, it is more nutritious, healthier and cheaper.	Exemplify other options for industrialized products.	These products are harmful to your health as they are high in fat, salt, and sugar and are low in vitamins and minerals. In addition, they can harm your child’s development. Other examples of industrialized products that can be harmful to you and your baby are: nuggets, sweet rolls, sliced bread, filled cookies, frozen pizzas and lasagnas, etc. Always favor homemade food, which is tastier, more nutritious, healthier and cheaper.

	Folder 1	Folder 2	Folder 3
1	Weight gain during pregnancy should be between 7.0kg and 11.5kg.	Gaining a lot of weight during pregnancy can compromise your health and that of your baby.	Healthy weight gain is critical for your health and that of your baby.
2	Get 30 minutes of physical activity 5 times a week, as instructed by your doctor.	Exercise during pregnancy as instructed by your doctor.	Remember to practice physical activities, if not prohibited by your doctor.
3	Eat homemade food every day for lunch and dinner.	Cooking is an act of love.	Have breakfast, lunch and dinner every day. Eat fruit between these meals.
4	Eat three types of vegetables and three fruits every day.	The more colorful the fruits and vegetables, the greater the variety of nutrients.	Favor homemade food instead of snacks and savories.
5	Before eating fruits and vegetables: wash, soak (1 tablespoon of bleach to 1 liter of water) for 15 minutes and rinse.	Drink water. Water is essential for your life and that of your baby.	Consume different types of vegetables, legumes and fruits every day.
6	Drink at least 8 glasses of water a day. Sodas and juice do not replace water.	Peel more and unpack less.	Drink water throughout the day to remain hydrated and for your baby’s health.
7	Limit the consumption of processed foods (sodas, artificial juices, cookies, savories). These foods harm your health and that of your baby.		Avoid consuming industrialized products, such as: cookies, savories, instant noodles, sausages, sodas, artificial juices and fast foods.
	*Attention: in special cases of health problems, talk to your doctor.	*Attention: in special cases of health problems, talk to your doctor.	*Attention: in special cases of health problems, talk to your doctor.

	Folder 1	Folder 2	Folder 3
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	Script 1	Script 2	Script 3
1	According to your weight and height, it is recommended that you gain 7.0 to 11.5kg throughout your pregnancy. It is more common for this weight gain to be greater towards the end of the pregnancy. If possible, monitor your weight gain regularly, preferably using the same scales, which does not necessarily have to be done at the Primary Health Unit. Remember that inadequate weight gain, greater or less than recommended, can be harmful to your health, increasing the risk of diabetes, obesity and high blood pressure. It can also harm your baby’s health, increasing the chance that he or she will be born with inadequate weight, prematurely and develop diseases in later life.	To track your weight gain during pregnancy, remember to weigh yourself regularly, preferably using the same scales. If you have already achieved the weight gain expected throughout the pregnancy (11.5kg), the important thing is not to continue gaining weight. Accordingly, you should opt for healthier eating habits. Adequate weight gain decreases the risk of complications in your pregnancy, such as gestational diabetes, high blood pressure, prematurity and inadequate birth weight of the baby.	Remember that, according to your weight and height, it is recommended that you have a total weight gain of 7kg to 11.5kg. Throughout pregnancy, weight gain occurs and in the last trimester this gain is greater, so be more attentive at this stage. Excessive weight gain during pregnancy can interfere with your health and that of your child, from gestation to adulthood. For you, complications can be: obesity, high blood pressure, swelling and diabetes. For your baby, the possible complications are: being born with low weight or overweight, diabetes, and obesity, among others.
2	This is the recommended frequency of physical activity during pregnancy, if you don’t have any contraindications from your doctor. If you don’t have this habit, start slowly, performing some physical activity that is pleasurable for you for 10 minutes a day and increase the time until you reach 30 minutes 5 days a week or a total of 150 minutes (2 hours and 30 minutes) per week according to your availability. Regular physical activity, such as walking, dancing, cycling or other activities, will help you control weight gain, reduce swelling in your legs, reduce stress and improve the functioning of your intestines.	During pregnancy, it is recommended that you do a physical activity such as walking or another activity of your preference, habit and according to your limit, for about 30 minutes 5 days a week. If you have any contraindications, always follow your doctor’s instructions. Regular physical activity helps at the moment of the birth and lowers your risk of developing gestational diabetes, high blood pressure, swelling and excess weight gain. In addition, it helps your child to be born with the proper weight.	If you don’t have any contraindications, do physical activity for about 30 minutes a day 5 times a week. The regular practice of physical activities helps to keep weight gain within the recommended limit during pregnancy. In addition, it decreases back pain and swelling, improves circulation and will help you during the birth and with weight loss after the birth of your child.
3	Always give preference to homemade food. If you are in the habit of cooking, keep it this way. However, if you don’t have this habit, start small, ask your family and friends for help and share some recipes. To make your day to day easier, it is important that you plan your food shopping and preparation. Know that you can freeze the food you have prepared. If you are going to eat out, look for a place where you recognize the food as being homemade. Homemade food, such as rice and beans, in addition to being tasty, is healthier and rich in important nutrients for you and your child.	When preparing meals for your family, you should ensure that everyone eats fresh natural food. Do not substitute homemade food (rice, beans, meats, salads, stir-fried vegetables, pasta, and vegetable soup, among others) for processed foods, such as: instant noodles, packet soup, frozen lasagna and pizzas, soft drinks, filled cookies and fast foods. These foods are high in calories and low in nutrients and contain excess sugar, salt, fat, preservatives and dyes. Give preference to roasted and grilled preparations instead of frying and use natural seasonings. Home cooking is tasty, rich in nutrients, and healthy for you, your baby, and your family.	Don’t go too long without eating throughout the day. It is better for you to eat less more times a day. Eat vegetables and legumes at lunch and dinner. Fruits, in addition to being tasty, are great options to eat for breakfast and between meals. It is essential to have these foods during the day, reducing the chance of having heartburn and constipation, which are very common symptoms in pregnancy.
4	To increase variety, you can consume fruits and vegetables that are cheaper. A tip is to buy these foods at street markets and greengrocers. These foods are rich in several vitamins and minerals that can lower the risk of high blood pressure, prematurity and swelling and can improve bowel function and strengthen your defense system and that of your child.	To maintain food variety, remember to consume at least 3 fruits and 3 types of vegetables every day. The more colorful your plate, the more vitamins and minerals it has. For example, for a five-color dish, you can include rice, beans, meat and/or eggs and vegetables. The vitamins and minerals present in fruit, vegetables and legumes are very important for your health and that of your baby (vision, hair, nails, body resistance and prevent malformation of the baby).	Do not substitute homemade food, such as rice, beans, meats, vegetables and legumes, for snacks, savories and fast food. Homemade food is healthier, nutritious and has fewer calories. Snacks, savories and fast food are more caloric and have more fat and salt, increasing the risk of you gaining excess weight and having greater fluid retention and high blood pressure.
5	If you are going to consume these foods raw, first wash them under running water to remove dirt. Soak in a mixture with 1 tablespoon of bleach in 1 liter of water (4 cups) for 15 minutes, and then rinse the food in drinking water. Example of step-by-step cleaning. Bleach is suggested to sanitize these foods. When buying this product, look for the brands that say on the label “Can be used to disinfect fruits and vegetables”; some brands that have this information on the label are: Qboa, Chemix, Cândida, Tá Boa and Triex. If you prefer, there is an option on the market for hypochlorite from the Pury Vitta or Hidroesteril brands. In this case, follow the same steps, but replace 1 tablespoon of bleach with hypochlorite. If you have received any advice not to consume these foods, remember that if you sanitize them properly when you consume them at home, there is no problem. However, if you are going to consume them in a place you don’t know, it’s better not to eat this food raw.	Most of our body is made up of water. It is important that you drink at least 8 glasses of water throughout the day to keep your body well hydrated. Water maintains good functioning of the entire body, such as digestion, transport of nutrients, circulation, body temperature balance and elimination of impurities and helps prevent urinary infection.	You can consume the cheapest fruits, vegetables and legumes, so you maintain the variety of these foods and ensure an adequate amount of vitamins, minerals and fiber in your diet. These foods are important for your health and that of your baby, as they reduce the risk of high blood pressure, fluid retention, excess weight gain, prematurity, and protect your defense system and that of your child.
6	Drink plenty of water throughout your day. A tip is to always have a bottle of filtered water with you (1 bottle of 500ml is equivalent to 2 glasses). Water hydrates the body, maintains the proper functioning of the organs, improves the functioning of the intestine and decreases the swelling of the legs. Water should not be replaced by soft drinks and artificial juices (boxed or powdered), as these contain a lot of sugar, which can cause excess weight gain and complications for your health. If your feet are very swollen or if you are very thirsty after meals, cut down on salt, but not water.	Avoid replacing natural foods and homemade food with industrialized products, such as: instant noodles, packet soups, sausages (sausage, ham, salami, bologna), hamburgers, nuggets, chips, crackers and packaged cookies, sweets, cereal bars, artificial juices (powdered or boxed) and sodas. These foods contain a lot of preservatives, colorings and flavorings and are high in sugar, salt and fat. Natural foods, consumed in a balanced way, are better for you and your baby’s health, as they reduce the risk of you gaining excess weight and other complications such as gestational diabetes, high blood pressure, swelling, prematurity and inadequate weight of the baby.	Throughout the day, you should drink at least 8 glasses of water. Adequate water consumption can decrease leg swelling and constipation and keep your body hydrated.
7	Although these foods are apparently attractive, they are harmful to health, as they are low in nutrients and very high in fat, salt and sugar, which can increase the risk of excess weight gain. If you are going to consume these products, make it a maximum of 2 servings per week. Some examples of 1 serving are: 1 200ml glass of soda or boxed juice or powdered juice; 2 filled cookies; 5 water and salt crackers or cream cracker; 1 cup (tea) of chips; 1 sugarplum; 1 popsicle; 1 scoop of ice cream; ½ packet of instant noodles.		These products are harmful to your health as they are high in fat, salt, and sugar and are low in vitamins and minerals. In addition, they can harm your child’s development. Other examples of industrialized products that can be harmful to you and your baby are: nuggets, sweet rolls, sliced bread, filled cookies, frozen pizzas and lasagnas, etc. Always favor homemade food, which is tastier, more nutritious and healthier, as well as cheaper.

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[1] Authors’ contribution

Manochio-Pina MG participated in the study design, data collection and analysis, and writing of the manuscript. Crivellenti LC and Diez-Garcia RW participated in the study design, data analysis and review of the manuscript. Sartorelli DS participated in the study design, data analysis and review of the manuscript. All authors approved the final version of the article and declared that there was no conflict of interest.