Pregnancy is physiologically and nutritionally a highly demanding period. Extra food is required to meet the requirements of the fetus. A woman prepares herself to meet the nutritional demands by increasing her own body fat deposits during pregnancy. Nutrition and lifestyle before and during pregnancy, lactation, infancy and early childhood have been shown to induce long-term effects on later health of the child, including the risk of common non-communicable diseases such as obesity, diabetes, and cardiovascular disease.
There are other diseases also such as an increased risk of adverse pregnancy outcomes including low birth weight, preeclampsia, pre-term birth, and neurodevelopment problems such as fatal alcohol spectrum disorder. This phenomenon is referred to as “Early metabolic programming of long-term health and disease” or “Developmental origins of adult health and disease”.
The additional nutrient requirements of the mother and her fetus during pregnancy are met by a combination of physiological events that affect maternal nutrient utilization and fatal nutrient transfer, and increased dietary intakes. The physiological changes complicate the interpretation of nutritional status measures in pregnancy. It is clear that the body composition of the mother in the periconceptional period affects pregnancy weight gain, so the newly revised weight-gain recommendations continue to be based on maternal body mass index (BMI) at conception. The adverse effects of consuming an inadequate amount of most vitamins and minerals during pregnancy are partially understood, often from research in developing country populations, but little is known about sub clinical or long –term effects of deficiencies or their role in specific adverse pregnancy outcomes. Estrogens synthesis is increased from early in pregnancy, and its functions include altering carbohydrate and lipid metabolism, increasing the rate of maternal bone turnover.
A healthy, balanced diet during pregnancy is essential to support optimal growth and development of the fetus and the physiological changes that occur in the mother. Fundamental aspects of healthy dietary behaviours during pregnancy include consuming foods that contain optimal amounts of energy as well as macro and micronutrients, achieving appropriate weight gain, adhering to general and pregnancy-specific food safety recommendations, and avoiding ingestion of harmful substances. The protein, fat, minerals, and vitamins deposited in fatal and maternal tissues come from increased maternal food intake and/or more efficient intestinal absorption or renal re-absorption, depending on the specific nutrient.
The dietary recommendations for pregnant women are to meet their increased caloric and nutrient needs. Additional recommendations include increasing water intake and avoiding foods associated with food-borne illnesses such as under cooked fish and meat, raw eggs, unpasteurized products, and raw sprouts. These guidelines exist to help women select a healthy diet. Good nutrition is the most important requirement of a mother during pregnancy. Effects of a Poor Diet – Premature birth, Low birth weight babies, Feeble, weak babies. Inability to breast-feed Malformed babies Complications at birth Depression in mother Babies with impaired brain cells. A pregnant woman should: choose nutrient-dense foods- consume 300 extra calories per day. Eat not more than 12 ounces of low-mercury fish weekly.
Healthy eating in pregnancy
The requirements for selected nutrients increase appreciably during pregnancy. The recommended intakes for the following nutrients are >25% higher than are the amounts recommended for non pregnant women: protein, α-linolenic acid, iodine, iron, zinc, folate, niacin, riboflavin, thiamin, and vitamin B6. The needs for protein, iron, folate, and vitamin B6 are about 50% higher. Good food sources of these nutrients are grains, dark green or orange vegetables, and the meat, beans, and nuts groups. Additional energy is also required to meet the needs for moving a heavier body, the rise in metabolic rate, and tissue deposition. Approximately 340–450 kcal are needed in the second and third trimesters, respectively. Although these increased nutrient requirements are significant, the same food pattern recommended for non pregnant women can be recommended to pregnant women because that food pattern meets pregnancy nutrient Recommended Daily Allowances (RDA) for all nutrients except iron and vitamin E. The shortfall in iron and vitamin E can be provided by any vitamin–mineral supplement supplying at least 10 mg iron and 9 mg vitamin E. Use of a common food pattern for women at all stages in the reproductive cycle enables dietitians and other health care providers to teach pregnant women the elements of a quality diet that will better ensure good health for a life time
Calorie restriction is not advised and recommendations focus on achieving and maintaining a healthy weight during pregnancy by basing meals on starchy foods (wholegrain if possible), eating fibre rich foods and consuming at least five portions a day of fruit and vegetables. Food high in fat and sugar (including fried, some drinks and confectionery) should be avoided. Pregnant women are also advised to eat breakfast, and to watch portion sizes and how often they are eating.
Low-fat dairy foods for a source of calcium are encouraged with a daily intake of protein in the form of lean meat, two portions of fish a week (one of which should be oily) or lentils, beans and tofu.
Nutrient requirements in pregnancy
Energy requirements are increased to cover energy deposited in the mother and foetus. The actual amount of energy required varies greatly among women because of differences in the amount of weight and fat gain, and energy expenditure. Excessive weight gain in pregnancy tends to cause excessive weight retention postpartum.
Excessive weight gain in pregnancy tends to cause excessive weight retention postpartum. Exclusive breastfeeding for at least 6 months reduces the risk of long – term retention of this weight.
Carbohydrates form the main substrate for foetal growth, fueling maternal and foetal organ function, and biosynthesis. Maternal and foetal brain functions use glucose from carbohydrate as their preferred source of energy with glucose providing at least 75% of foetal energy requirements.
The glycaemic index (GI) refers to the area under the curve for blood glucose concentrations during a 2 hr period after consuming a test food. A low GI suggests slower rates of digestion and absorption of a food’s carbohydrate, potentially relating to a lower insulin demand. It is therefore a modifiable macronutrient in the management of diabetes mellitus (gestational, type 1 and type 2).
Protein forms the building blocks for both structural and functional components of cells. Requirements are highest during the second and third trimesters due to extra development and growth of both maternal and foetal tissue. It is an alternative energy source when carbohydrate intake is insufficient therefore adequate carbohydrate intake is required in order for cell synthesis to continue. Plasma concentrations of most amino acids are higher in foetal circulation. Over 15 different amino acid transporters mediate their transport against a concentration gradient.
The RDA for an additional 925 g of protein deposited in the mother and fetus, of which 8 g/day are needed during the second trimester and 17 g/day during the third (Institute of Medicine). Thus the total RDA is 1.1 g/kg/ day or + 25 g/day additional protein. Most pregnant women in industrialized countries, and probably the majority in developing countries, consume at least the recommended intake of protein.
There are no specific recommendations for fats in pregnancy, apart from following normal dietary guidelines. Fats should make up 25 to 35 percent of daily calories, and those calories should come from healthy fats, such as avocados and other dry fruits. Foods with unhealthy fats, including French fries and other fast food, should be avoided. Also, it is not recommended for pregnant women to be on a very low-fat diet, since it would be hard to meet the needs of essential fatty acids and fat-soluble vitamins. Fatty acids are important during pregnancy because they support the baby’s brain and eye development. In particular, the brain depends on omega-3 and omega-6 fatty acids, such as the kind found in salmon and sunflower or safflower oil, for function, structure, and growth. Fats can also help the placenta grow and may help to prevent premature birth and low birth weight.
Essential polyunsaturated fatty acids (PUFAs), which must be consumed in the diet, found mainly in seed oils, the major sources are egg yolk and lean meat. DHA is found in meat and fatty fish.
Fibre affects the postprandial insulin response by influencing the accessibility of carbohydrates and nutrients to digestive enzymes thus delaying their absorption. Fibre supports maternal digestive health, providing bulk to stool and absorbing water to aid transit time. This is especially beneficial as progesterone levels in pregnancy can result in constipation by increasing relaxation of intestinal smooth muscle.
Pregnancy requires certain conditionally essential nutrients, which are nutrients that are supplied only under special conditions, such as stress, illness, or aging. The daily requirements for non pregnant women change with the onset of a pregnancy. Taking a daily prenatal supplement or multivitamin helps to meet many nutritional needs. However, most of these requirements should be fulfilled with a healthy diet. The following table compares the normal levels of required vitamins and minerals to the levels needed during pregnancy. For pregnant women, the RDA of nearly all vitamins and minerals increases.
Vitamin A deficiency during pregnancy and lactation is not a public health problem in industrialized countries. There is more concern about the dangers of excessive supplementation with retinol or the analog isotretinoin which is used to treat severe cystic acne. Ingestion of large amounts of retinol has been associated with birth defects including abnormalities of the central nervous system, craniofacial and cardiovascular defects, and thymus malformations (Rothman et al. , 1995 ). The first trimester is most critical because the malformations are derived from cranial neural crest cells. There are about 20 case reports of retinol toxicity during pregnancy although their interpretation is confounded by the fact that the retinol was usually consumed as part of a multinutrient supplement
The upper safe limit has been set at 3000 μ g daily for women of reproductive age and in pregnancy. In pregnant and non – pregnant individuals the serum concentration of 25 – hydroxyvitamin D, the main circulating form of the vitamin, is a good indicator of tissue stores of vitamin D. It crosses the placenta and is converted to the active form, 1,25 – dihydroxyvitamin D, by the neonate. The placenta synthesizes 1,25 – dihydroxyvitamin D; maternal serum levels are more
Calcium is made available to the foetus by the substantial increase in the efficiency of maternal calcium absorption starting early in pregnancy. Calcium is carried across the placenta by active transport involving calcium binding protein and 1,25 – dihydroxyvitamin D. Although maternal bone resorption increases during pregnancy, there is no detectable change in bone mineral content between conception and parturition.
There is little need for additional dietary calcium during pregnancy, and calcium supplements do not improve maternal bone calcium or infant bone in the first year of life, even when maternal intakes are very low. Recommended intakes are 1000 mg/day, the same as for non – pregnant women (Institute of Medicine, 2011).
Normal sodium intake is needed during pregnancy to support the large prenatal expansion of tissues and fluids. Sodium should not be restricted.
Helps red blood cells deliver oxygen to your baby. Sources include lean red meat, dried beans, peas, and iron-fortified cereals. During pregnancy you need 28 mg daily, which can be found in most prenatal vitamin supplements. Women who do not have enough iron stored in their bodies before pregnancy may develop anemia. Some women may need extra iron in the form of an iron supplement. On average an additional 6 mg iron per day needs to be absorbed during pregnancy. Iron is retained by the foetus (300 mg), deposited in the placenta (60 mg), used for the synthesis of additional maternal red blood cells (450 mg), lost in blood during delivery (200 mg), and retained by the mother’s increased red cell mass after parturition (200 mg).
Folate, also known as folic acid, plays an important part in reducing the risk of neural tube defects. Folic acid is a B vitamin that is also known as folate. Before pregnancy and during the first 12 weeks of pregnancy, you need 0.4 milligrams (or 400 micrograms) of folic acid daily in order to reduce the risk of neural tube defects. All women of childbearing age should take a multivitamin supplement containing 0.4 milligrams of folic acid a day. Women who have had a child with a neural tube defect or who are taking certain drugs need much higher doses of folic acid—4 milligrams daily. Women who need 4 milligrams should take folic acid as a separate supplement, not as part of a multivitamin. These are major birth defects that affect the baby’s brain and spinal cord, such as Spina bifida and anencephaly. The American College of Obstetrics and Gynecology (ACOG) recommends 600 to 800 mg of folate. Sources include liver, nuts, dried beans and lentils, eggs, nuts and peanut butter, dark green and leafy vegetables.
Common questions that are always been asked
If a pregnant woman is Vegetarian, what will be her diet?
Pregnant women consuming vegetarian diets need careful nutritional assessment. The type of vegetarian diet will determine the potential for nutrient deficiencies with increased risk as more foods are excluded. Most pregnant women consuming milk and eggs can meet the increased nutrient needs of pregnancy. Vegan diets will require careful planning to consume adequate protein from complementary plant proteins. Alternate sources of Vitamin B12 and calcium will be needed in a vegan diet. Iron status should be carefully monitored. Low pre-pregnancy weight and less than optimal weight gain are common problems for vegans. High calorie foods such as nuts, nut butter, wheat germ, avocados, dried fruit, coconut, honey and salad dressings may be needed. If you are a vegetarian, you will need to plan your meals with care to ensure you get enough protein. You will probably need to take supplements, especially iron, vitamin B12, and vitamin D.
Can being overweight or obese affect pregnancy?
Overweight and obese women are at increased risk of several pregnancy problems. These problems include gestational diabetes, high blood pressure, preeclampsia, and cesarean delivery. Babies of overweight and obese mothers also are at greater risk of certain problems, such as congenital abnormalities, macrosomia with possible birth injury, and childhood obesity. For women with a BMI of 30 or greater, a weight gain of between 11 pounds and 20 pounds is recommended during pregnancy. For women with a BMI of 40 or greater, a modest weight loss during pregnancy may be recommended.
Can consuming caffeine be harmful during pregnancy?
Moderate caffeine intake (200 milligrams per day—the amount in approximately two 8-ounce cups of brewed coffee) does not appear to lead to miscarriage or preterm birth. It is not clear whether caffeine increases the risk of having a low birth weight baby.
Excess caffeine can interfere with sleep and contribute to nausea and light-headedness. It also can increase urination and lead to dehydration.
How can I plan meals to get the nutrients I need during pregnancy
You should join the programme of Foodnwellness. This program gives you a personalized plan that includes the kinds of foods in the amounts that you need to eat for each trimester of pregnancy.
How Foodnwellness helps during this phase
During pregnancy, motivation for eating a healthy diet may change relative to the non-pregnant state as women prepare for motherhood and consider the impact of their dietary intake on the baby’s health. Personal values and beliefs about nutrition in pregnancy, advice from health professionals, and physical and physiological changes may interact with determinants of eating behaviours present in the non-pregnant state (e.g., personal preferences, time, money) to change diet-related behaviours. Although most women are aware that healthy eating is important during pregnancy, women may lack knowledge of specific dietary recommendations or may not have the skills required to improve their diet. Healthy eating may also be challenging during pregnancy as women face barriers such as food aversions, cravings, nausea, vomiting, tiredness, constipation, hemorrhoids, and heartburn. Women may receive plenty of advice from everywhere but it is worthy when you receive correct knowledge from panel of health professionals. Foodnwellness will always guide regarding every issues you face and it will be taken care of by our Dietitians.