Member - Academy Of Nutrition & Dietetics. USA.
Pregnancy Nutrition
Planning for a little one? Then it’s time to roll your sleeves up and settle down for some nutrition enriched diet and folate supplementation before conception. What you eat has a direct impact on the newborn-to-be.
Preconception
The traditional man—woman conception days are gone. Assisted Reproductive Technology (ART) has enabled even same-sex parents to nurture babies but at the cost of a fortune. In this technology, “parents” would be egg or sperm donors or surrogate carriers making nutrition assessment and help an elaborate procedure. Infertility, thus leading to ART, may be due to ovulation defect, male factor, fallopian tube defect or some unexplained cause.
Conception
For women with polycystic ovarian syndrome, obesity, amenorrhea (cessation of menses) and incomplete growth of the pelvic girdle, conception is a real problem. Also environmental toxins, dioxins and deficiency in vitamin B12 are few factors related to infertility.
Pregnancy
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People usually comment as pregnancy being the best period in a woman’s life. Pregnancy is usually counted from the first day of the last menstrual cycle, lasts about 40 weeks and is grouped into three trimesters. The mother’s nutritional state is greatly indicative of the infant birth weight and other fetal defects, if any. Along with this, poor quality of air and water are responsible for premature deliveries. Such premature infants are at a high risk for health diseases such as obesity, hypertension and cardiovascular diseases.
Low birth weight (LBW) of babies is a major cause of perinatal mortality. This is due to poor nutrition and low maternal weight gain. Underweight women have light-weight placentas and are likely to deliver LBW infants. The size of the placenta determines the amount of nutrition and oxygen passed to the fetus. Underweight women bearing larger infants are often operated during delivery. Women with nominal weight gain and a healthy body mostly deliver large babies. Given below are the recommended weight gains for women by the Institute of Medicine (IOM): |
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Effects of Nutritional Status on Pregnancy Outcome
Woman type |
Appropriate Gain |
Normal weight women |
11 to 16kg |
Underweight women |
12 to 18kg |
Overweight women |
7 to 11kg |
Since obesity crisis affects women during pregnancy, infants of overweight women must be checked for maternal health risk associated with increased weight gains. A BMI of 27.8 is termed as overweight. Increased sugar and blood pressure levels and cesarean section delivery are common in obese women. Miscarriage, preterm babies, overweight babies and infants with neural tube defects (NTDs) and cardiac defects are commonly seen when obese women give birth to children. Sometimes obese women take a drastic step of trying to reduce weight during pregnancy. This may led to negative outcomes and strict advice against this practice by the midwife is essential. Due to the complications that may occur in obese women as mentioned above, proper dietary guidance and optimum weight gain is necessary for delivering healthy infants.
Teen pregnancy almost always results in LBW babies. Also the nutritional needs of iron, calcium and folic acid intake are not fulfilled by teens during their pregnancy period. Improving this dietary need coupled with prenatal counseling can help the teen deliver a healthy baby. The technological and scientific improvements that aid in delivering babies through the use of fertility drugs, embryo transfer and increased pregnancy in older women often result in multiple births. These infants are commonly born prematurely. Summing up, normal weight, optimal age and a nutritious diet is what is required for delivering perfect healthy baby blossoms.
Teen pregnancy almost always results in LBW babies. Also the nutritional needs of iron, calcium and folic acid intake are not fulfilled by teens during their pregnancy period. Improving this dietary need coupled with prenatal counseling can help the teen deliver a healthy baby. The technological and scientific improvements that aid in delivering babies through the use of fertility drugs, embryo transfer and increased pregnancy in older women often result in multiple births. These infants are commonly born prematurely. Summing up, normal weight, optimal age and a nutritious diet is what is required for delivering perfect healthy baby blossoms.
Nutritional Supplementation during Pregnancy
A well-balance wholesome diet resulting in optimal weight gain during pregnancy supplies the required vitamins and minerals for pregnant women. Supplementation of energy, protein, vitamins and minerals is required in the case of undernourished women, teenage mothers, women with LBW infant history and multiple gestations. More than 60% of supplements are rich in iodine along with iron and folate content, and these iron and folate contents are recommended for pregnant women.
Physiologic Changes of Pregnancy
Blood volume expands almost 50% by the end of pregnancy, cardiac output and size increases and glomerular filtration rate increases while quantity of urine excreted remains constant. Function of the gastrointestinal system changes affecting nutritional status. Nausea, vomiting and like and dislike towards foods is common during the first trimester. Gallbladder disease is common in pregnant women and can occur during the second and third trimester. Placenta plays a vital role in transporting nutrients and oxygen for the growing fetus. A small placenta has a smaller capacity to do its transportation work, thus affecting fetal growth.
Nutritional Requirements
Pregnancy is the time to ensure best nutrient supply to both mother and child.
Energy and Protein
Any activity demands energy and during pregnancy additional energy is required to meet the demands of the growing fetus and the mother as metabolism increases marginally. The quantity of energy required depends on the maternal weight gain. If this gain is within the desirable limits, the intake can be changed accordingly keeping in mind the energy spent. The weight can be kept in check by involving in some light physical activity and not overdoing it at any point.
Additional protein is required during pregnancy for healthy maternal and fetal tissues. Since energy and protein intake happen together a deficiency in either makes it difficult to guess the right deficit nutrient. But when energy supply is doubled it compensates for the lost proteins henceforth clearly showing that an energy deficiency affects strongly during pregnancy.
Additional protein is required during pregnancy for healthy maternal and fetal tissues. Since energy and protein intake happen together a deficiency in either makes it difficult to guess the right deficit nutrient. But when energy supply is doubled it compensates for the lost proteins henceforth clearly showing that an energy deficiency affects strongly during pregnancy.
Carbohydrates, Fiber and Lipids
Carbohydrate intake constitutes about 35% of the calorie intake daily. Fiber in the form of whole grains, fruits, leafy veggies (particularly those rich in iron and folic acid) and nuts is highly recommended. Lipids, like energy, should be consumed in accordance with the energy requirements.
Vitamins
Some vitamins are acquired through diet and others through supplements to have significant effect on pregnancy. Folic acid for placental growth and to prevent NTDs, choline for cell membrane integrity and nerve impulse transmission, vitamin D for calcium balance, vitamin B6 to manage severe nausea and vomiting during pregnancy and vitamin K for bone health are very much essential during pregnancy for maximum outcome. Vitamin A, E, K and ascorbic acid are also needed for fitting pregnancy outcome.
Minerals
Calcium, phosphorus, sodium, magnesium, copper, fluoride and iodine in nominal quantity are required by the expected mother-to-be. Women, especially pregnant women rarely have self-sufficient amounts of iron content to cover their physiological needs during pregnancy. Hence iron supplementation has become a norm during pregnancy to prevent anemia. Zinc supplements are equally important for normal infant weight.
Guide for Eating During Pregnancy
Complications of Pregnancy with Dietary Implications
Nausea and Vomiting
The first thing we relate with pregnancy is nausea and vomiting. Morning sickness or nausea and vomiting in pregnancy (NVP) is present in 50% to 90% of pregnant women during the first trimester and subsides by the 17th week. The sad thing is that no cure is available for this phenomenon. Eating dry crackers and ginger ale, smelling lemons and consuming foods rich in protein can reduce nausea and vomiting.
Gastric esophageal reflux or heartburn as commonly known is common among pregnant ladies during the latter semesters and occurs often at night. Eating small meals at frequent intervals can reduce the impact of heartburn.
Constipation and Hemorrhoids
Inadequate water and fiber will lead to constipation in pregnant women. Straining when passing stools can lead to hemorrhoids.
Edema and Leg Cramps
Edema or swelling due to fluid accumulation in the extremities occurs in the third trimester. Reclining on one side removes the mechanical effect and the excess fluid is removed by increased urine output. There is no dietary intervention needed for this.
Diabetes Mellitus
Diabetes in pregnant women is dangerous as it may lead to prematurity and intrauterine fetal demise. Reduced carbohydrate intake, increased snacking and decreased quantity of meals are some common solutions to maintain blood glucose levels.
Pregnancy-Induced Hypertension
Eclampsia/preeclampsia and gestational hypertension both fall under pregnancy-induced hypertension (PIH). Gestational hypertension is marked by a blood pressure of 140/90 while eclampsia is defined by a blood pressure of 140/90 with huge quantity of protein passed during urination. Fetal death is often common in women with eclampsia. Preeclampsia is more dangerous with systolic and diastolic blood pressures of 160 and 110mm Hg respectively. The mother-to-be is impacted drastically in the form of liver impairment, renal disorder, cerebrovascular events and retinal damage in preeclampsia. Magnesium intake is recommended to treat eclampsia/preeclampsia.
Carbohydrate intake constitutes about 35% of the calorie intake daily. Fiber in the form of whole grains, fruits, leafy veggies (particularly those rich in iron and folic acid) and nuts is highly recommended. Lipids, like energy, should be consumed in accordance with the energy requirements.
Vitamins
Some vitamins are acquired through diet and others through supplements to have significant effect on pregnancy. Folic acid for placental growth and to prevent NTDs, choline for cell membrane integrity and nerve impulse transmission, vitamin D for calcium balance, vitamin B6 to manage severe nausea and vomiting during pregnancy and vitamin K for bone health are very much essential during pregnancy for maximum outcome. Vitamin A, E, K and ascorbic acid are also needed for fitting pregnancy outcome.
Minerals
Calcium, phosphorus, sodium, magnesium, copper, fluoride and iodine in nominal quantity are required by the expected mother-to-be. Women, especially pregnant women rarely have self-sufficient amounts of iron content to cover their physiological needs during pregnancy. Hence iron supplementation has become a norm during pregnancy to prevent anemia. Zinc supplements are equally important for normal infant weight.
Guide for Eating During Pregnancy
- Calcium intake in any form of milk is mandatory. Some non-dairy milks have no vitamin D content which must be compensated with supplements.
- Drink 8 to 10 glasses of fluid, mainly water, daily.
- Alcohol must be totally avoided during pregnancy for a healthy baby.
- Limit the intake of caffeine and artificially sweetened products.
- Avoid overeating or avoiding a particular food due to craving or aversion.
Complications of Pregnancy with Dietary Implications
Nausea and Vomiting
The first thing we relate with pregnancy is nausea and vomiting. Morning sickness or nausea and vomiting in pregnancy (NVP) is present in 50% to 90% of pregnant women during the first trimester and subsides by the 17th week. The sad thing is that no cure is available for this phenomenon. Eating dry crackers and ginger ale, smelling lemons and consuming foods rich in protein can reduce nausea and vomiting.
Gastric esophageal reflux or heartburn as commonly known is common among pregnant ladies during the latter semesters and occurs often at night. Eating small meals at frequent intervals can reduce the impact of heartburn.
Constipation and Hemorrhoids
Inadequate water and fiber will lead to constipation in pregnant women. Straining when passing stools can lead to hemorrhoids.
Edema and Leg Cramps
Edema or swelling due to fluid accumulation in the extremities occurs in the third trimester. Reclining on one side removes the mechanical effect and the excess fluid is removed by increased urine output. There is no dietary intervention needed for this.
Diabetes Mellitus
Diabetes in pregnant women is dangerous as it may lead to prematurity and intrauterine fetal demise. Reduced carbohydrate intake, increased snacking and decreased quantity of meals are some common solutions to maintain blood glucose levels.
Pregnancy-Induced Hypertension
Eclampsia/preeclampsia and gestational hypertension both fall under pregnancy-induced hypertension (PIH). Gestational hypertension is marked by a blood pressure of 140/90 while eclampsia is defined by a blood pressure of 140/90 with huge quantity of protein passed during urination. Fetal death is often common in women with eclampsia. Preeclampsia is more dangerous with systolic and diastolic blood pressures of 160 and 110mm Hg respectively. The mother-to-be is impacted drastically in the form of liver impairment, renal disorder, cerebrovascular events and retinal damage in preeclampsia. Magnesium intake is recommended to treat eclampsia/preeclampsia.
A bouquet filled with cheer, happiness, good health, peaceful mind and positive attitude is what is vital for a healthy and safe pregnancy period. Please avoid lots of synthetic hormonal injections, unnecessary IUI and IVF procedures. God has created simple solutions. Let's adopt, follow, uphold, simplicity and simple uncomplicated solutions.
