Pregnancy is often a time of great excitement, but it can also be a time of much anxiety. A common concern for many pregnant women is how eating can affect their pregnancy and the developing fetus. Pregnant women are often bombarded with much information about nutrition and their diets, some of which can be confusing, and in some cases very dangerous. Your obstetrician/ gynaecologist or other healthcare provider should be able to provide the pregnant woman with relevant information, but sometimes time restrains might make this difficult.
Nutrition and weight gain
Pregnant women are often advised to eat healthy and have a well-balanced diet prior to becoming pregnant and during pregnancy. How much weight gain is enough is often a common question from pregnant women. Weight gain in pregnancy is based on the pre – pregnancy body mass index. Pregnant women who are not overweight or obese should increase their caloric intake by a small amount (350-450 calories/d). Women with higher pre-pregnancy BMIs do not need to gain the same amount of weight as women with normal or low BMIs. All pregnant women are urged to gain weight gradually during their pregnancy, with most of the weight gained in the last trimester. When you are pregnant you might find that you are hungrier than usual, but you do not need to “eat for two” – even if you are expecting twins.
A healthy diet is an important part of a healthy lifestyle at any time but is especially vital if you are pregnant or planning a pregnancy. It is best to get vitamins and minerals from the foods you eat, but when you are pregnant you need to take a folic acid supplement, and some other nutrients, to make sure your developing fetus get everything he or she needs.
Prenatal vitamins
A variety of prenatal vitamins are available. It should be noted that except for folic acid, and possibly vitamin D and iron, it is unknown whether the other vitamin supplements improve or worsen the outcome of pregnancies.
Folic acid deficiency is associated with fetal defects (neural tubal). Women who do not consume at least 400-800 micrograms of folic acid daily should be advised to take folic acid supplementation from pre-pregnancy until the end of the first trimester. Women with a history of a fetal neural tube defect should take 4 mg of folic acid daily. Foods high in folic acid include leafy green vegetables, fortified or enriched cereals, beans, and citrus fruits.
Iron supplementation is often advised as a result of the risk of maternal anaemia at birth. If dietary iron is adequate (30mg/dl), and there is no anaemia, there is no known benefit to supplement iron in the absence of anaemia. To increase the absorption of iron, include a good source of vitamin C at the same meal when eating iron-rich foods. Foods with a good source of iron include meat, pigeon peas and fish. (Avoid excessive liver during pregnancy.)
Vitamin D deficiency is associated with several adverse outcomes in pregnancy, such as preterm birth, pre-eclampsia, but it is currently unknown whether supplementation improves outcome. It is felt that very few individuals in Anguilla have vitamin D deficiency.
Calcium – During pregnancy the recommended daily allowance of calcium for women age 19-50 years is 1,000 mg/d. Pregnant women with low calcium when given calcium have been shown to reduce the incidence of hypertensive disorders during pregnancy. Women should be sure to consume the recommended amount of calcium and this can be often achieved through their diet.
Good sources of calcium are: milk, yogurt, cheese, calcium-fortified juices and foods, sardines or salmon with bones, some leafy greens like kale.
Fish consumption
Various studies have shown fish intake is good for the developing fetus and lowered the risk of preterm birth in some pregnant women. It should be pointed out that fish is also a source of mercury exposure, and mercury can cause fetal neural damage.
Pregnant women are encouraged to eat two portions of fish a week, one of which should be oily fish such as salmon, sardines or mackerel. Various “pot” fish caught locally should be safe to eat as well.
Seafood such as swordfish, shark, king mackerel, marlin, and tilefish are high in levels of methyl mercury, and should be avoided during pregnancy.
Fruit and vegetables in pregnancy
All of us should eat lots of fruits and vegetables, but pregnant women are encouraged to eat plenty of fruit and vegetables because these provide vitamins and minerals, as well as fibre, which helps digestion and can help prevent constipation.
These pregnant women should eat at least five portions of a variety of fruit and vegetables every day – these can be fresh, frozen, canned, dried or juiced. Remember to always wash fresh fruit and vegetables carefully.
Healthy snacks in pregnancy
Pregnant women might notice that they get hungry between meals. Try not to eat snacks that are high in fat and/or sugar, such as sweets, biscuits, crisps or chocolate. Instead, choose something healthier, such as:
• small sandwiches with grated cheese, lean ham, mashed tuna, salmon, or sardines with salad.
• salad vegetables, such as carrot, celery or cucumber.
• low-fat, lower-sugar fruit yoghurt, plain yoghurt or fromage frais with fruit.
• vegetable and bean soups.
• a small bowl of unsweetened breakfast cereal, or porridge.
• fresh fruit.
Caffeine and pregnancy
Various studies on the effects of caffeine during pregnancy have given mixed results. Low to moderate caffeine intake in pregnancy does not appear to be associated with any adverse outcomes. In view of some negative effects in animal studies, pregnant women should probably limit their caffeine intake to less than 300mg/d (atypical 8-ounce cup of brewed coffee has approximately 130 mg of caffeine).
Raw and uncooked foods
In line with current recommendations, pregnant women should generally avoid uncooked fish and meat. They should also avoid undercooked meat and avoid unpasteurized dairy products to prevent Listeria infection.
Alcohol and pregnancy
High alcohol intake in pregnancy has been associated with fetal malformations and developmental delays including fetal alcohol syndrome. Although current data suggests that consumption of small amounts of alcohol during pregnancy (less than seven to nine drinks/week) does not appear to be harmful to the fetus, the exact threshold between safe and unsafe, if it exists, is unknown. Therefore, alcohol should be avoided in pregnancy.
Marijuana and pregnancy
Marijuana (cannabis) is used by some pregnant women. Studies of this illicit drug in pregnancy have been limited. Current recommendations are to avoid marijuana use in pregnancy as a result of concerns regarding fetal neurodevelopment.
Conclusion
Pregnant women are often bombarded by various information, and sometimes they are often confused. There is so much information on social media and the internet that it is often difficult for pregnant women to know what advice to follow. On the topic of nutrition and pregnancy, there is an abundance of information available. If you are going to use the internet, make sure the sources are from a reputable institution. You can then discuss this information with your obstetrician/gynaecologist or healthcare provider. What you eat just prior to pregnancy, and during pregnancy, can have significant effects on the pregnant woman and her developing fetus. Most recommendations – on nutrition and pregnancy are general recommendations and you and your healthcare provider should be able to individualize any recommendation so that you have a successful pregnancy and healthy newborn.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG is an Obstetrician/Gynaecologist and Family Doctor who has over thirty-five years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
