• Cara-Lee Compton

PART FOUR - Nutrition in pregnancy

A five-part series on nutrition and health,

by Jenna Selley

The first 1000 days of a baby’s life are considered to be the most important for establishing the foundation for optimum health, growth and neurodevelopment. This window of opportunity begins whilst the baby is in the womb up until about two years of age. While the brain develops throughout our lives, the most rapid period of growth period occurs during the third trimester. Proper nutrition during pregnancy and in early childhood can promote a baby’s learning, physical development and their immune system.


The nutritional needs of the mother increase as the foetus develops in her womb. Oxygen and nutrients are transferred via the mother’s blood, from her placenta to the foetus and through the umbilical cord.


In the first part of the blog, we discuss important nutrients for both the mother and baby during the gestational period (during pregnancy); followed by a look at how to cope with several symptoms that are so often caused by pregnancy: such as nausea/ vomiting, heartburn and constipation.

Eating a variety of fresh fruit and vegetables, lean meats, dairy, complex carbohydrates and healthy fats can provide the daily requirements of vitamins and minerals needed. It is important to strive for a balanced and healthy diet to best ensure the health of the mother and baby. Carbohydrates, protein and fat all play a role and should be carefully considered.

Carbohydrates: Are important to supply energy to the growing baby, as well as to help with breastmilk production.

Protein: Is important to optimise the baby’s development, build tissues, make hormones and enzymes, and establish the immune system.

Fats: (Especially Essential Fatty Acids- EFA) are important for brain and eye development for the baby, and for tissue and placenta growth for the pregnant mother.

Iron:

Iron is important for blood production, more specifically, for forming haemoglobin in red blood cells. In 2013, The World Health Organisation (WHO) estimated that 41.8% of pregnant women suffer from anaemia worldwide. At least half of those cases are due to Iron Deficiency Anaemia (IDA), the rest is possibly due to folic acid, Vitamin B12 or Vitamin A deficiency, chronic inflammation, inherited disorders of parasitic infections. Anaemia can cause tiredness and/or fatigue and possible complications and stress during labour. Iron supplementation for pregnant women is recommended in low and middle income countries. Studies show that women taking iron supplementation during pregnancy are also less likely to have low birth weight babies. Supplementation of folic acid is recommended to be taken with iron.

Daily recommended allowance: 14 – 50 years old: 27mg/d

Supplementation guideline: 30 – 60mg/d elemental iron

(30mg elemental iron= 150mg Iron Sulphate Heptahydrate/ 90mg of ferrous fumarate/ 250mg of ferrous gluconate)

Or Intermittent supplementation: 120mg on non- consecutive days (1 – 3x per week)

Food sources of Iron include: Liver Beans, Baked potato, Dark green leafy veg (i.e.: Spinach & Broccoli), Meat, Fortified cereals...

Folic acid:

Folic acid is a B Vitamin which helps to make DNA and RNA, the genetic material needed to grow tissues and cells, which is especially important in pregnancy and infancy. The WHO recommends the intermittent use of iron along with folic acid supplementation even in non-anaemic pregnant women in order to improve gestational outcomes and prevent developing anaemia1. Folic acid is not only helpful in preventing anaemia (specifically megaloblastic anaemia) but also preventing infants from defects affecting the brain and spinal cord (e.g.: Spina Bifida).

Studies show no significant difference between daily or intermittent supplementation of iron supplements with regards to maternal anaemia and risk of low birth weight babies.

Daily recommended allowance: 14 – 50 years old: 400µg/d1 - 600µg/d2

Or Intermittent supplementation: 2800µg (1 – 3x per week)

Food sources of Folic Acid include: Dark green vegetables (i.e.: Spinach & Broccoli), Chicken, Whole-grain products...

Vitamin A:

Vitamin A is important to the foetus, and thus the pregnant mother, for reasons such as organ and skeletal growth, cell division, the development of vision and eye health as well as strengthening the immune system.

Vitamin A supplementation may be suggested in the case of night blindness; however, a doctor should be consulted. Vitamin A deficiency affects around 19 million pregnant women a year. Studies have proven that Vitamin A supplementation reduced maternal night blindness with no effect on foetal and/or neonatal mortality and/or morbidity rates. However, an overdose in Vitamin A can lead to birth defects. Dietary diversity and consumption of fortified foods is encouraged in order to meet dietary requirements of Vitamin A.

Daily recommended allowance: 14 – 18 years old: 750μg/d

19 – 50 years old: 770μg/d

Food sources of Vitamin A include: Carrots, Green leafy vegetables, Sweet potato, Squash, Red bell peppers, Liver, Fish, Eggs...

Calcium:

Calcium plays many important roles in our body, including maintenance of nerves’ cell membrane, assisting muscle contractions, building strong bones and teeth, fluid balance within cells and even blood clotting. Some of these functions play a role in preventing preterm labour, reducing uterine muscle contractions and can possibly improve utero-placental blood flow.


Elemental calcium is recommended in a dosage of 1.5g – 2g/d, preferably taken with meals, for pregnant women at risk of low dietary calcium intake or at high risk of developing hypertension disorders during pregnancy. Hypertension during pregnancy (pre-eclampsia) usually occurs after twenty weeks gestation, which can cause reduced blood flow and thus reduced oxygen and nutrient supply to the baby. Calcium supplementation has shown to reduce the risk of pre-eclampsia for high-risk pregnant women who do not consume adequate amounts of calcium in their diet. However, other sources question this hypothesis, due to inconsistencies in research. Please consult a doctor before taking calcium supplementation. Excessively high doses of calcium may impair the absorption of zinc, iron, magnesium and phosphorus.

Daily recommended allowance: 14 – 18 years old: 1.3g/d

19 – 50 years old: 1g/d

Supplementation guideline: 1.5 – 2g/d

Food sources of Calcium include: Dairy products (i.e.: milk, yogurt and cheese), Dark green leafy vegetables ...

Vitamin D:

Vitamin D plays a major role in the maintenance of calcium and phosphorus blood levels. Vitamin D aids the absorption of calcium, thus preventing osteoporosis and loss of bone density (which could present as rickets). Vitamin D can be consumed orally or absorbed from exposure to sunlight. Vitamin D also regulates the immune system and neuromuscular system; as well as reducing the risk of high blood pressure for pregnant women.

Daily recommended allowance: 14 – 50 years old: 600IU/d

Food sources of Vitamin D include: Fortified foods (e.g.: Tofu, Soy milks and Soy yoghurt), Fish, Dairy...

Iodine:

Iodine assists in making thyroid hormones, which control body metabolism and proper bone and brain development during pregnancy and infancy. Iodine deficiency may compromise the development of the baby’s brain and nervous system.

Daily recommended allowance: 14 – 50 years old: 220μg/d

Food sources of Iodine include: Iodized salt, Iodine fortified foods, Fish (i.e.: Tuna and Cod)...


Vitamin C:

Vitamin C (ascorbic acid) plays a role in building, maintaining and repairing tissues; including skin, tendons, bones, cartilage, ligaments and blood vessels. Vitamin C also boosts the immune system (acting as an antioxidant), reduces the risk of high blood pressure and aids the absorption of iron. Vitamin C deficiency can impair the development of the foetal brain which cannot be reversed by supplementation after birth. A deficiency can also cause premature rupture of membranes (i.e.: premature labour). Vitamin C is a water-soluble vitamin which should be consumed daily. A pregnancy friendly multi-vitamin should be considered.

Daily recommended allowance: 14 – 18 years old: 80mg/d

19 – 50 years old: 85mg/d

Food sources of Vitamin C include: Citrus fruits, Strawberries, Chillies and Green leafy vegetables (e.g.: Spinach & Broccoli), Tomatoes, Potatoes...

Zinc:

Zinc promotes the production of antibodies (boosts the immune system), helps with wound healing and supports the functioning of metabolism. Zinc also helps with cell development and DNA storing. Although very rare, zinc deficiencies can present as hair loss, loss of taste, frequent infections and poor healing wounds. A deficiency can also lead to low birth weight in babies.

Daily recommended allowance: 14 – 18 years old: 12mg/d

19 – 50 years old: 11mg/d

Food sources of Zinc include: Oysters, Red meat, Poultry, Beans, Nuts, Whole-grain products...

Coping with symptoms such as nausea and/or vomiting, constipation and heartburn may be difficult during pregnancy. There are a few nutritional tips and tricks which are suggested to help cope with these symptoms.

(N.B.: If you suffer from or are at high risk of any medical conditions, i.e..: diabetes or hypertension, please consult your local doctor and dietitian).

Nausea and vomiting:

· Eat smaller meals more frequently throughout the day;

· Avoid very spicy or aromatic foods;

· Nibble of dry snacks (e.g.: rice crackers);

· Avoid fatty/ oily foods;

· Stay well hydrated;

· Avoid very concentrated and sugary foods;

· Rather eat foods which are at room temperature. Avoid having or combining very cold and very hot foods;

· Avoid lying down during or after eating; and

· Avoid exercise immediately after eating.

Constipation:

· Eat foods which are high in insoluble fibre. Insoluble fibre draws in water and adds bulk to stools, helping the stools to pass through the gut more easily. To best regulate the consistency of your stools it is always recommended to have a combination of soluble and insoluble fibre. Soluble fibre helps to lower blood cholesterol as well as blood sugar levels.

o Insoluble fibre: Whole-grain products, oats, root vegetables, beans, nuts and seeds, fruits (with edible seeds and skins)...

o Soluble fibre: Fruit, oats, peas, oats, legumes, many vegetables (e.g.: potatoes)...

· Drink an adequate amount of water daily;

o Aim for 6 – 8 glasses of water per day

· Avoid tea and coffee.

Heartburn:

· Eat smaller meals more frequently throughout the day;

· Avoid fatty, oily, spicy, sugary or highly concentrated foods and drinks;

· Avoid chewing gums;

· Avoid wearing tight fitting clothes or exercising immediately after eating;

· Avoid lying down during or after eating;

· Avoid caffeine and fizzy beverages.

And finally...


A few extra tips to give your baby the best chance of development and nutritional status after pregnancy includes:


· Breastfeed exclusively for the first 6 months of the baby’s life before you begin introducing complementary feeding (i.e.: introducing foods to your child);

· Try to breastfeed up to or beyond 2 years of the baby’s life;

· Expression and storage of breastmilk is encouraged if you are separated from your baby;

· Consume adequate amounts of Vitamin A (for women and children);

· Consume adequate amounts of iron (for women and children);

· Adequate intake of iodine.

These points were specifically identified by the World Health Organisation, in collaboration with UNICEF and BASICS, as the main focal points for nutritional and health interventions to prevent child mortality rates, improve mental, physical and developmental growth.

Bibliography:

1. World Health Organisation. Essential nutrition actions: improving maternal, newborn, infant and young child health and nutrition. WHO Press. Geneva: Switzerland; 2013. p. 41-6.

2. Mahan LK, Raymond JL. Krause’s food & the nutrition care process. 14th ed. Louis, Missouri: Elsevier; 2017.

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