Eating good and healthy food is one of the best things you can do during pregnancy. Good nutrition helps you handle the extra demands on your body as your pregnancy progresses. The goal is to balance getting enough nutrients to support the growth of your fetus and maintaining a healthy weight.
As we all knows that, it’s very dangerous to eat twice (EAT FOR TWO, a popular saying quote) during pregnancy period but we should recommend you to eat twice along with healthy.
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During pregnancy, the basic principles of healthy eating remain the same — get plenty of fruits, vegetables, whole grains, lean protein and healthy fats. However, the below mentioned 9 nutrients in a pregnancy diet deserve some kind of special attention. Here’s what tops the list.
- Weight Gain
- Vitamins and minerals
- Folic acid
- Vitamin D
- Vitamin Bs (pyridoxine)
- Vitamin B12 (cyanocobalamin)
- Vitamin C (ascorbic acid)
- Vitamin A
- Vitamin E (tocopherol)
- Vitamin K
1. Weight Gain
Pregnant women require only a slight increase in energy, from 100 kcal per day during the first trimester to 300 kcal during the second and third trimesters.
Pregnant women require 10-15% more kilocalories than before pregnancy, especially during the last months of pregnancy. This amount of energy can be provided by only a small quantity of food; expectant mothers frequently overestimate their need for additional energy.
The recommended increase depends on the basal metabolic rate, lifestyle and physical activity. The main indicator is the increase in the body mass of the pregnant woman, which should remain within the recommended range of 10-16; this range is based on guidance from a German national consensus, the Nordic nutrition recommendations and the Institute of Medicine (USA).
The recommendations of professional associations and institutions, however, differ significantly. We were unable to analyse weight gain during pregnancy, the prevalence of overweight and obesity and the associated health risks in Latvia, as data are not available. The recommended range of weight gain is therefore based mainly on European national guidance with reference to the approach in the USA: the desirable weight gain depends on the BMI before conception.
Educational outreach and health promotion help in achieving a normal pre-pregnancy weight, which is important for fertility, a successful pregnancy and delivery and the future health of the offspring.
During pregnancy, it is important to consume the required amount of protein, the basic building block of maternal and fetal tissues. The amount of protein required during the first half of pregnancy is the same as that for non-pregnant women, 0.8-1.0g/kg per day or 10-15% of the energy required, and that during the second half of the pregnancy is 1.1g/kg per day, on the basis of the diet in developed economies. Pregnant adolescents require 1.5g/kg of protein a day.
The recommended sources of protein are dairy products with a reduced fat content, fish and lean meat; proteins of plant origin, e.g. legumes, nuts and seeds, are other sources, although their protein content is lower than that of animal products.
For example, 100g of cooked meat contain 25-35g of protein, 120g of fish contain 25-30g protein, one egg has 6g of protein, a slice of cheese has 15g of protein, and 100g of cottage cheese has 18g of protein, while 150g of beans contain only 15g of protein.
Carbohydrates are a source of energy for both the mother and the fetus. The amounts required are the same as those recommended for the general population (50-60% of energy).
Appropriate amounts of suitable carbohydrates help to control blood glucose levels and provide protection against ketosis. The recommended sources of carbohydrates are wholegrain products and potatoes, which should be boiled or baked and not deep-fried or fried.
Consumption of sugar should be limited and should not exceed 5% of energy intake or 25 g (five teaspoonfuls). Excess sugar increases the risk for obesity. Expectant mothers should avoid sweetened soft drinks, which increase the risks for preeclampsia and premature birth.
Fats are an integral part of the diet and a source of energy; they are also required for numerous metabolic processes. Expectant mothers need not change their intake of fats. The recommended amount is 30% of the total energy consumption.
The choice of fats, however, is vital. Both w-3 fatty acids — eicosapentaenoic and docosahexaenoic acids — are required for the development of the fetal brain and retina, and they reduce the risk for premature birth, the child’s future risk for cardiovascular diseases and the risk of the mother for perinatal depression. @-3 fatty acids are especially important during the second and third trimesters.
The recommended amount of docosahexaenoic acid is 200-300 mg/day, which can be ensured by two servings (150-300 g) of fish a week, of which one should be oily fish (e.g. herring, trout, salmon, sardines).
Attention should be paid to the choice of fish and the way it is cooked: fish should be broiled, steamed or oven-baked, and salty, pickled, cured or smoked fish is not recommended. Overconsumption of fish may lead to excessive intake of mercury, which can damage the child’s nervous system. The amount of mercury depends on the type of fish (large oceanic fish contain more mercury) and the geographical region.
If a woman does not eat fish, she should choose an w-3 fatty acid of plant origin, e.g. a-linolenic acid, which is found, for example, in ground linseed and hemp.
Only part of a linolenic acid is converted to eicosapentaenoic and docosahexaenoic acids in the human body, however, and expectant mothers require w-3 fatty acid supplements. Fish oil supplements are not recommended because of their high vitamin A content, and foods that contain w-3 fatty acids, such as eggs and milk, are recommended.
The amount of saturated fats consumed in butter, cream, fat meat and palm oil should be restricted, and trans-fatty acids, which are frequently contained in partially hydrogenated vegetable fats often used in dairy and confectionery products, should be excluded.
The required intake of fibre in Latvia is 30-35 g. Fibre is required to prevent constipation and thus reduce the risk for haemorrhoidal vein disease; it also reduces the risks for gestational diabetes and preeclampsia. Furthermore, fibre-rich products contain minerals, vitamins and other biologically active substances.
The main sources of fibre are wholegrain products (e.g. wholegrain bread, porridge or pasta), legumes, dried and fresh fruit, vegetables, nuts and seeds. In Latvia, cereal products are the main source of fibre, the most common one being rye bread. Additional bran should be taken only on professional advice, as it tends to decrease the uptake of iron, calcium and other minerals and contributes to intestinal obstruction.
The required quantity can be absorbed in a balanced diet.
6. Vitamins and minerals
The requirements for vitamins and minerals in pregnancy are much higher than that for extra energy; therefore, expectant mothers should pay attention to the quality of the food they eat and balance their diet.
Most women require additional nutrients only after the fourth month of pregnancy, but the intake of certain micronutrients, such as folic acid, iodine and iron, is vital before conception and during early pregnancy.
- Folic acid
- Vitamin D
- Vitamin Bs (pyridoxine)
- Vitamin B12 (cyanocobalamin)
- Vitamin C (ascorbic acid)
- Vitamin A
- Vitamin E (tocopherol)
- Vitamin K
a) Folic acid
Folic acid is required for maternal erythropoietin, DNA synthesis, growth of the placenta and the development of the fetal spinal cord during the first month of pregnancy. Notably, the neural tube closes during weeks 3-4 of pregnancy when women are often unaware that they are pregnant. In most cases, the required amounts of folates cannot be supplied from food alone. (Folic acid and folates have a similar chemical structure; “folic acid” refers to synthetic supplements, while food products contain “folates”.)
An intake of 400 pg/day of folic acid reduces the risk for neural tube defects; therefore, women of reproductive age should make sure that their daily intake is at this level. Women who are planning pregnancy should start taking folic acid supplements before pregnancy in order to reach a stable level by the time of pregnancy, and they should continue supplementing their diet at least until the end of week 12 of gestation.
It is recommended that the intake of women at high risk (a history of spina bifida, diabetes mellitus, malabsorption syndrome, coeliac disease, use of anticonvulsants) should be 4 mg/day. Smokers, alcohol abusers and women who have regularly taken oral contraceptives or triamterene and trimethoprim as diuretics are at higher risk for folic acid deficiency or deficit.
Women who take multi-vitamin supplements should check the folic acid content. The foods eaten should be rich in folates. The main dietary sources of folic acid are green-leaf vegetables (broccoli, spinach, Brussels sprouts, cabbage, salad leaves), bovine liver, legumes (lentils, beans and peas), beetroot, oranges and tomatoes. Fresh, uncooked vegetables should be eaten daily, as folic acid is unstable to heat.
b) Vitamin D
Most vitamin D is formed in the skin when exposed to solar radiation or is absorbed with food. Spending time outdoors is important for vitamin D formation. Depending on the skin type, an adequate dose of vitamin D can be obtained by spending 5-10 min in the sun in the middle of the day with the face and arms uncovered and without sunscreen.
In summer (April- September), two to three exposures a week for 20-30 min should ensure an adequate vitamin D level.
Fish is the main food source of vitamin D; the amount derived from dairy products is insignificant. Mushrooms (especially boletus) contain considerable amounts of vitamin D, but they can hardly be considered part of the daily diet. Measurement of 25 (OH) D vitamins in serum gives a more accurate indication of the vitamin D required, but such testing is not recommended as routine practice in every pregnancy.
In autumn and winter (October—March), additional vitamin D should be taken at 800-1000 IU/day. Women, who spend little time outdoors, do not eat fish, have a BMI > 30 kg/m? or have a dark skin are at risk for vitamin D deficit.
Lodine is vitally important; it is required for the synthesis of maternal thyroid hormones, which, in turn, are essential for the development of the fetal central nervous system. An adequate intake of iodine should thus be assured before conception and during pregnancy and lactation. Thyroid hormones are necessary for programmed, coordinated development of the child’s central nervous system and cognitive and behavioral development; therefore, iodine deficit is one of the preventable causes of developmental and mental disorders.
The fetus is most susceptible to iodine deficit during the early stages of pregnancy. If iodine supplementation is given only after the first antenatal visit (ninth week), it is too late to ensure the best possible outcome of the pregnancy. To ensure an adequate intake of iodine before conception, women of reproductive age should have a sufficient daily intake. The daily intake of iodine before conception and during pregnancy and lactation should be 150-250 ug, which can be supplied by vitamin formulations with potassium iodide as the active ingredient.
The maximum dosage allowed for pregnant and lactating women is 600 g/day; a dosage > 1100 g/day is deemed unsafe. The dosage should be adjusted for women with a thyroid disorder, in consultation with an endocrinologist. Intake of iodine with food depends on the iodine levels in food and soil, the use of iodine disinfectants in the food industry and use of iodine-containing fertilizers in agriculture. The main sources of iodine in the diet are fish, seafood and dairy products.
Use of iodized salt in cooking food at home is important, as it is added to only a small proportion of processed foods in Latvia. For most pregnant women, the intake of iodine from food is insufficient: iodized salt, consumption of seafood twice a week and dairy products generally provide up to 100 yg/day; therefore, an additional 100-150 ug of iodine are required, which should be taken as supplements.
Complex supplements containing folic acid and iodine are available for use when planning a pregnancy. An expectant mother who is already taking multivitamin supplements that contain the required amounts of iodine does not require additional supplementation.
Seaweed and algae supplements are not recommended during pregnancy, as they might result in an overdose of iodine, with a negative impact on thyroid function. Exclusively breastfed children receive an adequate supply of iodine if the mother’s intake is adequate.
The requirement for iron increases during pregnancy, especially during the second half, when the volumes of blood and erythrocytes increase and the fetus and placenta require more iron. Furthermore, absorption of iron increases considerably during pregnancy, as there is no loss of blood through menstruation. It is important to ensure that the intake of iron from food is sufficient during pregnancy.
The capacity for iron absorption depends significantly on the type of food, other foods eaten at the same time and physiological requirements.
Haem iron is the form that is best absorbed and lean red meat and fish should be eaten regularly. Although foods of plant origin, including wholegrain products and vegetables, also contain large quantities of iron, its bioavailability is much lower.
Vitamin C significantly increases the uptake of iron (from e.g. citrus fruit juice), while fermented and non-fermented tea, coffee, wholegrain products and products rich in calcium decrease uptake. Therefore, it is important to avoid eating iron-containing food at the same time as food that delays iron absorption; a 2-h interval should be observed.
Plasma ferritin levels should be normal before conception and during pregnancy. lron-containing supplements should be used if the iron reserves are insufficient, which may result in reduced hemoglobin production; anemia, in turn, is associated with lower immunity and higher risks for infectious diseases, less productivity, cognitive disorders and emotional stress in the postnatal period, higher risks for maternal mortality, premature delivery and low birth weight, as well as placental abruption and blood loss after delivery.
The fetus is relatively well protected against iron deficiency due to transporter proteins in the placenta. Nevertheless, maternal iron deficiency is associated with a greater frequency of iron deficit anemia in the newborn by the age of 3 months, with delayed psychomotor and/or mental development.
This may have a negative effect on social and emotional behavior and possibly be linked with disease later in life. Preventive use of iron supplements is not advised in every pregnancy, as excessive iron can have negative consequences. Supplements should be taken only if indicated.
The fetus accumulates 30 g of calcium during pregnancy, 25 g of which are stored in the skeletal system. Calcium requirements increase during pregnancy; however, the body naturally absorbs increasing amounts by physiological processes, and the amount recommended during pregnancy is similar to that required by the general female population: 1000mg. As the bioavailability of calcium depends on vitamin D, sufficient supplies of this vitamin are vital.
Pregnant adolescents and women who have several consecutive pregnancies require more calcium (1300 mg). Dairy products, including milk, kefir, buttermilk, fermented milk products, yoghurt, cheese, cottage cheese and milk powder, are the main sources, as the calcium they contain is readily bioavailable.
A glass of milk, kefir or yoghurt, a slice of cheese or 200 g of cottage cheese contains about 300 mg calcium. As yoghurt often contains added sugar, natural yoghurt should be chosen. For women with lactose intolerance, calcium-enriched oats, almonds and soya milk are recommended. Other sources of calcium include small bony fish, almonds, legumes, broccoli and pumpkin seeds.
f) Vitamin Bs (pyridoxine)
Vitamin BG participates in amino acid metabolism and is also a catalyst in reactions such as the production of neurotransmitters. Vitamin BG helps to reduce nausea and vomiting.
The main dietary sources are meat (beef, pork and chicken), fish (tuna, salmon), legumes, oats, bananas, plums, avocado and potatoes. No supplementation is required during pregnancy.
g) Vitamin B12 (cyanocobalamin)
Vitamin B12 is involved in various enzymatic reactions and is required for the synthesis of methionine and tetrahydrofolate. It is found only in products of animal origin: meat, especially beef (also liver, which is not recommended during pregnancy), milk, dairy products and fish (mackerel, herring and tuna).
Mussels and oysters contain especially large quantities of this vitamin. Vitamin Bi2 and folic acid are required for both the cognitive and motor development of the fetus. Vegans and expectant mothers who have undergone gastrointestinal surgery may suffer from vitamin By2 deficit and should take supplements; otherwise, no supplementation is required during pregnancy.
Choline is required for the integrity of cell membranes, nerve impulse transmission and methyl group synthesis. The main dietary sources of choline are pork, chicken, turkey, egg yolk and soya lecithin. The recommended dose of choline during pregnancy is 450 mg/day.
i) Vitamin C (ascorbic acid)
Vitamin C is an antioxidant and is required for the synthesis of collagen and for prevention of preeclampsia toxemia. During pregnancy, vitamin C is required at an additional amount of 10 mg/day, which should be supplied from the diet.
Good sources of vitamin C are cabbage, tomatoes, paprika, broccoli, strawberries, pineapple, citrus fruit, blackcurrants and kiwi.
j) Vitamin A
Vitamin A is required for the development of the skin, mucous membranes (including those of the gastrointestinal and respiratory systems), skeletal system and teeth and for visual and immune functions. While vitamin A deficit is undesirable, excessive amounts (3000 pg or 10 000 IU of vitamin A) may be teratogenic.
Women who take medicine or food supplements containing vitamin A or retinol, such as fish oil supplements, should discontinue them before conception and throughout pregnancy. Vitamin A is found in foods of animal origin, e.g. fish, seafood, eggs, milk and dairy products, especially cheese.
Liver contains particularly high quantities of vitamin A and is therefore not advised during pregnancy. Certain foods of plant origin, such as pumpkin, carrots, red peppers, spinach, salad leaves and apricots, contain carotenes, which are pro-vitamins of vitamin A; they pose no risk during pregnancy.
k) Vitamin E (tocopherol)
Vitamin E is an antioxidant that ensures the formation and development of healthy cells in the fetus and protects pregnant women from toxins. Vitamin E enters the fetal circulation from maternal blood during the twelfth week of pregnancy. The recommended daily amount during pregnancy is 15 mg.
Some premature newborns may have a deficit of vitamin E, although this is very rare, and the potential toxicity of vitamin E during pregnancy is a more frequent concern, as it has been reported that intake of vitamin E above recommended levels is associated with complications during delivery and a risk for cardiovascular disease in the child.
Vitamin E is found in plant oils (olive, sunflower and rapeseed), wholegrain products, egg yolk, nuts and seeds (pumpkin, sunflower, sesame).
l) Vitamin K
Vitamin K is required for bone health and coagulation homoeostasis. A deficit of vitamin K during pregnancy may result in severe vomiting and Crohn disease, especially in women who have undergone gastrointestinal procedures. Dark-green leafy vegetables such as broccoli, various salads and spinach are rich in vitamin K; lesser quantities are contained in animal products, cheese and eggs.
Copper deficit may be teratogenic for the fetus, and a diet poor in minerals may increase the risk for anaemia. Seafood (oysters and crustaceans), wholegrain products, beans, nuts and animal offal contain large quantities of copper. Dark-green leafy vegetables and dried fruit are other sources.
During gestation, the fetus accumulates 1g/day of magnesium, and pregnant women should have sufficient quantities of magnesium to prevent leg cramps and preeclampsia. Nuts, wholegrain products and dark-green leafy vegetables are sources of magnesium.
During pregnancy, the maternal blood volume increases, resulting in a higher glomerular filtration rate, in which the water and electrolyte balance, is maintained by compensatory mechanisms. Strict reduction of sodium in the diet during pregnancy is not recommended, nor is use of diuretic agents.
It is advisable to cut down on salt in the diet and to use iodized salt. The recommended quantity is 1.5-2.3 g of sodium per day, equivalent to 4-5g of cooking salt.
This quantity of salt and an adequate volume of liquids ensure a sufficient blood volume for preventing dehydration and premature contractions. Most people consume significantly more salt than recommended, most of which is in food (added salt constitutes only a small part); therefore, it is recommended that the use of cooking salt during pregnancy be restricted.
As a deficit of zinc does not immediately trigger mobilization of zinc from the maternal skeletal system, zinc deficit sets in rapidly. This can result in congenital malformations and impaired brain development. Red meat, seafood and unrefined cereal products are dietary sources of zinc.
The volume of liquid required per day is 2—2.5 L, mostly in the form of water. The volume should be increased gradually as the pregnancy progresses and the expectant mother gains weight. During the last months of pregnancy, the volume required increases by 300 mL/day.
The volume depends on the body mass of the woman: the recommended amount of water (from both food and drink) is 35 mL/kg body weight per day and in no case lower than 1.5 L/day. More water is required in hot weather and during strenuous physical work. An adequate volume of water not only ensures the vital functions but also reduces the risks for urinary infections, urinary calculi and constipation.
Large quantities of caffeine restrict fetal development, and it is recommended that pregnant women not exceed 200 mg/day. The amount of caffeine in foods and drinks varies; however, two cups of coffee or four small mugs of tea contain 200 mg caffeine. Caffeine-containing energy drinks should be avoided during pregnancy.
Consumption of alcohol during pregnancy is harmful for the fetus. Children heavily exposed to alcohol antenatal may suffer from a number of physical and mental disorders before and after delivery and during their life course. They have a higher risk for impaired growth and may have neural disorders, resulting in serious learning and behavioral problems. Children exposed to smaller quantities of alcohol may develop similar but milder symptoms.
Professionals tend to disagree about whether drinking small quantities of alcohol during pregnancy harms the child. Although it has been demonstrated that heavy consumption of alcohol is associated with a high risk for the fetus, the “safe” dose of alcohol, which would not harm the child, has not been determined or standardized. There is evidence that consumption of more than one alcoholic drink per day during pregnancy increases the risk for premature birth and low birth weight. Therefore, the only “safe” level is complete abstinence during pregnancy and lactation.
The consequences of alcohol consumption depend on the period of the pregnancy. During the first 3 months, the risk for structural malformations is increased, whereas later, the risks for stunting and abnormal brain development increase.
Reduced IQ has been observed in genetically susceptible descendants even after consumption of small quantities of alcohol during pregnancy. Women who assume that small amounts of alcohol will not harm their child may tend to conceal their drinking, which may result in excessive consumption. Doctors should address this problem and clarify the patterns of use.
In the present state of knowledge and in view of the absence of a safe threshold for alcohol use, alcohol in any form or quantity should be excluded during pregnancy planning, pregnancy and lactation.