Diet in Pregnancy

Having a correct diet is crucial in every stage of life, especially during pregnancy where the diet plays a very important role, both for the mother’s and the baby’s health.

[1,3].

Generally the dietary recommendations for pregnant women are very similar to the normal recommendation for non-pregnant ones [4]. In particular it is important to have a healthy, balanced and varied diet that should be able to provide almost all the nutrients needed for both the mother and the baby.

The importance of maintaining a healthy weight before and during pregnancy

It is very important to get pregnant within a healthy weight range. In fact underweight and overweight mothers are more likely to have complications during pregnancy. The woman’s weight should be stabilized three months before the conception [2].

Due to the higher energy requirements during the last trimester of the pregnancy, women are advised to consume an extra of 200 Kcal daily during this period. However the best recommendation is to follow the appetite and monitor any weight gain regularly. A weight gain of 10-12.5 kg is recommended for women who have a normal BMI [2]. Women who gain an insufficient weight during pregnancy are more likely to have low birth weight babies. Instead women with an excessive weight gain are more likely to be overweight or obese after the delivery [3].

Which are some important dietary advises to follow during pregnancy?

• Eat a balanced and varied diet.
• Have breakfast daily to avoid eating excess snacks that are generally full of fats and sugars.
• Eat lots of fruits and vegetables (at least 5 portions a day are recommended). They are a good source of fibre that can help with digestion and prevent constipation. Furthermore they are rich in vitamins and minerals.
• Starchy foods are important sources of calories and fibre, helping to satisfy the appetite. Wholegrain products are advised instead of processed varieties.
• Having a good intake of protein (+ 6 gr of protein daily for pregnant women) is very important, especially for the formation of the new maternal and foetal tissues and organs. Pulses, meat, fish, eggs, nuts are all good sources of protein.
• Lean meats are advised, or remove any excess fat.
• Always ensure meat, fish and eggs are cooked thoroughly before consumption.
• Try to eat 2 portions of fish weekly [3]. Eating oily fish (no more than twice a week) such as salmon, mackerel and sardines is recommended. These fishes are rich in omega 3 that are essential fatty acids. They play an important role in the reduction of CVD (cardiovascular diseases) and are important for the development of the baby’s nervous system [3].
• Eat plenty of dairy foods because they contain important nutrients such as calcium.
• Consume plenty of iron rich foods to avoid suffering from anaemia.

Supplements

It is better to consume the vitamins from the diet rather than from the supplements. However, for folic acid and vitamin D a supplementation is recommended on the basis that the diet is unlikely to provide sufficient amounts of these vitamins.

In particular pregnant women should take:

• 10 mcg daily of VITAMIN D. Mothers should continue to take this supplement also after the delivery if they are breastfeeding.
• 400 mcg daily of FOLIC ACID, prior to the conception until the 12^th week of pregnancy.

Focus on vitamin D

Vitamin D is extremely important for the baby’s health because it influences the calcium and the phosphate homoeostasis and could help prevent your baby from developing rickets.

Beyond the supplements, mothers can improve their vitamin D intake by eating oily fishes, eggs, meats etc.

Focus on folic acid

Folic acid also referred to as vitamin B9, is extremely important both during the pre-conception period and during pregnancy. In particular it has been shown that a correct intake of folic acid can protect the baby against Neural Tube Defects (NTDs) such as spina bifida and anencephaly [3]. Beyond taking supplements mothers are also recommended to eat good sources of folate by consuming green leafy vegetables, oranges, brown rice, etc. Furthermore there are also some folic acid fortified foods such as certain breakfast cereals and some types of bread.

Women who are more likely to have a baby that could suffer from NTDs (e.g: family history for neural tube defects, previous pregnancy affected by neural tube defects etc.) are advised to take 5 mg of folic acid per day until the 12^th week of pregnancy.

Epileptic women should contact their GP because they could need a higher dose of folic acid.

Remember to do not take any supplements containing vitamin A because high levels of this vitamin can be very dangerous for the health and development of the baby.

Products to avoid during pregnancy

• Avoid liver due to its high content of vitamin A.
• Avoid all Pate types on the base that they can contain a dangerous micro-organism: Listeria monocytogenes.
• Avoid soft cheeses with white rinds (such as Camembert and Brie) and soft blue cheeses (like Gorgonzola, Roquefort) because they contain more moisture than hard cheese and they can be the ideal substrate for the growth of Listeria monocytogenes that can cause miscarriage, stillbirth and several illness to the new-borns [3].
• Avoid soft drinks and sweet beverages because they are full of refined sugars.
• Avoid alcohol:as it can affect the growth of the foetus. If you cannot avoid it completely the maximum dosage is 1-2 units once or twice a week [2]. Binge drinking must be avoided.
• Try to select pasteurized or UHT milk, because fresh milk can contain dangerous micro- organisms (e.g.: Toxoplasma gondii).
• Avoid eating saturated fats.
• Avoid eating raw fish, meat and eggs (e.g.: Raw poultry and eggs can contain Salmonella bacteria, raw meat can contain Toxoplasma gondii).
• Avoid eating shark, marlin and swordfish because they can contain heavy metals (especially mercury). For the same reason, try also to restrict your intake of tuna (no more than 2 steaks a week) [3].
• Try to not consume more than 200 mg of caffeine daily. High intakes of caffeine in fact can result in low birth weight babies and can increase the risk of miscarriage.
• Pay attention when eating foods like salami, Parma ham and, in general, cold cured meats, because they can contain parasites that are infected with Toxoplasma gondii.

Dieting is really discouraged during pregnancy. In particular it is linked with an increased risk of the baby suffering from neural tube defects and other complications [3].

Food safety and hygiene

• Always wash fruits and vegetables (even if you remove the skin).
• Wash the utensils, surfaces and hands before touching and cooking food.
• Store raw foods in the fridge separately from ready to use foods to avoid contamination.

Population with particular dietary requirements during pregnancy

There are some members of the population who during pregnancy, have a higher risk of not getting enough nutrients from their diet such as:

• Vegetarians and vegans - They can have difficulty meeting the requirements for certain nutrients from minerals and vitamins (in particular vitamin B12, riboflavin, iron, calcium and zinc). However careful meal planning could be sufficient to help them to meet their daily requirements. In particular they can be encouraged to use fortified foods or supplements.

• Adolescents - Adolescence is a very delicate and critical life stage, especially when a pregnancy occurs in this period. The dietary requirements of the adolescents are higher than normal adults for certain nutrients such as calcium. For this reason there can be a competition between the mother and the baby over certain nutrients. Additionally a lot of adolescences often do not meet the requirements for other nutrients such as iron, folate. Furthermore because a lot of pregnancies in adolescence are unplanned, folic acid is not taken before the conception. Finally a lot of psychological factors can play a very important role and can affect the pregnancy (e.g.: the desire to dieting). For this reason is really important to give advice and support to pregnant adolescences and to follow them in this delicate period of their life to guarantee their health as well the health of their babies.

Morning sickness

At the beginning of the pregnancy (first trimester), a lot of women suffer from morning sickness experiencing symptoms as nausea and vomiting, principally due to hormonal changes.

These are some tips to alleviate the symptoms:

• Have frequent and small meals every 2 hours.
• Eat foods rich in carbohydrates and low in fats because they are well tolerated.
• Avoid smells and foods that exacerbate the nausea.
• Try to eat and drink separately, as it can help reduce the nausea.
• Ensure adequate liquid intakes on the basis that dehydration can occur.
• Taking ginger supplements can help to manage this condition.

A good diet must be always accompanied with physical activity. If you do not have pregnancy related conditions, it is important to stay active and continue normal life activities. Partaking in regular exercise helps to maintain a correct weight during pregnancy and to stay fit and healthy.

Remember to not complete strenuous exercises but gentle exercises [5].