If you are pregnant, or if you are trying to fall pregnant, a good diet is a top priority. Good nutrition can have a big impact on your own health and the health of your unborn baby.
Calorie Requirements During Pregnancy
The energy required during pregnancy varies considerably from person to person. This reflects wide differences in the body’s energy needs and the amount of exercise performed. For most women, the extra calories required are not huge – only some 100 to 300 calories per day.
In women who substantially reduce their exercise, the need for extra calories may be minimal. Even towards the end of the pregnancy only 2400 calories daily are needed by the average woman (where 2100 calories daily are the average for non-pregnant woman).
While few extra calories are required during pregnancy, there is a greater demand for extra nutrients. It is important to choose nutrient-dense foods, and to avoid high fat, and calorie-dense foods such as biscuits, confectionery and soft drinks.
Vitamin/mineral supplementation, particularly of iron, folic acid and zinc is usually prescribed as a safeguard.
|Average Calorie Needs|
|(Average Activity)||Normal Weight||Overweight|
Extra 100-150 calories
(e.g. one large banana)
|2200 Cals||1800 Cals|
Extra 200-300 calories
(e.g. two crackers with cheese)
|2300 Cals||1800 Cals|
Extra 300 Calories
(e.g. one chicken sandwich)
|2400 Cals||2000 Cals|
Dieting During Pregnancy
While it is important to have healthy eating habits during pregnancy, it is not recommended that you attempt to lose weight. Losing weight places the health of the growing foetus at risk, particularly if the baby is of a low birth weight.
Further reasons for not strictly dieting during pregnancy include:
- Inadequate energy intake could ‘starve’ the foetus of nutrients, especially in the third trimester, and increase the risk of a low birth weight baby.
- Excessive weight loss can produce ketones, a by-product of fat breakdown, that may be detrimental to the baby’s development.
- The mother runs the risk of ill-health both during pregnancy and in subsequent years e.g. inadequate calcium will increase the risk of osteoporosis (brittle bones) in later years.
- Unbalanced nutrition during pregnancy can severely affect milk production during lactation. Adequate protein and energy is required for optimal growth of the mammary glands. Even adequate nutrition during lactation may not overcome the lack of mammary gland growth that occurred during pregnancy.
Special Nutritional Requirements
During pregnancy, nutrients are of vital importance as both the developing foetus and the mother have nutritional needs. It is important to ensure that your intake of vital nutrients is covered by a healthy diet. However, most pregnant women do not meet their nutritional needs through diet alone and find that a vitamin and mineral supplement is necessary.
There are many supplements designed specifically for pregnant women. Talk to your health care provider about the right supplement for you.
The following is a guide to some of the most important nutrients that may require supplementation:
Inadequate calcium intake during pregnancy can increase a woman’s risk of developing osteoporosis later in life. It is therefore important to ensure that your calcium intake is adequate throughout pregnancy and the period during which you are breastfeeding.
It is recommended that pregnant women have a calcium intake of 1200 mg per day.
You may find that you have an adequate calcium intake from your diet if you include two or more servings of dairy foods per day. However, you may require a supplement – discuss your needs with your doctor.
Folate is helpful in preventing neural tube defects (NTDs), such as spina bifida, in newborn babies. Seventy per cent of cases of NTDs can be prevented by women increasing their intake of folate to .5 mg per day at least a month before conception and in the first three months of pregnancy. The timing is essential because NTDs occur in the first few weeks of pregnancy, when the baby’s brain and spinal cord are forming.
Folate is a form of a water-soluble B vitamin. It occurs naturally in many foods. Folic acid is the synthetic version of folate and is found in supplements and fortified foods.
There are three ways of increasing your folate intake:
- Eat foods that are rich in folate.
- Include foods in your diet that have been fortified with folate, such as breakfast cereals.
- Take a folic acid supplement. Don’t rely on your normal multivitamin to provide the required daily amount of folate as most supplements only contain minimal amounts.
Good sources of folate include green leafy vegetables, fruits including citrus fruits, berries and bananas, legumes and some fortified cereals.
During pregnancy, extra iron is required for the increase in the mother’s blood volume and for the normal growth of the foetus and placenta. Since it can be difficult to get the recommended amounts of iron from food, a daily supplement may be prescribed. The extra iron promotes adequate stores in the mother’s body to be used during breastfeeding. An iron supplement may also be beneficial in combating fatigue.
Potential Food Hazards
During pregnancy, there are certain foods that should be avoided due to the health risks they pose to the developing foetus. The following is a brief guide to some of the potential food hazards. If you are concerned about any of the recommendations or your intake of any of the listed foods, please discuss your concerns with your doctor.
A mother’s excess alcohol intake during pregnancy can cause physical, mental or behavioural problems that can affect the child throughout his or her life. Studies have shown that consuming alcohol during pregnancy can harm the developing child’s brain and maybe even their DNA.
The most serious problems manifest in what is known as Foetal Alcohol Syndrome, or FAS. Children with FAS may experience the following problems:
- Small birth weight
- Difficulties eating and sleeping
- Problems with sight and hearing
- Have trouble following directions and learning how to do simple things
- Have trouble paying attention and learning in school
- Have trouble getting along with others and controlling their behaviour
- Need medical care throughout their lives
It is best to avoid alcohol throughout your pregnancy. Here are some points to consider:
- If you’re drinking alcohol, so is your baby.
- If you were drinking before you knew that you were pregnant, stop drinking now.
- If you’re planning to get pregnant, stop drinking alcohol now, as you may not know that you are pregnant straight away.
Alcohol in cooking: You can add some wine to your casserole or risotto, just make sure that the food is extremely well cooked. Cooking for an hour or more burns off the actual alcohol content but leaves the flavour intact.
Listeria is a bacteria found in some foods. Over the past ten years, the dangers of listeria have become more widely known. While incredibly uncommon, listeria can be very dangerous for pregnant women as the bacteria can be transmitted to the foetus. If the unborn child is infected with listeria, miscarriage, still birth, premature birth or a very ill baby can result.
Unfortunately, the symptoms of listeria can be difficult to recognise. In some cases, symptoms do not show up at all. The symptoms often resemble those of a bad flu or food poisoning, such as vomiting or diarrhoea, muscle aches and pains and headaches. It is difficult to test for listeria, although it can be treated with antibiotics once diagnosed.
Preventing listeria is easy if you avoid certain foods and handle food safely throughout your pregnancy. Use good food hygiene practices at home and be particularly vigilant in the foods you choose when eating out.
Here is a guide to some of the foods to avoid:
- Soft cheeses, such as brie, camembert and ricotta (these are safe if cooked and served hot)
- Takeaway cooked chicken, served cold, as used in chicken sandwiches or sushi
- Cold meats, including ham and salami
- Pre-prepared salads, such as coleslaw or pasta salad from the deli or a smorgasbord
- Raw seafood, such as oysters and sashimi
- Smoked seafood, such as smoked salmon or smoked oysters (canned smoked oysters are safe)
The listeria bacteria is killed by heat, so hot foods can be consumed. This means that you can eat ham on a pizza, if it is very hot. When you buy or are served hot food, make sure it is really hot. If you reheat leftovers, make sure they are steaming hot throughout.
Don’t eat food that is served lukewarm. It’s best to avoid places like smorgasbords or salad bars. If this isn’t possible, choose only steaming hot foods.
Here are some tips for good food hygiene:
- Always thaw frozen food in the fridge or microwave, not at room temperature.
- Keep raw meat covered and separate from ready-to-eat food. Don’t let the juices from raw meat drip onto other food.
- Wash your hands, knives and cutting boards after handling raw food to avoid cross-contamination with cooked or ready-to-eat food.
- Thoroughly cook all foods of animal origin.
- Keep hot food hot (above 60°C) and cold foods cold (at or below 5°C)
- Don’t let cooked foods cool down before serving
- Thoroughly reheat food until it is steaming hot
- Avoid unpasteurized milk or foods made from unpasteurized milk
- Use cooked foods, such as leftover chicken or meat, within 12 hours of cooking, or freeze
- Wash all fruits and vegetables thoroughly
- Follow label instructions on products that must be refrigerated or that have a ‘use by’ date.
- Keep the inside of the refrigerator, counter tops, and utensils clean.
Contact your doctor or local health authority for more information on listeria.
Mercury in Fish
There has been much controversy of late as to the mercury content of fish and the risks this may pose for pregnant women.
Unborn children who are exposed to mercury while they are still in the womb may experience subtle side-effects after they have been born – such as delayed development, particularly in walking and talking. The most dangerous time for exposure to mercury is in the third and fourth months of pregnancy.
For this reason, pregnant women (and women considering getting pregnant) are advised not to eat more than four servings of certain types of fish each week.
These fish are:
- Orange roughy
- Southern bluefin tuna
- Fish caught in geothermal waters
These fish are all large fish at the top of the food change. They tend to live longer and therefore have more time to accumulate mercury in their flesh.
All other types of fish and shellfish are safe, including canned tuna. For instance, pregnant women could eat as many as 119 servings (at 150 g each) of salmon, including canned salmon, per week before exceeding safe levels of mercury.
Eating a variety of fish is recommended, rather than sticking to one kind.
However – do remember that smoked salmon or smoked oysters, and raw fish such as sashimi or raw oysters are not recommended.
It’s also important to remember that fish is highly nutritious and that it contains helpful nutrients, such as omega 3 fatty acids. So, before considering excluding fish from your diet, note that fish is extremely good for you and your baby.
Omega 3 fatty acids function as building blocks in all cell membranes and also produce prostaglandins – hormone-like substances necessary for energy metabolism, cardiovascular and immune health. Omega 3s help keep hormone levels balanced and keep the skin and other tissues supple and healthy.
Eating a variety of fish during pregnancy may help to prevent high blood pressure and can help to enhance the baby’s brain development.
Food or Diet-Related Pregnancy Conditions
During pregnancy, your body undergoes major changes and many temporary conditions develop. Some of these conditions are related to the digestive system and can be eased with some changes to your diet.
Constipation is common during pregnancy. On the whole, your digestive system slows down, so the elimination of waste takes longer than usual. Stools can become harder, drier and difficult to eliminate. Constipation and straining when going to the toilet can contribute to haemorrhoids, another common condition that develops during pregnancy.
To avoid constipation, it is important to increase both your fluid intake and your fibre intake throughout the pregnancy.
Note that some iron supplements may also contribute to constipation, so speak to your doctor if you are taking supplements and constipation has become a problem for you.
Here are some hints for avoiding constipation:
- Breakfast is an important contributor to daily fibre intake. Eat high-fibre breakfast cereals, such as bran-based cereals, muesli or rolled oats. Add two or three tablespoons of unprocessed bran if required. Be patient – the full benefits of the increased fibre may not be evident for several weeks.
- Eat more wholegrain or wholemeal bread and less white bread. One slice of wholemeal bread has more fibre than three slices of white bread. Choose wholemeal pasta and brown rice.
- Eat fresh fruit, with the skin on where possible, rather than choosing fruit juice. Eat potatoes with the skins on.
- Eat more salads and vegetables – especially dried beans (even baked beans), avocado, broccoli, cabbage, carrots, celery, peas, tomatoes and lettuce.
- Add unprocessed bran to soups, gravies, stews, yoghurt, dessert, biscuits, cakes. Also, use wholemeal flour instead of white flour in your cooking.
- Drink eight or more glasses of fluid each day. Fibre absorbs many times its own weight in water. Your fluid requirements are greater during pregnancy anyway, so make sure you are drinking enough water or other fluids.
- Exercise regularly to strengthen the abdominal muscles and stimulate the gut. Walking and swimming are ideal.
- Avoid using laxatives. They can overstimulate the intestinal muscles and may make normal bowel activity impossible. See your doctor for more advice regarding laxatives.
A gradual increase in fibre is likely to be more comfortable for you than a rapid addition of large amounts of fibre. Note that excess fibre can interfere with the absorption of minerals such as calcium, iron, magnesium and zinc, which can upset the nutritional balance. Aim for between 30g and 40g of fibre per day.
Indigestion and Heart Burn
The uncomfortable and sometimes painful conditions heartburn and indigestion can occur during pregnancy. One of the main causes of this condition during pregnancy are hormonal changes that relax the valve between the oesophagus and stomach, allowing digestive acids to flow out of the stomach into the oesophagus, throat and mouth.
This can be very uncomfortable as the acids burn the sensitive lining of the oesophagus. The condition may be worse during the later stages of pregnancy as the uterus is taking up more space, compressing the stomach, and in general the digestion of food is slower.
Here are some tips to ease indigestion and heartburn:
- Stay upright as you digest. For many women, heartburn or indigestion is made worse at night when they lie down in a horizontal position. Try to eat your evening meal several hours before you go to bed, giving your body time to digest your food. Propping your bed up with a few pillows or books under the mattress may help you to stay more upright yet comfortable enough to sleep.
- Eat frequently. Have five or six small meals throughout the day instead of the normal three meals a day.
- Eat slowly. Take your time to chew properly and give your body time to digest.
- Avoid spicy and fatty foods. You may find that simple foods are more agreeable to you. Some foods, such as cabbage, chocolate, garlic, onions or caffeine may make the problem worse.
- Try to drink fluids between meals rather than with meals. You may find that sipping water helps.
- Check with your doctor regarding any antacids or medications that may be helpful for you.
Some women experience no morning sickness at all, while others feel sick morning, noon and night! For many women, the nausea and vomiting eases off by the end of the first trimester, yet for an unlucky few, morning sickness will continue throughout the whole pregnancy.
Strong smells can cause nausea, as can different foods. Experiment with your diet to find foods that you are comfortable with and try to eliminate those foods that make you feel ill. A food diary may help you in tracking foods and their relationship to your nausea.
Many women find that crackers, bread, lemonade or ginger tea help to ease the nausea. If you feel particularly ill in the morning, try having a small snack before you get out of bed.
Eat small, frequent meals and drink plenty of fluids. Try not to go for long periods without food as this may make the nausea worse.
Talk to your doctor if your morning sickness is severe and you are vomiting several times a day.
Gestational diabetes is a temporary form of diabetes which begins during pregnancy and usually disappears after delivery.
Any woman can develop gestational diabetes during pregnancy, though there are a number of strong contributing factors. These include:
- Family history of diabetes
- Having had a large baby previously
- Having had a stillbirth
- Having had a child with a birth defect
- Having too much amniotic fluid (polyhydramnios)
- Being older than 25 (small indicator)
Women who have gestational diabetes have a higher than normal potential of developing diabetes later in life (50-60 per cent if a healthy life style is not met) as well as further periods of gestational diabetes in future pregnancies.
If you are believed to be at risk for gestational diabetes, your doctor will recommend a test in the 26th to 28th week of the pregnancy.
Gestational diabetes can be managed by diet and exercise. If the condition is managed well, there is little risk to your baby. If not managed properly, gestational diabetes can result in a larger-than-normal baby and the baby may develop low blood sugar levels soon after it is born.
Children whose mothers had gestational diabetes are at higher risk for certain health problems:
- As babies, they are at higher risk for Respiratory Distress Syndrome (RDS), a disease that makes it hard for the baby to breathe.
- They are more likely to be obese as children or adults, which can lead to other health problems.
- They are at higher risk for getting diabetes, or high blood sugar, as they get older.