Pregnancy Care

Pregnancy | March 28, 2018 | Author: Naturopath

pregnancy

Pregnancy Care

A healthy diet before and during pregnancy is not only crucial for the optimal development of the baby, as well as the health of the mother, but can also influence and “program” the baby’s future health and increase risk of chronic adult diseases.

One example is what is known as the ‘Dutch Winter Famine’: During the German occupation in 1944, babies of Dutch women who were exposed to famine in the first trimester of their pregnancy grew up to have higher rates of obesity and coronary heart disease than those born before and after the war.

The first trimester

Diet during the first trimester is particularly important, as it is the time where most dramatic growth and development happen. Inadequate nutrition in the first trimester can also put you at a risk of developing preeclampsia later in pregnancy. This is a condition that occurs only during pregnancy, and can lead to serious complications if not treated properly.

Role of specific nutrients

Pregnancy is a time of increased nutrient needs for the mother. It is especially important to consume adequate amount of the following nutrients:

Omega-3 fatty acids

Omega-3 fatty acidsOmega-3 is a type of polyunsaturated fat that cannot be made by the body and therefore must be obtained from the diet. These fatty acids are crucial for development of the brain and central nervous system. Consumption of omega-3 fatty acids during pregnancy has been linked to many health benefits for mother and baby, such as:

  • Higher IQ in children
  • Reduced risk of premature birth
  • Reduced risk of post-partum depression
  • Reduced the risk of asthma and lower respiratory tract infections in the offspring  

Fish and fish oil is the best source of omega-3 fatty acids; however, vegetarians can obtain omega-3 from flaxseeds, canola oil, soybean, walnuts, and dark leafy vegetables. 
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How much omega-3? The requirements during pregnancy have not been established,

Iron

Iron deficiency during pregnancy can increase the risk of preterm birth, low birth weight and post-partum haemorrhages.

Animal sources of iron are better absorbed than those from plants. They include red meat, poultry and fish. Plant sources of iron include dark green vegetables (spinach, kale, Swiss chard), legumes (peas, beans and lentils), dried fruit, (raisins, apricots, figs), nuts and seeds.
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How much iron? The requirement for iron is greatly increased in the second and third trimesters, and the recommended daily intake for pregnant women is 27 mg/day of iron.

Iodine

Iodine is key component of thyroid hormones. As thyroid activity is increased in pregnancy, so do iodine requirements. Severe iodine deficiency in women who are pregnant or lactating can lead to miscarriages and to a condition in their infants called cretinism, of severe physical and mental retardation. In fact, iodine deficiency is the world’s greatest single cause of preventable brain damage, mainly in countries in central Africa, South East Asia, and the Middle East.
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How much iodine? Taking too much iodine can be harmful. The estimated amount to avoid deficiency during pregnancy is 220 µg/day.

Calcium

CalciumCalcium is critical for bone health. Increased intake of dietary calcium during pregnancy appears to benefit bone health of the baby. The majority of foetal bone is gained during the last trimester of pregnancy, but most of the calcium is transferred from the mother’s skeleton to the fetus beginning around week 20 of the pregnancy. Moreover, reduced calcium intake is associated with preeclampsia.

Dairy products are a rich source of calcium, but certain vegetables also provide calcium, such as broccoli, bok choy, cabbage, kale, as well sardines, tofu, and fortified cereal.

How much calcium? The recommendations for pregnant women are 1000 mg/day.

Vitamin D

Vitamin D plays a role in development and maintenance of bone health by promoting absorption of calcium. Deficiency of vitamin D in pregnancy can result in reduced bone mineral density of the offspring. Deficiency has also been linked to increased risk of developing preeclampsia and gestational diabetes. 

Vitamin D is synthesised by the human body through exposure to UVB radiation from sunlight. Vitamin D can also be found naturally in very few foods, including fatty fish, cod liver oil, and egg yolk.
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How much vitamin D? Supplementation with vitamin D is recommended for pregnant women at a dose of 5.0 µg/day. Pregnant women who receive regular exposure to sunlight do not require supplementation.

Folic acid

Folic acidFolate is a B vitamin that occurs naturally in food. Folic acid is the synthetic form of folate that is found in supplements and fortified foods. Folate is essential for foetal development and deficiencies can result in:

  • Pre-term birth/low birth weight/foetal death
  • Down Syndrome
  • Neural tube defects
  • Cleft palate
  • Cognitive difficulties

Food sources of folate include leafy green vegetables, citrus fruit, beans, enriched whole-grain breads and bread products, and fortified breakfast cereals

How much folic acid? Folic acid supplementations have long been recommended before and shortly after conception for the prevention of neural tube defects, such as spina bifida. These birth defects occur in the first month of pregnancy, often before a woman even knows that she is pregnant. For protection against neural tube defects, folic acid supplements should be taken in the month preceding conception at a dose of at least 400 mcg/day, and at a dose of 600 mcg/day during pregnancy.

Do I need to “eat for two”?

You do not need to eat for two, even if you are expecting twins, but you do need to increase your energy (calorie) intake. According to the National Health and Medical Research Council the average extra requirements for pregnancy are:

  • 1st trimester - No additional requirement
  • 2nd trimester - Additional 1.4 MJ/day
  • 3rd trimester - Additional 1.9 MJ/day

The Australian Dietary Guidelines: helpful hints for healthy eating during your pregnancy  

1. Steady weight gain during pregnancy is normal and important for the health of the mother and baby. However, it is also important not to gain too much weight.

The Australian Dietary Guidelines: helpful hints for healthy eating during your pregnancy  2. Choose foods from the Five Food Groups:

  • Vegetables and legumes
  • Fruit
  • Grain
  • Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans
  • Milk, yoghurt, cheese and/or alternatives, mostly reduced fat. Enjoy a variety of fruits and vegetables of different types and colours.

3. Increase your grain consumption to 8–8½ serves a day – mostly wholegrain. 

4. Choose foods high in iron, such as lean red meat or tofu

5. Make a habit of drinking milk, eating hard cheese and yoghurt, or calcium enriched alternatives. Reduced fat varieties are best.

6. Enjoying a wide variety of vegetables, legumes, fruit and whole grains and drinking plenty of water every day can assist with constipation - a common occurrence during pregnancy.

7. Limit discretionary foods and drinks high in saturated fat, added sugars and added salt such as cakes, biscuits and potato chips.

9. Prepare and store food safely.

Food to avoid during pregnancy

  • Fish high in mercury. Food Standards Australia New Zealand recommend consuming no more than one serve (100g cooked) per fortnight of shark/flake, marlin or broadbill/ swordfish, and no other fish that fortnight, or one serve (100g cooked) per week of orange roughy (deep sea perch) or catfish and no other fish that week
  • Raw, uncooked seafood or ready-to-eat chilled peeled prawns.
  • Raw meat, poultry and eggs. Including homemade mayonnaise, aioli, chocolate mousse, cake batter, pancake batter, all may include raw eggs.
  • Stuffing from chicken or turkey.
  • Processed meat (ham, salami, cold chicken or turkey, etc.)
  • Liver and pate
  • Unpasteurised milk.
  • Soft and semi-soft cheese, eg, brie, camembert, ricotta, fetta, blue etc
  • Soft serve ice cream
  • Store-bought sushi
  • Pre-prepared or pre-packaged salads including fruit salad, eg. from salad bars, smorgasbords.
  • Unwashed fruits and vegetables
  • Sprouts. Alfalfa sprouts, broccoli sprouts, onion sprouts, sunflower sprouts, clover sprouts, radish sprouts, snow pea sprouts, Mung beans and soybean sprouts.
  • Alcohol. Alcohol puts you at a higher risk of miscarriage and stillbirth.
  • Avoid excess caffeine. Caffeine can cross the placenta, and the effects on your baby are unclear. 

Can I have a healthy vegetarian or a vegan pregnancy?Can I have a healthy vegetarian or a vegan pregnancy?

Vegans and vegetarians can still get all the nutrients they need from a varied, balanced, and well-planned diet. However, the might be at risk of iron and vitamin B12 deficiencies, and need to include fortified and supplements to make sure they are getting enough.

Do I need to take vitamin supplements?

Prenatal formulas: it is always best to get vitamins and minerals from the food you eat; however, studies suggest that taking prenatal multivitamin/mineral supplements during pregnancy can help improve nutrient status of mothers and reduce risk of delivering low birth weight babies.

Do not take any supplements containing vitamin A.

The bottom line

Nutritional status and lifestyle choices, not only during all stages of pregnancy, but also preconception, can have a profound impact on fertility and future offspring health.
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References

Bisgaard, 2016. Fish Oil–Derived Fatty Acids in Pregnancy and Wheeze an. N Engl J Med, 26375, pp.2530–9. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1503734

Cetin, I., Berti, C. & Calabrese, S., 2010. Role of micronutrients in the periconceptional period. Human Reproduction Update, 16(1), pp.80–95. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19567449

De Boo, H.A. & Harding, J.E., 2006. The developmental origins of adult disease (Barker) hypothesis. The Australian and New Zealand Journal of Obstetrics and Gynaecology, 46(1), pp.4–14. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16441686

Food Authority - NSW Government, 2016. Foods to eat or avoid when pregnant. Available at: http://www.foodauthority.nsw.gov.au/foodsafetyandyou/life-events-and-food/pregnancy/foods-to-eat-or-avoid-when-pregnant

Ganpule, A, et al. 2006, ‘Bone mass in Indian children--relationships to maternal nutritional status and diet during pregnancy: the Pune Maternal Nutrition Study’, JClin Endocrinol Metab. Vol. 91, no. 8, pp. 2994-3001

Helland, I.B. et al., 2003. Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lactation augments children’s IQ at 4 years of age. Pediatrics, 111(1), pp.e39-44. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12509593

Magnusardottir AR, Steingrimsdottir L, Thorgeirsdottir H, Hauksson A, Skuladottir GV. Red blood cell n-3 polyunsaturated fatty acids in first trimester of pregnancy are inversely associated with placental weight. Acta Obstet Gynaecol Scand 2009;88:91 –97.

Marangoni, F. et al., 2016. Maternal Diet and Nutrient Requirements in Pregnancy and Breastfeeding. An Italian Consensus Document. Nutrients, 8(10). Available at: http://www.ncbi.nlm.nih.gov/pubmed/27754423

Schulz, L.C., 2010. The Dutch Hunger Winter and the developmental origins of health and disease. Proceedings of the National Academy of Sciences of the United States of America, 107(39), pp.16757–8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20855592

Shah, P.S., Ohlsson, A. & Knowledge Synthesis Group on Determinants of Low Birth Weight and Preterm Births, 2009. Effects of prenatal multimicronutrient supplementation on pregnancy outcomes: a meta-analysis. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 180(12), pp.E99-108. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19506270

National Health and Medical Research Council. Healthy eating during your pregnancy. Available at: https://www.eatforhealth.gov.au/sites/default/files/content/The Guidelines/n55h_healthy_eating_during_pregnancy.pdf

National Health and Medical Research Council, 2017. Nutrient Reference Values for Australia and New Zealand. Available at: https://www.nrv.gov.au/dietary-energy

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