Nutrition counselling is a cornerstone of prenatal care for all women during pregnancy. A woman’s nutritional status not only influences her health, but also pregnancy outcomes and the health of her unborn baby. It is important to eat a healthy, balanced diet when pregnant. A varied diet during pregnancy will give a woman’s body the nutrients it needs, while also helping her baby to grow and develop. The food pyramid gives guidance as to the food groups you should eat to help you achieve this balance. Eating regular meals with a variety of foods will help keep you healthy and strong.
The age of old myth of 'Eating for 2' is not true. The NICE guidelines for weight management in pregnancy is to partake in at least 30 minutes of moderate exercise per day during pregnancy, and that pregnant women should avoid dieting for weight loss during the pregnancy period. An additional 200 calories per day is needed in the final trimester of pregnancy only. Currently there are no formal evidence-based guidelines from the UK or Irish Government or professional bodies on what constitutes appropriate weight gain during pregnancy.
However, it is recommended that pregnant women eat a varied diet of foods to obtain vitamins and minerals, as they play important roles in all bodily functions. During pregnancy, women require additional folic acid and iron. A well-balanced diet should supply all of the other vitamins and minerals you need, although many women also choose to use pregnancy supplements.
Folic acid is the synthetic form of the naturally occurring B vitamin, folate. Folate requirements increase during pregnancy as a result of rapidly dividing cells related to the unborn baby’s growth. Folic acid supplements (400-800μg daily) taken prior to conception can reduce the risk for neural tube defects in the fetus. Neural tube defects result from incomplete development of the brain, spinal cord, or their coverings, such as spina bifida. Folate deficiencies have also been associated with megaloblastic anemia in pregnant women.
It is recommended for pregnant women to take a folic acid supplement containing at least 400mg of folic acid per day 12 weeks prior to conception and for the first 12 weeks of pregnancy. Pregnant women with certain medical conditions may need to take more, so please consult your health care provider if you are concerned about this. Folic acid is incorporated in most pregnancy vitamin supplements, and many foods including bread, cereal, and pasta are fortified with folic acid. However, it is also recommended that pregnant women consume folate-rich food sources such as citrus fruits, dark-green leafy vegetables and nuts.
Within the human body iron is used to make a substance called haemoglobin, which transports oxygen to organs and body tissues. During pregnancy, women require additional iron—approximately double the amount that a non-pregnant woman needs. This extra iron helps the body to make more blood to supply oxygen to the unborn baby. The daily recommended dose of iron during pregnancy is 27 mg and to help to meet these needs, pregnant women should aim to eat foods rich in iron at least twice a day.
There are two types of iron, haem and non-haem. Haem iron is easily absorbed by the body and can be obtained from red meats such as beef, lamb, mutton and pork. Non-haem iron is less-well absorbed by the body and sources include eggs, green leafy vegetables, pulses and fortified breakfast cereals.
During pregnancy if your blood tests show that you have low iron levels, your GP or midwife may prescribe a supplement for you to take. Common side effects of iron supplementation are stomach pain, constipation, nausea, and vomiting and are often reasons why women decide not to continue with them. Therefore, eating a variety of haem and non-haem sources of iron is clearly helpful.
Vitamin C helps the body to absorb iron, therefore eating foods rich in vitamin C at the same time as non-haem iron sources is advisable. Rich sources of Vitamin C include oranges, kiwis, strawberries and red peppers. Tea and coffee contain tannins which can reduce the amount of iron your body absorbs, therefore avoid drinking them with meals.
All women, including pregnant women, aged 19 years of age or older are recommended to consumer 1,000 mg of calcium daily; those aged between 14-18 years should aim for 1,300mg daily. Milk and other diary products, such as cheese, and yoghurt, are the best sources of calcium, however it is also present in broccoli; dark leafy greens and sardines. Calcium is used to build healthy bones and teeth and pregnant women are recommended to eat 3 servings of calcium rich foods per day. Low fat dairy products contain the same amounts of calcium as full fat versions.
Vitamin D is a fat-soluble vitamin primarily found in fortified milk or juice; natural sources include eggs and fish such as salmon. Vitamin D is often referred to as 'the sunshine vitamin' because our skin manufactures it when exposed to sunlight. Vitamin D is essential for appropriate bone mineralization and growth. Deficiency is common in pregnancy, especially in high-risk groups such as vegetarians, women who live in cold climates, and ethnic minority women with darker skin. Vitamin D works in conjunction with calcium to help the development of the baby’s bones and teeth. It also promotes healthy skin and eyesight. All women, including those who are pregnant, are recommended to get 600 international units of vitamin D a day. Food sources rich in vitamin D include oily fish such as salmon and mackerel, eggs and milk- which now has it added.
Vitamin A is essential for cell differentiation and proliferation in the unborn baby, as well as development of the spine, heart, eyes, and ears. Although most micronutrients are safe to consume in large amounts without adverse effects during pregnancy, vitamin A is one exception. Excessive doses of Vitamin A (>10,000 IU/day) have been associated with cranial- facial (face, palate, ears) and heart birth defects. It is important to note that the maximal supplement in pregnancy is 8000 IU/day.
Eating a wide variety of food from different food groups will help to ensure you maintain a balanced diet rich in the vitamin and minerals required to support your growing baby. Understanding which foods to consume and which supplements are helpful during pregnancy will support both you and your baby’s health throughout your pregnancy.