Nutrition in pregnancy deserves special attention as good nutrition is an important component of a healthy lifestyle and a healthy baby. The best time to review the nutritional status to make appropriate changes is prior to conception.
A very important time of fetal development is during the first several weeks of pregnancy, as all of the major fetal body systems are undergoing formation and rapid development. Many women may not even realize they are pregnant at this time. Therefore it is prudent to make lifestyle and nutritional changes several months before conception occurs.
Pregnancy is the only time in life of women when weight gain is not only desirable, but also encouraged. Weight gain should not be confused with being obese. There are multiple growth spurts of multiple organ systems that contribute to the normal weight gain. The recommended weight gain is about 11-14 kgs.
Extra 11-14 kgs translate into a requirement of additional 200-300 calories/day. This increases the average daily caloric intake from 2200 calories per day to approximately 2400-2700 calories per day.
Anemia remains a major cause of maternal & fetal morbidity, mortality and low birth weight. Too early, too close, too many and too late conceptions also adversely affect the health status (nutritional status) of the females. Another indirect important factor is gastro-intestinal infections, infestations, which are heralded further with under-nutrition, setting up a vicious cycle.
Important nutrients for pregnancy include:
- Vitamin D
- Vitamin A
- Omega Fatty Acids
- Essential amino acids from protein sources
Folate is needed to reduce the risk of neural tube defects, congenital heart defects, cleft lips, limb defects, urinary tract anomalies, preterm delivery, infant low birth weight and fetal growth retardation.
400 micrograms of synthetic folic acid daily from fortified foods and/or supplements has been suggested for all non-pregnant women, in order to have adequate folic acid intake even in cases of un planned pregnancies. Ideal is to start folate intake before conception occurs.
Certain foods are rich sources of folate, including leafy vegetables (spinach, asparagus, turnip greens, lettuce), legumes (dried or fresh beans, peas and lentils), egg yolks, baker’s yeast, fortified grain products (pasta, cereal, bread), breakfast cereals (ready-to-eat and others), sunflower seeds andLiver and liver products.
Pregnancy causes a surge in the volume of blood in the body; the expanded volume may go up by 50%. To meet the demands of the increased blood volume, iron requirements increase significantly. Iron is also required for the normal development of the growing baby and the placenta.
An additional 500-600 mg iron is required in pregnancy. If the patient is chronically anemic, her iron stores are already depleted. This necessitates an extra supplementation of 500 mg, thus total iron supplementation stands at 1000 mg.
Iron requirements in pregnancy go up from 18 to 27-30 mg per day. Because iron is not easily absorbed from the diet, it is recommended to take an iron supplements. Risk profile of an anemic mother includes:
a) Preterm birth
b) Low birth weight
c) Increased blood loss during and after labour
d) Depleted iron stores
Rich sources of iron include cooking in an iron skillet, fortified bread & breakfast cereals, red meat, soybean, poultry, spinach, lentils, beetroot, beans, jaggery and leafy vegetables.
Calcium is required during pregnancy because total calcium concentration falls in the body because of physiologic hypoalbuminemia. The placental produces 1,25-dihydroxyvitamin D, which results in increased intestinal absorption of calcium. Calcium is actively transported across the placenta to the fetus, facilitated by parathyroid hormone-related peptide.
This increased demand, if not met in the diet will lead to excessive calcium reabsorbtion from the maternal bones, resulting in osteoporosis. Calcium is involved in mineralization of bones and teeth, energy and cell production and electrolyte acid-base buffering. Fetal bone and teeth calcification primarily occurs in last 2-3 months. 2 cup full of milk daily, or equivalent, to supply 1200 mg calcium/1200mg phosphorous daily is required. Therapeutic calcium supplementation (1200mg/day) should be in the form of calcium citrate/calcium gluconate supplemented with Vitamin D.
Rich sources of calcium include dairy foods (milk, yogurt, cheese, cottage cheese), leafy & green vegetables (broccoli, spinach), fruits (oranges, bananas), beans and peas, peanuts, fish, corn, almonds and fortified foods.
Vitamin D helps the body to use calcium. It maintains blood calcium & phosphorous levels. Recent studies indicate increased risk of autism in infants with vitamin D deficiency.
Important sources of vitamin D include sunlight exposure, fish, milk, cereals, mushrooms and cod liver oil.
Vitamin A is needed for healthy growth but too much can cause birth defects. It helps in formation of Rhodopsin, essential for normal vision. It maintains normal skin health by switching on genes and differentiating keratinocytes (immature skin cells) into mature epidermal cells. It also regulates gene transcription and has anti oxidant action.
Important sources of vitamin A include liver, cheddar cheese, turkey, fish, melon, cod liver oil, eggs, dandelion Greens, apricot, carrots, papaya, broccoli leaves, mangoes, sweet potatoes, peas, butter, spinach, milk, pumpkin and tomatoes.
Omega Fatty Acids
Omega-3 fatty acids are fats commonly found in marine and plant oils. They are considered essential fatty acids, meaning that they cannot be synthesized by the human body but are vital for normal metabolism. Though mammals cannot synthesize omega−3 fatty acids, they have a limited ability to form the long-chain omega−3 fatty acids, including Eicosapentaenoic Acid, Docosahexaenoic Acid and α-Linolenic Acid.
DHA is important for development of the central nervous system in all mammals. There is an enormous growth spurt in the human brain during the last trimester of pregnancy and the first post-natal months, with a large increase in the cerebral content of Arachidonic Acid (AA) and DHA. The fetus and the newborn infant depend on a continual maternal supply of DHA and AA.
Amino acids serve as building blocks of proteins and are used in production of DNA, cell membranes, hemoglobin, receptors, enzymes, neurotransmitters, hormones, antibodies & other bio active molecules. They serve as body store of energy after fat stored in adipose tissues.
Pregnant women require about 71 grams of complete proteins each day. Some types of amino acid protein supplements contain only certain essential amino acids required by the body. If consuming amino acid protein supplements during pregnancy, choose those that contain all nine essential amino acids.