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 Pregnancy & Motherhood

March 2011
Nutrition for To-be Moms
Ishi Khosla
 
This special time in a woman’s life brings with it the need for special focus in diet, nutrition and eating patterns - some drawn from customs and traditional feeding practices, some from medical advice and some peculiar changes experienced by the woman herself.

What exactly are the nutritional demands for a healthy pregnancy needs to be understood. It is important to note that while a good diet goes a long way in meeting the increased demands during pregnancy, her nutritional status at conception is also important.

A woman who has adequate nutrient stores, particularly folic acid, has a healthy weight, does not suffer from eating disorders and does not indulge in substance abuse (smoke, alcohol abuse) can reduce the risk for maternal and foetal complications.

The Possible Problems
Maternal obesity can complicate pregnancy, delivery and increase the risk for high blood pressure, gestational diabetes etc. Meanwhile, being too thin also carries similar risks. However, the time to lose or gain weight is well before pregnancy and it is certainly not a good idea for obese pregnant women to diet. Anorexic or bulimic women need to be treated well before conception to give the mother’s body plenty of time to recover and prepare for pregnancy, birth and breastfeeding. According to researchers, maternal under-nutrition can strongly influence the development of degenerative problems like diabetes, heart disease and obesity later in life.

Recommendations for Optimum Health
Scientific recommendations require all women of childbearing age, not just pregnant women, to consume supplements of folic acid (400 micrograms) to prevent neural tube defect (spina bifida). While, it is important to get enough folic acid, it is also crucial to avoid getting too much Vitamin A during pregnancy as this can lead to birth defects.

Any woman, who might become pregnant, must not use drugs, which contain vitamin A like acne medications containing retinol or its analogues. However, getting abundant amounts of its plant version- beta-carotene through natural sources (vegetables and fruit) poses no risk, rather offers many health benefits.

‘Eating for two’ with respect to calories is a myth as energy needs during the first trimester are more or less similar to non-pregnant woman. During second and third trimesters, energy needs are increased by about 15% (300 kcal/ day) of a non-pregnant woman. A glass of skimmed milk provides roughly about 80 Kilocalories. Increased caloric requirements must be met through high-nutrient and high-fibre foods like whole grains (millets, whole wheat, wheat germ, amaranth, ragi and oats), nuts, dry fruit, eggs, fatty fish, skimmed milk, fruit and vegetables.

Proteins and Fats
Besides good quality calories, protein requirements are also increased marginally (15-20gms/day). A well-planned vegetarian diet including pulses, soy, dhal, sprouts, low-fat milk, yogurt, tofu, nuts and seeds should be able to meet this requirement. Non-vegetarian women should aim to include at least 1-2 servings of fatty fish, eggs and lean meats.

The choice of fat is crucial as the needs for essential fatty acids and some fat-soluble vitamins increase during pregnancy. The body also needs to store extra fat to support breastfeeding. Low fat diets are not recommended during pregnancy. Cold pressed oils, nuts, coconut, desi ghee and seeds are some of the good ways to meet increased fat needs. Pregnant women may consider intake of omega-3 fats prior to conception and throughout pregnancy to prevent pre-term delivery, promote easier births, assist in baby’s brain and eye health, and prevent post-natal depression. Good sources of omega-3 fats include walnuts, fish, seafood, flaxseeds, mustard seeds, sesame seeds and dark green leafy vegetables.

Vitamins and Minerals
There is an increased need for some vitamins and minerals, the most important being iron, calcium, folic acid, zinc and some B-vitamins. Good sources of iron include animal foods, especially organ meats (liver), poultry and fish, green leafy vegetables including cauliflower greens, mustard greens, radish leaves, amaranth (chaulai), lotus stem, black gram, sea weed, soybean and some dry fruit like dates and sultanas. Iron is absorbed 2-3 times more efficiently when taken with foods high in vitamin C including citrus fruit (oranges, lemon, guava), amla and some vegetables like tomatoes. Iron intake can also be increased by cooking foods in iron cast vessels. Increased calcium needs can be met by including low-fat milk and milk products, beans, soybean, tofu, dark green leafy vegetables (broccoli), sesame seeds and cumin. A cup of milk or yogurt provides about 300 mg of calcium (1/3 rd of the day’s requirement). To facilitate absorption of calcium, extra vitamin D is needed. Regular exposure (30 minutes/ day) to sunlight helps meet increased vitamin D needs. Good sources of folic acid include fresh orange juice, green leafy vegetables, wheat germ, nuts and seeds.

Supplements
So important are iron, folic acid and calcium that supplements are routinely prescribed by medical practitioners. Supplements of vitamin A and D must be avoided, as they can be toxic. Herbal preparations are also not recommended.

Vegetarian women, in addition should look at supplements of vitamin B12 and zinc under qualified practitioners. Women who are not exposed to the sun may discuss supplementation of vitamin D as well. In general, varied, well-planned vegetarian diets should meet other nutritional needs.

Wherever possible, pregnant women should prefer organic produce, particularly fats and oils.

Pregnancy No-no’s
Pregnant women should avoid alcohol, tobacco, artificial sweeteners and resort to moderate caffeine intake. Smoking, alcohol and drug use during pregnancy can have devastating effects on the foetus. Low birth weight, pre-term delivery and birth defects are known consequences. Foetal alcohol syndrome is a set of physical, mental and behavioural consequences of alcohol consumption during pregnancy.

Food cravings and aversions are common during this period. Interestingly, one of the most common foods that women become averse to eating during pregnancy is meat. Therefore, women may become vegetarian or nearly vegetarian during pregnancy simply due to a food aversion.

Helpful Foods
Morning sickness or nausea in early pregnancy is due to hormonal changes. Eating a dry toast, cereal or crackers half an hour before getting out of bed, eating small frequent meals, drinking fluids between meals and avoiding food aromas which trigger nausea are helpful techniques. Ginger and lime preparations may be helpful.

Heartburn and constipation are also common as a result of slower gastro-intestinal movements. Remaining upright for at least half an hour after eating, high fibre diet, plenty of fluids, eating in small intervals, avoiding fried foods and regular moderate exercise are helpful. Food preferences can be altered, while some crave pickles, spicy chaats, others may want ice creams or specific foods. Some pregnant women may even crave non-food items such as clays, starch, dirt, ice etc. , these should be discouraged as they carry risks of infections.

Those suffering from high blood pressure, gestational diabetes or other complications must remain in close contact with their healthcare physicians and nutritionists.

Several foods are tabooed during pregnancy due to traditional, cultural beliefs. Check with a qualified health counsellor about them.

Aim Daily:
  • 2-3 servings of dairy, milk, yogurt, cheese, soy
     
  • 2-3 servings of fruit
     
  • 3-5 servings of vegetables (dark green leafy and brightly coloured)
     
  • 2 servings of pulses and dhal
     
  • 1-2 servings of meat, fish, poultry and eggs
     
  • 6-11 servings of cereals (50% whole grains)
     
  • 1 serving nuts and seeds
     
  • Plenty of fluids
     
  • Moderate fats and oils (cold pressed), sugar and salt.  Prefer jaggery, honey and mollases, brown sugar and dry fruit.
     
  • Limit caffeine intake.

Ishi Khosla is a Clinical Nutritionist and Director-Whole of India


    
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