Nutrition during pregnancy

Let's start with the obvious - eating a healthy and balanced diet during pregnancy is crucial for both you and your baby (like, DUH!).

Not only does eating the right foods provide the necessary nutrients for your baby's growth, but it also helps you maintain a healthy weight and promotes your overall well-being. Nutritionist Fleur Bugeja summarises what you need to know (and PRACTICE!) when it comes to your diet during pregnancy.

Why is nutrition during pregnancy important?

 A healthy diet is an important part of a healthy lifestyle at any time but is especially vital if you're pregnant or planning a pregnancy. Eating healthily during pregnancy will help your baby to develop and grow, and it will help you maintain your weight after pregnancy. You do not need to go on a special diet, but it's important to eat a variety of different foods every day to get the right balance of nutrients that you and your baby need.

How much should I eat during pregnancy?

The popular saying that pregnant women should “eat for two” is far for healthy. Eating twice your usual amount of food during pregnancy will cause weight gain and you will be at increased risk of developing gestational diabetes. Instead of “eating for two,” think of it as eating twice as healthy.
If you are pregnant with one foetus, nutrition recommendations for total daily energy intake are as follows:

• No additional calories in the 1st trimester
• + 340kcal / day for the 2nd trimester
• + 452kcal / day for the 3rd trimester

How much weight should I gain by the end of pregnancy?

 Refer to the table below for an indication of the amount of weight you should gain:

A Healthy Diet in Pregnancy

Eat a healthy, balanced Mediterranean diet by eating a variety of foods from the 6 main food groups:

• Cereals and wholegrains

• Fruit

• Vegetables

• Dairy Products

• Lean meat, fish, poultry, eggs, legumes, nuts and seeds

• Healthy fats and oils

Avoid foods high in sugar, saturated fats, processed meats, and salt.

Carbohydrates in pregnancy

Carbohydrates are an important source of energy, some vitamins and fibre, and help you to feel full without containing too many calories. They include bread, potatoes, breakfast cereals, rice, pasta, noodles, millet, oats, and sweet potato.
These foods should make up roughly 55% of the food you eat. Instead of refined starchy (white) food, choose wholegrain or higher-fibre options such as wholewheat pasta, brown rice or simply leaving the skins on potatoes.

Fruit and vegetables in pregnancy

Eat plenty of fruit and vegetables because these provide vitamins and minerals, as well as fibre, which helps digestion and can help prevent constipation. Eat at least 5 portions of a variety of fruit and vegetables every day – these can include fresh, frozen, and canned varieties. Always wash fresh fruit and vegetables carefully.

Protein in pregnancy

• You should aim to consume around 1.1g of protein per kg/body weight. Eat some protein-rich foods every day. Sources of protein include:
• beans
• pulses
• fish
• eggs
• meat (but avoid liver)
• poultry
• nuts

Choose lean meat, remove the skin from poultry, and try not to add extra fat or oil when cooking meat. Make sure poultry and whole cuts of meat such as lamb, beef and pork are cooked very thoroughly until steaming all the way through. Check that there is no pink meat, and that juices have no pink or red in them. Try to eat 2 portions of fish each week, 1 of which should be oily fish such as salmon, sardines or mackerel.

Dairy in pregnancy

Dairy foods such as milk, cheese, and yoghurt are important in pregnancy because they contain calcium and other nutrients that you and your baby need. Choose low-fat varieties wherever possible, such as semi-skimmed, skimmed milk, low-fat and lower-sugar yoghurt and reduced-fat hard cheese. If you prefer dairy alternatives, such as soya drinks and yoghurts, go for unsweetened, calcium-fortified versions.

Healthy snacks in pregnancy

If you get hungry between meals, try not to eat snacks that are high in fat and/or sugar, such as sweets, biscuits, crisps or chocolate. Instead, choose something healthier, such as:

• small wholemeal bread sandwiches or pitta bread with grated cheese, lean ham, mashed tuna, salmon, or sardines, with salad
• salad vegetables, such as carrot, celery or cucumber
• low-fat, lower-sugar fruit yoghurt, plain yoghurt with fruit
• hummus with wholemeal pitta bread or vegetable sticks
• fresh vegetable and bean soups
• a small bowl of unsweetened breakfast cereal, or porridge, with milk
• milk drinks
• fresh fruit
• baked beans on toast or a small baked potato

When choosing snacks, you can use food labels to help you.

Vitamins and Minerals for Pregnant Mums

It's best to get vitamins and minerals from the foods you eat, but when you're pregnant you need to take some supplements as well, to make sure you get everything you need.

Folic Acid
It’s important to take a 400 micrograms folic acid tablet every day before you're pregnant and until you're 12 weeks pregnant. Folic acid can help prevent birth defects known as neural tube defects, including spina bifida.If you did not take folic acid before you conceived, you should start as soon as you find out you're pregnant. Try to eat green leafy vegetables which contain folate (the natural form of folic acid) and breakfast cereals and fat spreads with folic acid added to them.
It's difficult to get the amount of folate recommended for a healthy pregnancy from food alone, which is why it's important to take a folic acid supplement.

Higher-dose folic acid
If you have a higher chance of your pregnancy being affected by neural tube defects, you will be advised to take a higher dose of folic acid (5 milligrams). You will be advised to take this each day until you’re 12 weeks pregnant.
You may have a higher chance if:

• you or the baby's biological father have a neural tube defect
•  you or the baby's biological father have a family history of neural tube defects
• you have had a previous pregnancy affected by a neural tube defect
• you have diabetes
• you take anti-epilepsy medicine

If any of this applies to you, talk to a GP. They can prescribe a higher dose of folic acid.

Vitamin D
You need 10 micrograms of vitamin D each day and should consider taking a supplement containing this amount in winter.
Vitamin D regulates the amount of calcium and phosphate in the body, which are needed to keep bones, teeth and muscles healthy. Our bodies make vitamin D when our skin is exposed to summer sunlight. Vitamin D is also found in some foods, including:

•  oily fish (such as salmon, mackerel, herring and sardines)
•  eggs
• red meat

Because vitamin D is only found in a small number of foods, whether naturally or added, it is difficult to get enough from foods alone. Do not take more than 100 micrograms (4,000 IU) of vitamin D a day as it could be harmful.

Omega 3 Fatty Acids
Necessary for proper foetal eye and brain development.Omega 3 FA deficiency linked with lower IQ scores in infants and lower scores for visual acuity.Daily supplementation of 1.4g / day of Omega 3 increases availability to foetus.

Iron
If you do not have enough iron, you'll probably get very tired and may suffer from anaemia. Lean meat, green leafy vegetables, dried fruit, and nuts contain iron. If you'd like to eat peanuts or foods that contain peanuts (such as peanut butter) during pregnancy, you can do so as part of a healthy, balanced diet unless you're allergic to them or your health professional advises you not to. Many breakfast cereals have iron added to them. If the iron level in your blood becomes low, a GP or midwife will advise you to take iron supplements.

Vitamin C
Vitamin C protects cells and helps keep them healthy. It's found in a wide variety of fruit and vegetables, and a balanced diet can provide all the vitamin C you need.
Good sources include:

• oranges and orange juice
•  red and green peppers
• strawberries
• blackcurrants
• broccoli
• brussels sprouts
• potatoes

Calcium
Calcium is vital for making your baby's bones and teeth. Adequate consumption necessary to protect mum’s Calcium stores. Sources of calcium include:

• milk, cheese and yoghurt
•  green leafy vegetables, such as rocket, or curly kale
• tofu
• soya drinks with added calcium
• bread and any foods made with fortified flour
• fish where you eat the bones, such as sardines and mackerel

Vegetarian, vegan and special diets in pregnancy

A varied and balanced vegetarian diet should provide enough nutrients for you and your baby during pregnancy. But you might find it more difficult to get enough iron and vitamin B12.
If you're vegan or you follow a restricted diet because of a food intolerance (for example, a gluten-free diet for coeliac disease), ask to be referred to a dietitian for advice on how to make sure you're getting all the nutrients you need for you and your baby.

Foods to Avoid during Pregnancy:

Unpasteurised Dairy

• Foods made from unpasteurised milk, such as soft ripened goats' cheese
• pasteurised or unpasteurised mould-ripened soft cheeses with a white coating on the outside, such as Brie, Camembert and chèvre (unless cooked until steaming hot)
• pasteurised or unpasteurised soft blue cheeses, such as Danish blue, Gorgonzola and Roquefort (unless cooked until steaming hot)
• unpasteurised cows' milk, goats' milk, sheep's milk or cream

There's a small chance that unpasteurised or soft ripened dairy products may contain Listeria bacteria. This can cause an infection called listeriosis.
Listeriosis can lead to miscarriage or stillbirth, or make your newborn baby very unwell.
Soft cheeses with a white coating on the outside have more moisture. This can make it easier for bacteria to grow.
Cooking cheese until it's steaming hot kills bacteria, reducing the risk of listeriosis.

Certain Meat Products

• raw or undercooked meat
• liver and liver products
• all types of pâté, including vegetarian pâté

There's a small risk of getting toxoplasmosis if you eat raw and undercooked meat, which can cause miscarriage. Cured meats are not cooked, so they may have parasites in them that cause toxoplasmosis. Liver and liver products have lots of vitamin A in them. This can be harmful to an unborn baby.

Raw Eggs
Raw or partially cooked eggs may have salmonella in them. Salmonella is unlikely to harm your unborn baby, but you could get food poisoning. You should cook all eggs thoroughly.

Fish and Smoked Fish
Smoked fish, such as smoked salmon and trout, can cause listeria. You should eat no more than 2 portions of oily fish a week, such as salmon, trout, mackerel or herring. You should eat no more than 2 tuna steaks (about 140g cooked or 170g raw) or 4 medium-size cans of tuna (about 140g when drained) per week.

Avoid:

• swordfish
• marlin
• shark
• raw shellfish

You should limit tuna because it has more mercury in it than other fish. If you eat too much mercury, it can be harmful to your unborn baby.
You should limit oily fish because they can have pollutants such as dioxins and polychlorinated biphenyls in them. If you eat too much of these, they can be harmful to your unborn baby.
You should avoid raw shellfish because they can have harmful bacteria, viruses or toxins in them. These can make you unwell and give you food poisoning.

Caffeine
You can have caffeine, but no more than 200mg per day. There is:

• 100mg in a mug of instant coffee
•  140mg in a mug of filter coffee
•  75mg in a mug of tea (green tea can have the same amount of caffeine as regular tea)
• 40mg in a can of cola
• 80mg in a 250ml can of energy drink
• less than 25mg in a 50g bar of plain dark chocolate
• less than 10mg in a 50g bar of plain milk chocolate

Alcohol
Drinking alcohol in pregnancy can lead to long-term harm to your baby. The safest approach is to not drink alcohol at all. This keeps risks to your baby to a minimum.

Preparing food safely

• Wash fruit, vegetables and salads to remove all traces of soil, which may contain toxoplasma (a parasite that can cause toxoplasmosis) which can harm your unborn baby.
• Wash all surfaces and utensils, and your hands, after preparing raw foods (poultry, meat, eggs, fish, shellfish and raw vegetables) to help you avoid food poisoning.
• Make sure that raw foods are stored separately from ready-to-eat foods, otherwise there's a risk of contamination.
• Use a separate knife and chopping board for raw meats.
• Heat ready meals until they're steaming hot all the way through – this is especially important for meals containing poultry.
• You also need to make sure that some foods, such as eggs, poultry, burgers, sausages and whole cuts of meat like lamb, beef and pork, are cooked very thoroughly until steaming all the way through.

Remember to consult with your healthcare provider or a registered dietitian for personalized advice and guidance on nutrition during pregnancy. They can help you create a meal plan that meets your specific needs and ensures a healthy pregnancy for you and your baby.

Embrace this special time and nourish yourself and your baby with a wholesome and balanced diet. Eating well during pregnancy sets the foundation for a healthy future for both of you. Enjoy the journey!

Should you like to book a personalised consultation regarding your pregnancy or postpartum nutrition,  the author Fleur Bugeja (State Registered Nutritionist, MSc. Weight Management, BSc. (Hons.) Physiotherapy, P.G. Dip. Nutr. & Diet., SRP) can be contacted on [email protected] or on +356 79314049.