For women, a diet adequate in the right nutrients is important throughout her childbearing years. Poor quality of the diet does not only affect women’s health and nutrition status but can also influence the health of the next generation. Even though in the modern world, we have access to more foods than ever before, making the right food choices is no easy task.
Women may alter their diet throughout the course of pregnancy, but getting the right nutrients is as important before getting pregnant. Ideally, the body should be prepared before the physiological demands of pregnancy occur.
No single food contains all of the nutrients that the body requires, so eating a balanced diet means eating a wide variety of foods in proportions needed for good health. All pregnant women need to get more protein, more of certain vitamins and minerals especially folic acid and iron and more calories.
Better Nutrients and Their Requirements During Pregnancy
Energy needs during pregnancy increases due to the growth of a foetus and its activity, growth of a placenta, increase in maternal tissues. Energy requirement is mostly increased in the later half of the pregnancy. Pregnant women in the trimester would require extra about 200 Kcal/ day as against a woman in the second trimester who would require much lesser as 90 Kcal/day Similarly the women in the first trimester would require a bare minimum of 10 Kcal/ day.
Protein is needed during pregnancy for cellular development and physical growth of the foetus along with expansion of blood volume and formation of new blood cells. An addition of 15 gms per day would be sufficient. Inclusion of an egg white or a cup of extra dal or pulses should be sufficient.
Calcium has important biochemical and physiological roles in pregnancy, including supporting cell growth, the transmission of nerve signals and the release of brain neurotransmitters. Some studies have shown that it also helps in the uterine contraction during child birth. Calcium requirement increases from 400mg/ day to 1000mg per day and it can go upto 2500mg/day in high-risk pregnancies. Inclusion of calcium-rich foods such as milk and milk products, ragi, green leafy vegetables will help.
Iron deficiencies in pregnancy are linked with preterm deliveries, reduced infant birth weight, height and iron stores. Low iron stores during the periods of infant brain growth may also have a permanent effect on the cognitive functions of the offspring. An increase of 8 – 10 g of iron intake every day is advisable. Inclusion of iron-rich foods such as sesame seeds, raisins, figs, green leafy vegetables, watermelon etc is necessary.
Pregnant women have higher iodine requirements because renal clearance and foetal demands are higher during this phase of lifecycle. Iodine deficiency might cause the thyroid to under function leading to development of goitre. In some severe cases even the newborn may have enlarged thyroid gland or goitre. Thyroid hormones are needed for the development and maturation of foetal brain. The nervous system of the developing child is very sensitive to the changes in mothers thyroid status. Iodine supplementation can be a major cause of preventable mental retardation. A marginal increase is necessary which can be met through milk and iodized salt consumption.
Sodium referred to as common salt, is found in most of the food products. During pregnancy, sodium intake must just be maintained as before. Sodium is often rather restricted during edema or hypertension.
Zinc is a major component of 100 plus metalloenzymes involved with metabolism, oxygen uptake, folate utilization etc. Zinc deficiency during antenatal periods might lead to adverse effects in the newborn including foetal malformation, reduced intrauterine growth and foetal mortality. Generally, the recommended intake of 11mg/day can be met from the usual habitual intake of whole grains, cheese etc.
Vitamin A a fat-soluble vitamin is essential for growth and differentiation of cells. To achieve 2400 mcg of vitamin A daily an inclusion of plant-based sources such as dark green and orange/ red vegetables and fruits are fine. However rich animal sources such as liver and organ meats are restricted due to toxicity.
Vitamin D recommendation for the pregnant women is not yet established but Vitamin D is essential for calcium absorption and it also influences the foetal calcium metabolism. Daily sunlight expose for 30 mins along with rich sources like mushrooms, milk and milk products in the diet is necessary
Although some studies have shown that vitamin E reduces the chances of stillbirth and spontaneous abortions, the relations are not strongly established. The inclusion of nuts in the daily diet compliments the intake of 15 mg/day.
Vitamin K is essential for the synthesis of prothrombin that is necessary for normal coagulation of blood. Since the recommendations are low as 90 microgram /day this can be achieved through consumptions of green leafy vegetables such as spinach, broccoli etc.
Vitamin B complex plays quite an essential role throughout pregnancy.
Thiamin( Vitamin B1) supports the role of coenzymes in carbohydrate metabolism. Deficiencies of the same can lead to a feeling of confusion or dizzy. Allowance of 1.4 mg/day can be easily met through a balanced diet, Inclusion of oats can be beneficial.
Riboflavin ( Vitamin B2) helps in the mobilization of iron during pregnancy. Diets including animal proteins such as milk, curd, cheese, meat etc can meet the recommendation of 18mg/day.
Niacin( Vitamin B3) adequacy is essential for the metabolism of the body and also in prevention of spina bifida. Eating niacin-rich foods such as whole wheat, lean meat, fortified cereals helps to achieve the values of 18 mg/day.
Panthotenic acid (Vitamin B5) and Pyridoxine (Vitamin B6) are essential in the body metabolism of fat and carbohydrate. Daily recommendations of 1.9mg/day can be met through a balanced diet.
Folic acid( Vitamin B9) by far is a very important nutrient throughout the pregnancy and even later. Folic acid helps in the prevention of neural tube defects such as spina bifida along with a reduction in the risk of cleft lip/palate syndrome. During the early stages, it not only helps in conception but also helps to maintain pregnancy. Adequacy of folic acid can also have an impact on the birth weight of the foetus.
The recommendation can vary from 5 mg/day in normal pregnancy to 20 mg/day in a high-risk pregnancy. The inclusion of green leafy vegetables, fortified foods and beverages are essential.
Cobalamin( Vitamin B12) deficiency are usually associated with the premature birth of the foetus They are usually found in animal proteins like milk and milk products, eggs, meats unlike the other B complex vitamins.
Women must be guided to make the right for choices from early pregnancy, if not, ideally before conception. Eating better does not mean eating more but infers a nutritional transition of the regular consumption. When recommended micro nutrients intake cannot be met through the diet, supplementation may become necessary.
Mrs. Namratha Pramod
Nutrition & Diet Consultant (Registered Dietitian)
Gunasheela Surgical & Maternity Hospital