Nutrition in pregnancy

1. Nutrition in pregnancy

2. Definition of terms Body Mass Index (BMI) • a calculation that uses your height and weight to estimate how much body fat you have. Toxoplasmosis Parasite •  animals are infected by eating infected meat, by ingestion of feces of a catthat has itself recently been infected, or by transmission from mother to fetus.  Listeria • bacteria responsible for listeriosis, a rare but potentially lethal food-borne infection Fetal Alcohol Syndrome •  a pattern of mental and physical defects that can develop in a fetus when a woman drinks alcohol during pregnancy

3. Healthy eating is important for pregnant women and their unborn babies. There are many nutritional issues to consider ensuring good health of both the woman and baby, during and after pregnancy. A wide varied diet is vital in supporting the growth and development of the fetus and the maintenance of the woman’s own health. During pregnancy, a woman must eat adequately to supply enough nutrients to the fetus, so it can grow, as well as to support her own nutrition. Adequate protein intake is vital because so much is needed by a fetus to build a body framework. Adequate protein may also help prevent complications of pregnancy such as pregnancy-induced hypertension or preterm birth. Either deficiencies or overuse of vitamins may contribute to birth anomalies.

4. Recommended Weight Gain A weight gain of 11.2 to 15.9 kg (25 to 35 lbs) is recommended as an average weight gain in pregnancy. If a woman is at high risk for nutritional deficits, a more precise estimation of adequate weight gain can be calculated. This is done by computing body mass index (BMI). Women who are high or low in weight for their height (BMI below 18.5 or above 25kg/m2) need to have their expected outcomes for weight gain adjusted. Weight gain in pregnancy occurs at approximately 0.4kg (1 lb) per month during the first trimester and then 0.4 kg (1 lb) per week during the last two trimesters. Women who are underweight coming into pregnancy should gain slightly more weight than the average woman (0.5 kg per month or week). An obese woman might be advised to gain less than average (0.3 kg).However, to ensure adequate fetal nutrition, advise women not to lose weight during pregnancy. Weight gain will be higher for a multiple pregnancy than for a single pregnancy. Encourage women with multiple pregnancies to gain at least 1 lb per week for a total of 40 to 45 lbs.

5. Daily Caloric Needs Calorie needs increase during pregnancy to help support a woman's maternal body changes and the baby's proper growth and development. The RDA for energy intake during pregnancy is an additional 300 calories per day for the second and third trimester, in addition to maintenance needs. All the calories you consume during pregnancy should be healthy calories that contain plenty of protein, complex carbohydrates, fiber, vitamins, and minerals. Complex carbohydrates such as fruit, whole-grain starches, cereal, pasta, rice, potatoes, corn, and legumes should be the main source of energy. ALERT! Dieting or skipping meals during pregnancy can have serious effects on the development of the baby. It takes more than 85,000 calories over the course of a nine-month pregnancy, in addition to the calories the mother needs for her own energy needs, to produce a healthy, well-developed baby.

6. Nutritional requirements Good nutrition is important during pregnancy and breastfeeding, as there is an increased need for calories and for most nutrients. A particularly important nutrient during pregnancy is folic acid, one of the B vitamins . Folic acid reduces the chance of having a baby with birth defects of the brain and spinal cord. Experts recommend that women of childbearing age consume400 micrograms (μg) of folic acid every day. Pregnant women should consume 600 μg per day. Good sources of folic acid include dark green leafy vegetables, oranges and orange juice, dried beans and peas, and fortified breads and cereals. Adequate calcium intake during both pregnancy and breastfeeding is also important, since calcium is drawn from the mother. The recommended intake of calcium during pregnancy and lactation is 1,000 mg a day. A pregnant or lactating teenager needs 1,300 mg of calcium a day. Before becoming pregnant, a woman should discuss folic acid or calcium supplementation with a physician, as well as multivitamin supplementation.

7. Nutritional requirements Protein needs increase when you are pregnant, to help develop the body cells of the growing baby. Other changes that are taking place in your body during pregnancy also require protein, such as the building of the placenta. You need an extra 10 grams of protein above your extra daily calories, or about 70 grams of protein daily, compared with 60 grams for women who are not pregnant. Ten grams of protein is equivalent to a an ounce-and-a-half serving of lean meat, about 10 ounces of fat-free milk, or 1½ ounces of tuna canned in water. Most women do not have a problem meeting their protein requirements. Consuming plenty of lean meats, fish, tuna, eggs, and legumes, as well as increasing your dairy servings, will ensure you meet your protein needs. If you are a vegetarian, consume a variety of legumes, grain products, eggs, low-fat or fat-free dairy products, vegetables, fruits, and soy foods to ensure proper protein intake.

8. Nutritional requirements Getting the extra calories your body needs for pregnancy just takes a small adjustment in a healthy eating plan. • Bread, cereal, rice, & pasta: 6-7 (or more) servings daily • Vegetable and fruit groups: 5 or more servings daily • Milk, yogurt, and cheese group: 2-3 servings daily • Meat, poultry, fish, dried beans, eggs, nut: 5-7 ounces daily • Unsaturated fats: 3 servings daily Also be aware of increased fluid needs. Water is an important nutrient and is essential for the nourishment that passes through the placenta to the baby. Drink at least 8 to 12 cups daily, and more if you are thirsty. ALERT! Raw foods can increase your risk for bacterial infection. Avoid anything raw, including sushi and other raw seafood, undercooked meat or poultry, beef tartar, raw or unpasteurized milk, soft-cooked or poached eggs, and raw eggs (possibly found in eggnog). 

9. Essential nutrients a) Folate (B vitamin) --helps prevent birth abnormalities like spina-bifida --take a daily supplement of at least 400 micrograms one month before becoming pregnant and during the first three months of pregnancy --green leafy vegetables such as broccoli, spinach and salad greens, chick peas, nuts, orange juice, some fruits and dried beans and peas b) Calcium --keep bones healthy and strong. --dairy foods: milk, cheese, yogurt & Ca fortified soy milk

10. Essential nutrients c) Omega 3 --development of the central nervous system, brain growth and eye development in your baby before and after he or she is born --oily fish like salmon, trout, herring, anchovies and sardines, chicken, eggs, canned tuna and flaxseed oil d) Iodine --required for healthy thyroid function in both the mother and unborn baby --insufficient iodine can lead to brain development and neurological issues problems in the baby

11. Essential nutrients e) Zinc --rapid cell growth that occurs during pregnancy --found in lean meat, wholegrain cereals, milk, seafood, legumes and nuts f) Vitamin C --increased in pregnancy due to larger blood volume in the mother and the growth of the unborn baby --fruit and vegetables

12. Essential nutrients g) Fiber --high fiber intake combined with plenty of fluid is encouraged to help prevent constipation --wholegrain breads and cereal products, legumes, nuts, vegetables and fruit h) Water --drink eight to twelve glasses of fluid a day

13. Foods to avoid a) Fish & Seafood --fish at the top of the food chain tend to contain more heavy metals, especially mercury, which can cause developmental delays in children who are exposed to mercury during pregnancy. It has also been known to cause miscarriage. --types of fish to avoid are; shark/flake, ray, swordfish, barramundi, gemfish, orange roughy, ling, and southern bluefin tuna. Tinned tuna is fine as long as you have no more than 2 servings per week. --it is recommended to eat other types of fish twice a week to obtain the nutritional benefits --avoid all types of shellfish, prawns and smoked fish

14. Foods to avoid b) Raw & Seared Fish --sushi, sashimi and seared fish are definitely out of the question. It is probably best to avoid all uncooked food prepared where you buy sushi and sashimi as the preparation surface may have been in contact with uncooked fish. Uncooked meat can contain toxoplasmosis parasite c) Red Meat & Chicken --all meat and chicken need to be thoroughly cooked through or well done - so no more rare roast beef. Chicken especially should not be eaten cold the next day

15. Foods to avoid d) Deli Foods --they are high risk for listeria: has the ability to cross the placenta and may infect the baby leading to infection or blood poisoning, which may be life-threatening --include all processed and sliced meats (salami, smoked meats), and any foods served from open containers (cheeses, olives, salads) e) Fruit and Vegetables --wash thoroughly before eating --do not use any that have gone moldy- don't just cut off the bad area - throw the item out all together.

16. Foods to avoid f) Soft Serve Ice-cream --avoid all soft serve ice creams and yoghurts as there is a risk of listeria g) Eggs & Mayonnaise --raw egg can contain salmonella, so make sure all your eggs are cooked through --avoid sauces like hollandaise and Caesar dressing --commercial mayonnaise sold in jars is fine as it contains egg that has been pasteurized --avoid fresh mayonnaise as it could contain raw egg

17. Foods to avoid h) Peanuts --avoid these to reduce your child's chance of allergy to peanuts and stop the possibility of an allergic reaction in the womb --a type of mould called aflatoxin which is dangerous also grows on peanuts i) Eating Out --only eat food that is served steaming hot --do not eat food that is served lukewarm --best to avoid smorgasbords --avoid pre-prepared salads (such as in salad bars) --check your hamburger pattie is cooked through and avoid hotdogs and other processed meat

18. Foods to avoid j) Food Additives --saccharin (artificial sweeteners) --MSG can cause headaches and stomach upsets k) Water --drink purified, filtered or bottled water only as they are least likely to contain contaminates and can reduce birth defects l) Alcohol --even one glass a day can have detrimental effects on the unborn baby, especially in the first trimester, so it is recommended that you avoid all alcohol during pregnancy --low IQ in babies, low birth weight and birth defects --it prevents the absorption of folic acid and iron, and pulls calcium out of your bones --your baby is so small compared to you - if you are tipsy, your baby has probably passed out “Fetal Alcohol Syndrome ”

19. Foods to avoid m) Caffeine --found in coffee, tea and chocolate as well as Coke-a-cola --raises blood pressure and acts as a diuretic: result in water and calcium loss --it prevents the absorption of folic acid and iron --miscarriage, birth defects and SIDS, as well as affecting the growth of the baby, even in small amounts --avoid caffeine during the first trimester to reduce the likelihood of a miscarriage --limited to fewer than 300 mg per day --large amounts of caffeine are associated with miscarriage, premature birth, low birth weight, and withdrawal symptoms in infants

20. Common problems Women have special nutritional needs due to hormonal changes that occur with menstruation, pregnancy, lactation, and menopause, all of which alter the recommended daily intake of nutrients. Of the many diseases that affect women, five have a scientific-based connection to nutrition: iron-deficiency anemia , osteoporosis , heart disease , type 2 diabetes , and some types of cancer. In addition, many women look to nutrition for the management of premenstrual and menopausal symptoms.

21. Common problems Anemia Iron-deficiency anemia is a very common nutritional disorder among females following the beginning of the menstrual cycle. Iron deficiency is also common among females with poor diets or very low body weight. The recommended intake of iron for females is 15 to 18 milligrams (mg) per day. Good sources of iron include red meat, dark green leafy vegetables, legumes , and fortified breads and cereals.

22. Common problems PMS and Menopause Many women seek medical help for premenstrual syndrome (PMS). While nutrition advice often varies, there is insufficient scientific evidence that any diet modifications will prevent or relieve PMS symptoms. A combination of good nutrition, exercise, and stress management may be the best way to relieve the symptoms of PMS. Soy has garnered much attention in recent years as a dietary treatment for menopausal symptoms. Soy is a rich source of isoflavones, an estrogen-like substance found in plants. Some studies suggest that regularly eating moderate amounts of soy-based food products can help decrease menopausal symptoms; however, other studies do not support the idea. More research is needed to gain a better understanding of the effects of soy on menopausal symptoms. During menopause, a woman's metabolism slows down and weight gain can occur. The accumulation of body fat around the abdomen also increases. Exercise and careful food choices can minimize both of these occurrences.

23. Common problems Chronic Diseases As women age, the risk of developing chronic disease increases. Women over age forty-five who are overweight, physically inactive, and have a family history of diabetes are more likely to develop type 2 diabetes. Maintaining a healthy weight, eating a varied and balanced diet, and engaging in an active lifestyle can reduce the risk of developing type 2 diabetes. Diabetes carries many risks with it, including eye disease, nerve disease, kidney disease, and heart disease. Women are at a higher risk of developing osteoporosis as they age than men are. Osteoporosis is an irreversible disease in which the bones become porous and break easily. There are many factors that contribute to this disease, including genetics , diet, hormones , age, and lifestyle factors. The disease usually has no symptoms until a fracture occurs. Diets low in calcium, vitamin D , or magnesium—or high intakes of caffeine, alcohol, sodium, phosphorous, or protein —may increase the chance of developing osteoporosis. Good nutrition and weight-bearing exercise, such as walking, hiking, or climbing stairs, helps to build strong bones.

24. Common problems Good sources of calcium include low-fat dairy products such as cheese, yogurt, and milk; canned fish with bones, such as salmon and sardines; dark green leafy vegetables; and calcium-fortified foods such as orange juice, bread, and cereal. The recommended intake of calcium for women ages nineteen to fifty is 1,000 mg per day. Women over the age of fifty should consume 1,200 mg of calcium per day. Breast cancer is the most common type of cancer among U.S. women other than skin cancer. Obese , sedentary women are more likely to develop breast cancer, and dietary factors may possibly play a role in its development. Some studies suggest that excessive fat intake may increase breast-cancer risk, either by raising estrogen levels in a woman or by altering immune function. Diets that include adequate amounts of fruits, vegetables, and other fiber-rich foods may protect against breast cancer. However, controversy exists as to whether diet is actually a contributing factor. Excessive alcohol consumption does appear to raise the risk of breast cancer in women.

25. Food beliefs MYTH: You're eating for two. In reality, you are eating for one plus one very small being. Most women only need to consume an extra 300 calories per day. Far from being a time for overindulgence, pregnancy is a time to eat sensibly and healthily. The suggested weight gain during pregnancy is approximately 24 to 35 pounds; however, this weight may vary depending upon each mother-to-be's pre-pregnancy weight and the number of babies she is carrying. An underweight woman may gain up to 40 pounds while an overweight woman may be asked to gain just 15 pounds. Your doctor will specify an appropriate weight gain for your height and body build.

26. Food beliefs MYTH: Eat a low-carbohydrate, high-protein diet. Though popular among today's array of weight-loss diets, a high-protein diet is not recommended during pregnancy. According to the Daily Food Guide Pyramid, grains, fruits, and vegetables should comprise more of your diet than the milk and meat groups. In fact, only 2-3 servings of protein are required each day for non-pregnant women. This is easily achieve by consuming an egg, 2-3 oz. of poultry or meat, and ½ cup of dried beans or peas in the course of one day. Extra calories consumed during pregnancy should be evenly distributed among the five groups of the food pyramid.

27. Food beliefs MYTH: Pregnancy-induced high blood pressure is caused by too much salt. The reality is that pregnancy-induced high blood pressure is due to a variety of physiological changes in the body during pregnancy and is therefore not treated the same way as hypertension in non-pregnant adults. Moderation is key. While overindulging in processed foods that typically contain too much sodium would be unhealthy, eliminating salt and consuming no-salt or low-sodium specific foods would also be inappropriate.

28. Food beliefs MYTH: Now that you're pregnant, it's a good time to start thinking about folic acid (B complex vitamins). Folic acid is particularly important in the first days and weeks of fetal formation. For this reason, it is recommended that women take a multi-vitamin before becoming pregnant to ensure that they have adequate folic acid during the early development of the baby's brain and spinal cord. Optimal folic acid consumption should continue throughout pregnancy and in every woman's diet during the childbearing years. Besides vitamins, excellent sources of B complex vitamins include orange juice, beans, citrus fruits, dark green leafy vegetables, nuts and whole grains.

29. Food beliefs MYTH: It is better to rely on vitamins rather than one's diet during pregnancy. Vitamins should never be a substitute for a healthy diet. While most obstetricians and midwives will prescribe a multivitamin for their patients, these vitamins are intended to supplement—not replace—a sensible diet. The best sources of vitamins and minerals may be found in their "natural state," as they are better absorbed and are accompanied by other nutrients such as protein or fiber.

30. Food beliefs MYTH: Whole milk is more nutritious than skim milk. Actually, skim milk remains the preferred choice for all individuals over age three. Skim milk provides all of the same nutrients as whole milk with less fat and cholesterol. In fact, it has more calcium than whole milk. *A moderate, healthy diet during pregnancy that includes wise choices form the different food groups will lead to appropriate weight gain that will enhance both the mother-to-be's and her baby's health. If you are unsure about your diet or have specific questions, ask your doctor or request a referral to see a dietician who will address any dietary concerns you may have.

31. Food beliefs Myth: Gaining less weight during pregnancy will make delivery easier. Mothers who do not gain enough weight during pregnancy place their babies at risk for severe complications such as premature birth, which can cause lung and heart problems. Women with a normal weight should gain about 25-35 lb in pregnancy. If you are underweight you should gain a little more and if you are overweight a little less. Myth: If you gain the right amount of weight during pregnancy, none of it will be fat gain. A healthy pregnancy includes fat storage. Fat is one of the body’s most efficient means of calorie burning. Your body uses this excess fat as energy during labor and breastfeeding.

32. Food beliefs Myth: Pregnant women only crave the foods their body needs. Pregnant women can crave foods of any type. Cravings should not be a sole indicator of nutritional needs. Myth: A pregnant woman who is healthy will not experience discomforts. Nausea, heartburn, and constipation are not biased! They will afflict women regardless of healthy living. However, women who regularly eat healthy, wholesome foods, drink plenty of water, exercise regularly, and avoid excess sugar and fat may significantly reduce these uncomfortable symptoms.

33. Food beliefs Myth: Drinking coffee during pregnancy is prohibited. Research has shown that excessive coffee consumption can lead to miscarriage or lack of weight in babies born. But actually, drinking coffee is still allowed for pregnant women, as long as they drink the right portion and at a certain time of pregnancy. Pregnant women are still allowed to drink coffee, but not more than 0.8 cups per day. Try to balance the consumption throughout the day. Do not forget, not only the caffeine found in coffee, but also tea and soda.

34. Food beliefs Myth: hemoglobin (red blood cells) is in a standard number during pregnancy There is a physiological decline in hemoglobin levels during pregnancy. This is because blood volume increases and the needs of growing infants. Therefore, the mother must provide a sufficient amount of iron to the body. To do this, they can consume iron-rich foods or take special pills. Iron deficiency may increase the risk of miscarriage and premature birth, also lack of weight and malnutrition. Myth: Green vegetables contain much iron Actually a lot of iron can be found in liver, beef, turkey, chicken and fish. Cereals are also rich in iron. Green leafy vegetables do contain iron, but not completely can be absorbed and digested.