Pregnancy and Diet: Nutrition for Two

Pregnancy is a state in which a pregnant female is not only catering for the physiological changes in her body but also the demands of a growing fetus. Good nutrition is essential to meet the additional dietary requirements of mother and responsible for the growth and development of the baby. 
Pregnancy is divided into three trimesters, in which each trimester has different nutritional requirements, being minimal in the first trimester, moderate in the second and maximum in the third but right after conception, nutrition cannot be compromised because the brain, the most important structure, develops within the first 3 weeks. This means that the baby’s development has started before the mother realizes that she has good news. Although all nutrients are important for brain development, but key nutrients that are essential include proteins, zinc, iron, choline, folate, iodine, vitamins A, D, B and long chain fatty acids. That is why it is highly recommended to use all the multivitamins recommended by the obstetrician. This also highlights the importance of consulting a doctor even when you are planning a pregnancy, because this is the best time to start taking important supplements, like folic acid, essential for the neurodevelopment of your baby in the first month.

‘Good Nutrition’ in terms of quality and quantity in pregnancy is vital. The total cost of energy during pregnancy is estimated at around 80,000 kcal, which comes to 300-350 kcal per day. The recommended daily allowance is increased from 1gm/kg of body weight to additional energy and protein intakes during the second and third trimesters of 300 kcal/day, 7 g/day and 23 g/day, respectively. In addition to this, prime macronutrient 15 mg iron, 220μg folate, 400 mg calcium, 400 mg phosphorus per day is recommended. Optimum weight gain during pregnancy is marker of birth weight; poor weight gain leads to intrauterine growth retardation which results in low IQ and poor school performance in later life. Both under and over weight gains during pregnancy are associated with pregnancy complications and adverse pregnancy outcomes. For overweight and obese women, lesser gestational weight gain (<12 kg), for normal-moderate weight gain (12 kg) and for underweight, greater weight gain (12-14 kg) of their pre-pregnancy weight is recommended. Diet should comprise 5 food groups to constitute a balanced meal divided into three major meals with two snacks. 

Food and portion sizes for pregnant women:

• Milk and milk products (2-3 servings/day)
(1 serving) 1 cup of milk or 1 cup of yogurt or 1 slice of cheese or 1 cup of kheer or feerni or other milk-based products equivalent to nutrients supplied by 1 cup of milk. 1 cup of whole milk will provide 15 g carbohydrates, 6 g proteins, 8 g fat and 150 calories.

• Cereals (5-6 servings/day
(1 serving) 2 slices of bread (toast) or 1 chapatti or 1 cup of cooked rice or 1 cup of cereals equivalent to nutrients supplied by 2 slices of bread. One serving of cereal bread will provide (2 toast x 30 g=60 g) shall provide 30 g carbohydrates, 6 g protein, 0-2 g fat and 160 kcal.

• Vegetables (2-3 servings/day
(1 serving) 1⁄2 cup of cooked non-starchy vegetables or 1⁄2 cup of vegetables juice/soup or 1 cup of fresh vegetables/salad. One serving of vegetables will provide 5 g carbohydrates, 2 g protein and 25 calories. One serving of starchy vegetables (1 potato (100 g) or maize (1/2 cup) or peas (1⁄2cup) will provide 15 g carbohydrates, 3 g protein, 0-1 g fat and 80 calories.

• Fruits (2-3 servings/day
(1 serving) 1 medium sized banana or 1 apple or 1 peach or 2-3 plums or 3-4 apricots. One serving will provide 20 g carbohydrates and 80 calories.

• Meat and pulses (2-3 servings/day
(1 serving) 28 g lean meat or 2-3 small pieces of meat or 1-2 pieces of fish or 1 egg, or 1⁄2 cup of cooked pulses. One serving of lean meat will provide 7 g protein, 3 g fat and 55 calories. One serving of meat with medium fat will provide 7 g protein, 5 g fat and 75 calories. One serving of meat with high fat will provide 7 g protein, 8 g fat and 100 calories.

• Salt, Sugar and Oil 
These recommendations should be followed as to avoid any complications associated with pregnancy such as high blood pressure and gestational diabetes which are a leading cause of bad outcome for both mother and baby.
Use minimum amount of salt (less than 5g salt per day), sugars and oils in cooking.
Take less than 10% calories from free sugars and less than 10% of total fat calories from saturated fat.
Avoid junk, refined foods, sweets, soft drinks, french fries, samosas and other deep fried foods.
(Adapted from ‘Pakistan dietary guidelines.’)
General Precautions:
Use clean water to wash vegetables and fruits, especially those which are to be consumed in raw form.
Prefer using freshly cooked food. Refrigerate them at 50C or below for a day only if unavoidable. 
Protect foods from flies, pathogens, and dirt.
Being physically active has many benefits. If you keep yourself active and fit, and are experiencing a normal pregnancy, you can remain physically active during your pregnancy. Otherwise, consult your doctor for advice.
Drink plenty of fluids to keep yourself hydrated.
Do not smoke — both direct and passive smoking (exposed to someone else smoking in your surroundings) — is associated with growth retardation, increased risk of spontaneous abortion, stillbirths, placental complications and low birth weight.HH

The writer is head of Community Medicine Department at Services Institute of Health Sciences, Lahore.
E-mail: [email protected]

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