NUTRITION DURING PREGNANCY

When a woman starts thinking of getting pregnant, she should start a good pre pregnancy health regime. If she wishes to get pregnant in the near future she should make sure that she is not overweight, obese or too thin. Her blood pressure should be normal and thyroid function tests, blood sugars as well as basic bloods are within normal range. Besides all these it is very important to take 400 mcg of folic acid every day. This has been proven without doubt that this prevents occurrence of neural tube defects (abnormalities  of brain and spinal cord) in the new born. This is able to prevent it by almost 70%. These are far more common in the Asian population. I feel folic acid pre pregnancy and the first three months of pregnancy is recommended all over the world. In fact many foods are fortified with folic acid. Women may continue to take it for the rest of the pregnancy. When pregnancy begins many women feel that it is happening very quickly, within two weeks, some start getting sick and get a feeling of liking or disliking certain foods (This is called pica of pregnancy).The sickness of pregnancy is called morning sickness, as it is worse in the mornings. The medical word for this is nausea and vomiting of pregnancy. This usually settles down after 12 weeks, however it can continue throughout the pregnancy in a small number of women. If it is severe then the care givers, have to watch for dehydration, too much weight loss and rarely liver failure in women who were already malnourished in poorer socioeconomic countries. These women are often admitted to the hospital for supervised treatment of morning sickness.   The morning sickness happens during pregnancy  due to hormones; Chorionic- gonnadotrophins hormone of pregnancy, increased levels of oestrogens, increased sense of smell and taste, sensitive stomach, stress and unhappy surroundings. In general it can be controlled by a gentler life style, dry snacks, cooled food, less fat, small and frequent meals and adequate rest. Vitamin B6 is very useful. Ginger and its preparation; such as tea, candy, ginger ale, are all excellent. In fact in very ill women we use ginger injections in a hospital setting and for some women there are tablets which help with day to day work. I have used a preparation like a balm which had Vitamin B6, lemongrass, ginger, and women inhaled the balm and found it to be very useful. Acupressure on the wrist points and an acupressure wrist band is also useful. It is just like the one used for travel sickness. If you are well eat normal food like grains, complex carbohydrates, protein, lean and cooked, fish free of mercury, cheeses’ made from pasteurised milk, not soft  cheese, and not processed meats, small quantity of good fats. A good range of assorted fruits, vegetables and dark green leafy vegetables; depending on the seasonal growth in your country. Avocado and spinach are two of the best foods both for vegetarians and non-vegetarians. Avocado has Omegas 3 fatty acids, Vitamin B5 (pantothenic acid), Vitamin K and C, phosphors, iron and fibre. Half an Avocado per day is very useful, however more than that, you may put on weight. Please do not fall into the mindset of thinking that you need to eat for two.   Women need to increase their calories by 300 for a single pregnancy and 600 for a twin in the first trimester. 300 calories are equal to a glass of fat free or low fat milk and a medium sized half a sandwich. Please do not eat food full of calories and have no food value. Women need many vitamins and minerals, Iodine and Selenium for foetal thyroid and brain development. Calcium and Vitamin D for bones, Iron, Copper, Zinc, Vitamins B1, B6, B12, C , K, E, are required for immunity and other developments.

Nuts, beans, and lentils, are also very important particularly for vegetarians.  Try to keep your weight gain to about 2 -4 kgs in the first trimester. A weight gain of 25 -35 kgs is best for the whole pregnancy. If a woman has a balanced diet she may get all her vitamins and minerals, however inmost countries there are special pre natal capsules which provide all the nutrients. It is worth while taking a capsule or a tablet daily throughout the pregnancy. If you put on too much weight in the second or third trimester, a woman runs the risk of diabetes or blood pressure (Preccelamsia) of pregnancy.  Both these conditions, make the pregnancy complicated and can also cause long term problems. Do not eat for 2 as already mentioned and be aware of the following points: - Do not eat shellfish which is raw, raw eggs, refrigerated and smoked food as it can have Listeria.

Women must abstain from alcohol, limited caffeine intake (one medium cup in 24 hrs), over the counter food from take away places, unwashed fruits and vegetables. Make sure that your hands, cutlery and crockery are clean.

Generally in the first trimester women can have 1800 calories, in the 2nd trimester 2200 and the 3rd trimester 2800 calories.

During lactation women have to worry about her nutrition as well as baby’s nutrition. Please maintain the calories required. Do not start funny diets to lose weight in a hurry, gently do it with restricting too much sugar, fat, and increased exercise levels. Most important nutrients required are, calcium, iron, Vitamin D, vitamin B12 and Iodine. Stick to your diet rich in protein, whole grains, nuts and seeds. Avoid too many juices, as they produce a change in the taste of breast milk and babies do not like it. Do not drink too much coffee (may be just 1-2 cups in a 24HR period) as this makes the baby’s restless and upsets their sleep. For women who may not get enough, Vitamin D and B12 they can take supplements. Iodine is also very important for the baby’s brain development. These can all be obtained from prenatal supplements. Iodised salt can also provide the iodine. Please watch your food intake and notice the baby’s behaviour, avoid foods that upset the baby. Many foods can improve your milk supply; these include Fenugreek seeds, oats, nuts, fennel, and many local healthy food items.  Grandmothers and lactation consultants can be of a great help with a woman’s lactation problems, depending on where they live in the world. A woman must take care of calcium, vitamin D, B12, Iron, and Iodine intake. Avocado is an excellent food for lactating mothers.