- Key nutrients required prior to conception
- Optimal weight gain during pregnancy
- Nutrients needs during pregnancy
- Foods & beverages to avoid when pregnant
- Fetal Alcohol Syndrome
- Gestational Diabetes
This chapter will examine how a nutritious diet is important for the mother and father before conception. We will learn the impact on the mother and child’s health based on the mother’s weight gain during pregnancy.
The Early Days of Pregnancy
Pregnancy is measured from the first day of a woman’s last menstrual period until childbirth and typically lasts about forty-two weeks. It begins with the first trimester (weeks one to week twelve), extends into the second trimester (weeks thirteen to week twenty-seven), and ends with the third trimester (week twenty-eight to birth). Changes begin to occur in the earliest days, often weeks before a woman even knows that she is pregnant. During this period, adequate nutrition supports cell division, tissue differentiation, and organ development. Therefore, women trying to conceive should make proper dietary choices to ensure a healthy baby’s delivery. Fathers-to-be should also consider their eating habits. A sedentary lifestyle and a diet low in fresh fruits and vegetables may affect male fertility. Men who drink too much alcohol may also damage the quantity and quality of their sperm.
Weight Gain during Pregnancy
During pregnancy, a mother’s body changes in many ways. One of the most notable and significant changes is weight gain. If a pregnant woman does not gain enough weight, her unborn baby will be at risk. Poor weight gain, especially in the third trimester, could result in low birth weight and infant mortality, and intellectual disabilities. Infant birth weight is one of the best indicators of a baby’s future health. Pregnant women of normal weight should gain between 25 and 35 pounds in total throughout the entire pregnancy. The precise amount that a mother should gain usually depends on her beginning body mass index (BMI). The Institute of Medicine (IOM) recommends women with a BMI between 18.5-24.9 gain 25-35 pounds.
IOM’s Recommended Weight Gain
|Prepregnancy BMI||Weight Category||Recommended Weight Gain|
|Below 18.5||Underweight||28–40 lbs.|
|Above 30.0||Obese (all classes)||11–20 lbs.|
A starting weight below or above the normal range can lead to complications. Pregnant women with a prepregnancy BMI below twenty are at a higher risk of preterm delivery and an underweight infant. Pregnant women with a prepregnancy BMI above thirty have an increased risk of needing a cesarean section during delivery. Therefore, it is optimal to have a BMI in the normal range before pregnancy. Women who are pregnant with more than one fetus are advised to gain even more weight to ensure their unborn babies’ health.
The weight an expectant mother gains during pregnancy is almost all lean tissue, including the placenta and fetus. Women gain 2 to 5 pounds in the first trimester. After that, it is best not to gain more than one pound per week. Weight gain often breaks down in the following manner, as shown below.
|Pregnancy Weight Distribution
Blood 3-4 pounds
Protein and fat storage 8-10 pounds
Body fluids 3-4 pounds
Breast 1-2 pounds
Baby 6-8 pounds
Placenta 1-2 pounds
Uterus 1-2 pounds
Amniotic fluid 2-3 pounds
The pace of weight gain is also important. If a woman puts on weight too slowly, her physician may recommend nutritional counseling. If she gains weight too quickly, especially in the third trimester, it may result from edema or swelling due to excess fluid accumulation. Rapid weight gain may also result from increased calorie consumption or a lack of exercise.
Weight Loss after Pregnancy
New mothers lose some of their weight during pregnancy with their child’s delivery during labor. In the following weeks, they continue to shed weight as they lose accumulated fluids, and their blood volume returns to normal. New mothers who gain a healthy amount of weight and participate in regular physical activity during their pregnancies also have an easier time shedding weight post-pregnancy. However, women who gain more weight than needed for a pregnancy typically retain that excess weight as body fat. If those few pounds increase a new mother’s BMI by a unit or more, that could lead to complications such as hypertension or Type 2 diabetes in future pregnancies or later in life.
As a mother’s body changes, so do her nutritional needs. Pregnant women must consume more calories and nutrients in the second and third trimesters than other adult women. However, the average recommended daily caloric intake can vary depending on the activity level and the mother’s normal weight. Also, pregnant women should choose a high-quality, diverse diet, consume fresh foods, and prepare nutrient-rich meals. Steaming is the best way to cook vegetables. Vitamins are destroyed by overcooking, whereas uncooked vegetables and fruits have the highest vitamin content. It is also standard for pregnant women to take prenatal supplements to ensure adequate intake of the needed micronutrients.
Energy and Macronutrients
During the first trimester, a pregnant woman has the same energy requirements as normal and should consume the same number of calories. However, as the pregnancy progresses, a woman must increase her caloric intake. According to the IOM, she should consume an additional 340 calories per day during the second trimester and an additional 450 calories per day during the third trimester. This is partly due to an increase in metabolism, which rises during pregnancy and contributes to increased energy needs. A woman can easily meet these increased needs by consuming more nutrient-dense foods.
The recommended daily allowance, or RDA, of carbohydrates during pregnancy is about 175 to 265 grams per day to fuel fetal brain development. The best food sources for pregnant women include whole-grain bread and cereals, brown rice, root vegetables, legumes, and fruits. These and other unrefined carbohydrates provide nutrients, phytochemicals, antioxidants, and the extra 3 mg/day of fiber recommended during pregnancy. These foods also help to build the placenta and supply energy for the growth of the unborn baby.
During pregnancy, extra protein is needed for the synthesis of new maternal and fetal tissues. Protein builds muscle and other tissues, enzymes, antibodies, and hormones in both the mother and the unborn baby. Additional protein also supports increased blood volume and the production of amniotic fluid. During pregnancy, the RDA of protein is 71 grams per day, which is 25 grams above the normal recommendation. Protein should be derived from healthy sources, such as lean red meat, white-meat poultry, legumes, nuts, seeds, eggs, and fish. Low-fat milk and other dairy products also provide protein, along with calcium and other nutrients.
There are no specific recommendations for fats in pregnancy, apart from following normal dietary guidelines. Although this is the case, it is recommended to increase the amount of essential fatty acids because they are incorporated into the placenta and fetal tissues. Fats should make up 25 to 35 percent of daily calories, and those calories should come from healthy fats, such as avocados. It is not recommended for pregnant women to be on a very low-fat diet since it would be hard to meet the needs of essential fatty acids and fat-soluble vitamins. Fatty acids are important during pregnancy because they support the baby’s brain and eye development.
Fluid intake must also be monitored. According to the IOM, pregnant women should drink 2.3 liters (about 10 cups) of liquids per day to provide the body with enough fluid for blood production. It is also important to drink liquids during physical activity or hot and humid outside to replace fluids lost to perspiration.
Vitamins and Minerals
The daily requirements for nonpregnant women change with the onset of pregnancy. Taking a daily prenatal supplement or multivitamin helps to meet many nutritional needs. However, most of these requirements should be fulfilled with a healthy diet. The following table compares the normal levels of required vitamins and minerals to the levels needed during pregnancy. For pregnant women, the RDA of nearly all vitamins and minerals increases.
Recommended Nutrient Intakes during Pregnancy
|Nutrient||Nonpregnant Women||Pregnant Women|
|Vitamin A (mcg)||700.0||770.0|
|Vitamin B6 (mg)||1.5||1.9|
|Vitamin B12 (mcg)||2.4||2.6|
|Vitamin C (mg)||75.0||85.0|
|Vitamin D (mcg)||5.0||5.0|
|Vitamin E (mg)||15.0||15.0|
|Niacin (B3) (mg)||14.0||18.0|
|Riboflavin (B2) (mg)||1.1||1.4|
|Thiamine (B1) (mg)||1.1||1.4|
The micronutrients involved with building the skeleton—vitamin D, calcium, phosphorus, and magnesium—are crucial during pregnancy to support fetal bone development. There is an increased need for all B vitamins during pregnancy. Adequate vitamin B6 supports the metabolism of amino acids, while more vitamin B12 is needed to synthesize red blood cells and DNA. Additional zinc is crucial for cell development and protein synthesis. The need for vitamin A also increases, and extra iron intake is important because of the increase in blood supply during pregnancy and to support the fetus and placenta. Iron is the one micronutrient that is almost impossible to obtain in adequate amounts from food sources only. Therefore, even if a pregnant woman consumes a healthy diet, there still is a need to take an iron supplement in the form of ferrous salts. Also, remember that folate needs increase during pregnancy to 600 micrograms per day to prevent neural tube defects. This micronutrient is crucial for fetal development because it helps produce the extra blood a woman’s body requires during pregnancy.
For most other minerals, recommended intakes are similar to those for nonpregnant women, although pregnant women must meet the RDAs to reduce the risk of congenital disabilities. Also, pregnant mothers should avoid exceeding any recommendations. Taking megadose supplements can lead to excessive amounts of certain micronutrients, such as vitamin A and zinc, which may produce toxic effects that can also result in congenital disabilities.
Guide to Eating during Pregnancy
While pregnant women have an increased need for energy, vitamins, and minerals. Nutrient-dense foods are essential to a healthy diet. Examples of nutrient-dense foods include fruits, vegetables, whole grains, peas, beans, reduced-fat dairy, and lean meats. Pregnant women should be able to meet almost all of their increased needs via a healthy diet. However, expectant mothers should take a prenatal supplement to ensure an adequate intake of iron and folate. Here are some additional dietary guidelines for pregnant women:
- Eat iron-rich or iron-fortified foods, including meat or meat alternatives, bread, and cereals, help satisfy the increased need for iron, and prevent anemia.
Include vitamin C-rich foods, such as orange juice, broccoli, or strawberries, to enhance iron absorption.
- Eat a well-balanced diet, including fruits, vegetables, whole grains, calcium-rich foods, lean meats, and a variety of cooked seafood (excluding fish high in mercury, such as swordfish and shark).
- Drink additional fluids, water especially.
Foods to Avoid
Several substances can harm a growing fetus. Therefore, women need to avoid them throughout a pregnancy. Some are so dangerous that a woman should avoid them even if she suspects that she might be pregnant. For example, consumption of alcoholic beverages results in a range of abnormalities that fall under the umbrella of fetal alcohol spectrum disorders. They include learning and attention deficits, heart defects, and abnormal facial features. Alcohol enters the unborn baby via the umbilical cord and can slow fetal growth, damage the brain, or even result in miscarriage. The effects of alcohol are most severe in the first trimester when the organs are developing. As a result, there is no safe amount of alcohol that a pregnant woman can consume. Although pregnant women in the past may have participated in behavior that was not known to be risky at the time, such as drinking alcohol or smoking cigarettes, today, we know that it is best to avoid those substances completely to protect the health of the unborn baby.
Pregnant women should also limit caffeine intake, which is found not only in coffee but also in tea, colas, cocoa, chocolate, and some over-the-counter painkillers. Some studies suggest that very high amounts of caffeine have been linked to babies born with low birth weights. The American Journal of Obstetrics and Gynecology released a repo thatch found that women who consume 200 milligrams or more caffeine a day (which amount to 10 ounces of coffee or 25 ounces of tea) increase the risk of miscarriage. Consuming large quantities of caffeine affects the pregnant mother and leads to irritability, anxiety, and insomnia. Most experts agree that small amounts of caffeine each day are safe (about one 8-ounce cup of coffee a day or less). However, that amount should not be exceeded.
For both mother and child, foodborne illness can cause major health problems. For example, the foodborne illness caused by the bacteria Listeria monocytogenes can cause spontaneous abortion and fetal or newborn meningitis. According to the CDC, pregnant women are twenty times more likely to become infected with this disease, known as listeriosis, than nonpregnant, healthy adults. Symptoms include headaches, muscle aches, nausea, vomiting, and fever. If the infection spreads to the nervous system, it can result in a stiff neck, convulsions, or disorientation feeling. Foods more likely to contain the bacteria that should be avoided are unpasteurized dairy products, especially soft cheeses, smoked seafood, hot dogs, paté, cold cuts, and uncooked meats. To avoid consuming contaminated foods, women who are pregnant or breastfeeding should practice food safety guidelines. It is always important to avoid consuming contaminated food to prevent food poisoning. This is especially true during pregnancy. Heavy metal contaminants, particularly mercury, lead, and cadmium, pose risks to pregnant mothers. As a result, vegetables should be washed thoroughly or have their skins removed to avoid heavy metals.
Pregnant women can eat fish, ideally 8 to 12 ounces of different types each week. Expectant mothers can eat cooked shellfish such as shrimp, farm-raised fish such as salmon, and a maximum of 6 ounces of albacore or white, tuna. However, they should avoid fish with high methylmercury levels, such as shark, swordfish, tilefish, and king mackerel. Pregnant women should also avoid consuming raw shellfish to avoid foodborne illness. The Environmental Defense Fund eco-rates fish to provide guidelines to consumers about the safest and most environmentally friendly choices. Visit the FDA for more information https://www.fda.gov/food/consumers/advice-about-eating-fish
Food Cravings and Aversions
Food aversions and cravings do not have a major impact unless food choices are minimal. The most common food aversions are milk, meats, pork, and liver. It is not harmful to most women to indulge in the occasional craving, such as the desire for pickles and ice cream. However, a medical disorder known as pica is willingly consuming foods with little or no nutritive value, such as dirt, clay, and laundry starch. In some places, this is a culturally accepted practice. However, it can be harmful if these substances take the place of nutritious foods or contain toxins.
Physical Activity during Pregnancy
For most pregnant women, physical activity is a must and is recommended in the 2015 Dietary Guidelines for Americans. Regular exercise of moderate intensity, about thirty minutes per day most days of the week, keeps the heart and lungs healthy. It also helps to improve sleep and boosts mood and energy levels. Also, women who exercise during pregnancy report fewer discomforts and may have an easier time losing excess weight after childbirth. Brisk walking, swimming, or an aerobics class geared toward expectant mothers are all great ways to get exercise during pregnancy. Healthy women who already participate in vigorous activities, such as running, can continue doing so during pregnancy provided they discuss an exercise plan with their physicians.
However, pregnant women should avoid pastimes that could cause injuries, such as soccer, football, and other contact sports, or activities that could lead to falls, such as horseback riding and downhill skiing. It may be best for pregnant women not to participate in certain sports, such as tennis, that require you to jump or change direction quickly.
Complications during Pregnancy
Expectant mothers may face different complications during the course of their pregnancy. About 4 percent of pregnant women suffer from a condition known as gestational diabetes, which is abnormal glucose tolerance during pregnancy. The body becomes resistant to the hormone insulin, which enables cells to transport glucose from the blood. Gestational diabetes is usually diagnosed around twenty-four to twenty-six weeks, although the condition can develop later into a pregnancy. Signs and symptoms of this disease include extreme hunger, thirst, or fatigue. If blood sugar levels are not properly monitored and treated, the baby might gain too much weight and require a cesarean delivery. Diet and regular physical activity can help to manage this condition. Most patients who have gestational diabetes also require daily insulin injections to boost glucose absorption from the bloodstream and promote glucose storage in the form of glycogen in liver and muscle cells. Gestational diabetes usually resolves after childbirth, although some women who suffer from this condition develop Type 2 diabetes later in life, particularly if they are overweight.
- Identify key nutrients required before conception. (MCCCD Competency 4)
- Learn how nutrient needs change during pregnancy. (MCCCD Competency 4)
- Identify optimal weight gain during pregnancy. (MCCCD Competency 9)
- Discuss the health complications associated with underweight and overweight mothers.(MCCCD Competency 9)
- Discuss the health consequences of gestational diabetes. (MCCCD Competency 9)
- Identify foods and beverages to avoid during pregnancy and the health impact for mother and child. (MCCCD Competency 5)