Rational diet during pregnancy should be an adequate source of energy and necessary nutrition (proteins, fats, carbohydrates, minerals, and vitamins), in terms of quantities and proportions alike. Diversity is important: insufficient or excess intake of any product may be disadvantageous both to the mother and baby. Daily food intake should comprise products from all food groups, in correct […]

Rational diet during pregnancy should be an adequate source of energy and necessary nutrition (proteins, fats, carbohydrates, minerals, and vitamins), in terms of quantities and proportions alike.

1. Diversity is important: insufficient or excess intake of any product may be disadvantageous both to the mother and baby. Daily food intake should comprise products from all food groups, in correct proportions and with fluid complementation. All meals should be colourful, chiefly based on a variety of vegetables, diverse in consistency and culinary preparation methods applied.
2. Regular meals: food ingredient intake is at its optimum at 5-6 meals a day every 3-4 hours.
3. Moderation: the daily diet should be an adequate source of energy (calories) to meet current requirements. According to medical recommendation, the calorific value of female nutrition during pregnancy does not undergo any significant change, growing by approximately 360 and 475 calories per day during the second and third trimester, respectively.
4. Avoidance: so-called “empty calorie foods” ought to be eliminated, as they provide little nutrition while causing excess body mass gain. Furthermore, many products are a major source of fat, especially of saturated fatty acids and trans-fatty acids of potentially adverse health impact. Excess amounts of salt should also be avoided despite the fact that cooking salt is a source of iodine. Pregnant women should stay away from raw meat and fish – even if fresh, they may be a source of pathogenic bacteria. Other products to be avoided include unpasteurised milk and blue cheese made from unpasteurised milk. Liver is another product to be skipped when pregnant – not only because of its high cholesterol content, but also of excess vitamin A (retinol). When overdosed, vitamin A may result in a number of congenital foetal anomalies, such as craniofacial defects, central nervous system impairment, or cardiac disorders.
5. Moderate activity: pregnant women should remain active, walking and engaging in simple physical exercise. Any physical activity should be consulted with the attending physician.
6. Correct fluid balance: a healthy and balanced diet requires proper fluid complementation as an indispensable condition to the correct fluid and electrolyte balance in the maternal and foetal bodies. Pregnant women should drink approximately 2,300 ml of water per day.

7. Supplement only what you need: a healthy and balanced diet should provide all nutritive ingredients, vitamins and minerals required. Given the considerably greater nutrition demand during pregnancy, proper supply may occasionally prove tedious. Vitamin and mineral supplementation should be individually adjusted to the needs and nutrition habits of the pregnant patient, and always consulted with a physician.

Vitamins and micronutrients all expecting mothers should remember

Foetal health is considerably affected i.a. by the mother’s lifestyle and diet, before and during pregnancy. Learning more about key medical recommendations concerning vitamins and micronutrients indispensable to women planning a baby and to expectant mothers is definitely worthwhile. What is their role, and how may their shortage affect the body?

Before and during pregnancy, women need specific vitamins and micronutrients; not only do they directly affect foetal development; they also help prevent certain female medical conditions, such as muscular contractions. Yet all ladies ought to bear in mind that despite universally positive reviews of all such compounds, more does not necessarily mean better. Some (such as folic acid) should not be overdosed; vitamin A requires special attention. Such matters should always be discussed with a physician.

What should never be missed?

• Folic acid

Folic acid is the vitamin most frequently mentioned during pregnancy, and for a reason: folic acid prevents neural tube defects. 0.4 mg is the recommended daily dose (1). Yet it is always worthwhile to consult the issue with a physician, as in some cases – of BMI over 30 or certain diseases – dosage should be increased.

• Magnesium

We usually associate magnesium with preventing muscular spasms or eyelid twitching. Yet it is of much greater importance to our bodies; not everyone realises that magnesium deficiency increases the risk of arterial hypertension, may lead to increased sodium and/or calcium concentration rates, and reduces intracellular potassium levels. Moreover, correct magnesium concentration rates are crucial to calcium absorption rates, improving tissue, bone, and tooth development. Magnesium eliminates well-known leg (calf) muscle spasms as well as abdominal cramping, common in pregnant women. During pregnancy and breastfeeding, the female body requires increased magnesium intake, 200 to 1,000 mg per day (1). Increasingly often, such patients are recommended to take pure magnesium with no supplementary substances (such as vitamin B6) to avoid extra charge to the liver.

• Iron

In a simile to folic acid, it is vital to the correct development of the foetal central nervous system. It is particularly recommended prior to conception for women suffering of anaemia, to be resumed after the eighth week of pregnancy. The physician may also recommend iron to breastfeeding anaemic mothers to reduce the risk of anaemia in the infant. Daily recommended iron doses are 18 mg, 26-27 mg, and 20 mg when not pregnant, when pregnant, and during lactation, respectively (1). In case of oral supplementation, the Centre for Disease Control recommends the use of 30 mg iron preparations; the dose may be increased to 60-120 mg in case of anaemic female patients.

What else is worth knowing?

– Women lose more iron than men for reasons of the monthly menstrual blood loss, which is why they should supplement its deficit.

– Iron loss may cause anaemia, which may in turn result in low birth weight and/or premature birth.

• Calcium

Supports bone development and affects the endometrial cavity by reducing uterine contractions, which is of particular importance immediately before birth. Daily calcium demand totals 1,000 mg, reaching 1,200 mg per day in women in the second and third trimester and in breastfeeding mothers (1). Often as not, such calcium quantities cannot be delivered via a proper diet only; the use of oral preparations is then required. High intake of animal protein, cooking salt and coffee may result in excess calcium loss.

• Vitamin D3

It is a well-known fact that vitamin D3 is referred to as “sunny vitamin”, generated upon skin exposure to sunlight; it is thus natural that vitamin D3 deficiencies are typical for winter months (October to March) and may result in mineral, calcium, and phosphate imbalance, consequently in skeletal structure disorder. 800-1,000 μg is the daily recommended vitamin D3 dose for pregnant and breastfeeding women with low D3 diet or dermal absorption rates (1).

• Vitamin A (also referred to as retinol)

It improves skin, hair, and nail condition, and is beneficial to eyesight (in ancient times, its deficiency was referred to as “night blindness”). Beta-carotene carried by carrots and pumpkins is the perfect source of vitamin A, as the body can process and absorb it easily. Approximate daily demand for vitamin A totals 1 mg (1). Yet it should be borne in mind that vitamin A overdoses may cause cranial and cardiovascular system defects. The use of beta-carotene with reduced biological activity – vitamin A’s precursor – is safer for pregnant women, as its intestinal absorption drops when the body’s demand for vitamin A decreases.

• Vitamin E

It protects cell membrane against damage, prevents atherosclerosis, and reduces the risk of cancer. In pregnant women, daily vitamin E demand reaches 15-19 mg (1). While present in foods, they are not always sufficient in terms of required daily delivery. Oral supplementation is then required. Pre-term babies are frequently diagnosed with vitamin E deficiencies.

• Zinc

Ensures proper reproductive organ functionality. Zinc deficiencies hinder foetal development, and may potentially result in birth defects. Zinc loss may be caused by excess confectionery (sugar) intake.

• Omega-3 fatty acids

Residents of all areas located at considerable distance from the marine coast suffer of Omega-3 fatty acid deficiency. Acids in the meat of oily saltwater fish affect the heart by reducing cholesterol levels and blood coagulability, which in turn prevents clot forming – the cause of strokes and myocardial infarction. The demand for Omega-3 fatty acids increases during pregnancy, especially in the third trimester, given the rapid growth of the foetal central nervous system. Once the deficiency is eliminated, both maternal and foetal health improves; not only is the development of the foetal central nervous system boosted – the risk of preterm birth drops, mental functions improve, the baby’s motoric and cognitive functions expand, eyesight improves, and the risk of adult diabetes and hypertension decreases. Furthermore, the risk of postpartum depression and allergy is reduced, and foetal nutrition improves. The daily demand for Omega-3 acids in pregnant and breastfeeding women reaches approximately 200-300 mg DHA (1).

• Iodine

Approximately 50% of European residents suffer of iodine deficiency. Why is it so important? Iodine deficiency (slight to moderate) causes psychomotor development disorders and Attention Deficit  Hyperactivity Disorder (ADHD). Severe iodine deficiency may even result in nervous system development disorders tying in with hypothyroidism. Arising from iodine deficiency, hypothyroidism increases the risk of miscarriage and/or preterm birth. Iodine demand increases in pregnant women (especially during the first trimester) and in breastfeeding mothers. Appropriate daily iodine intake should be secured by supplementation with potassium iodide preparations (150 μg) and the use of cooking salt or iodised water (1).

Paper drafted on the basis of Zdrowa ONA programme materials.

Sources:

1. Position paper of the Polish Expert Team of the Polish Gynaecological Society regarding the use of vitamins and micronutrients during pregnancy – Ginekologia Polska 2011, 82, 550-553.

Folic acid – indispensable diet ingredient, during and after pregnancy

Observing recommendations concerning appropriate folic acid doses is vital to the correct course of pregnancy and the wellbeing of the mother and child. Why should women of reproductive age use folic acid prior to conception – and what is its role in the various foetal and infant development phases?

Folic acid – prior to pregnancy

Folic acid usually brings early weeks of pregnancy to mind. Yet it is essential before as well, for potential mothers in particular (see: http://www.swiadomemacierzynstwo.com/suplementacja#folik). Folic acid deficiencies may cause megaloblastic anaemia, digestive disorders, elevated blood homocysteine levels (and atherosclerotic lesions in consequence), decreased DNA synthesis, and reduced rates of cellular division. Folic acid deficiencies may also affect the nervous system, symptoms including concentration, memory, and sleep disorders, as well as anxiety and depression.

Folic acid is important when preparing for pregnancy – during the early days and weeks of foetal life, cells divide rapidly, resulting in the development of vital organs and nervous system structures. The neural tube then evolves into the foetal brain and spinal cord. In normal gestation, the neural tube should close during the first month of foetal life.

Regrettably, many sexually active women may not realise their condition early enough, and begin their course of folic acid late – whereas securing appropriate folic acid supply around the time of conception prevents the development of dangerous neural tube defects, as well as cardiac, limb, and urinary system defects; furthermore, it prevents cleft craniofacial abnormalities. (1)

Folic acid – during pregnancy

Specialists recommend folic acid intake by pregnant patients, during the first trimester in particular; yet foliates are also beneficial during the second and third trimesters. Foliates are a simple remedy to prevent complications, such as:

– miscarriage,

– low birth weight,

– neural tube defect with varying clinical presentations, including cranial and spinal deformation, anencephaly, spina bifida.

Folic acid intake by pregnant women reduces the neural tube defect risk by 58-100%. (2) The recommended dosage can be delivered by a supplement with a 0.4 g folacin content.

Pregnant women, especially if over thirty, are also prone to megaloblastic anaemia (3). In such cases, the folic acid dosage may be increased – yet the anaemia treatment decision lies with the physician.

Can a healthy diet not replace a supplement?

While folic acid is delivered with green leafy vegetables, yeast, citrus fruit, legumes, and meat, it should be borne in mind that major vitamin loss occurs during thermal processing and whenever food is exposed to sunlight. Moreover, foliates are not fully absorbed by the human digestive system –  occasional absorption disorder issues may occur. Furthermore, not all good folic acid sources are appropriate for pregnant patients (citrus fruit, vegetables conducive to gas – brassicas and legumes – or liver). In such cases, actual meals have auxiliary properties.

When the baby is born: folic acid postpartum

Breastfeeding is also hugely important to the proper development of the baby, who has to receive an adequate portion of vitamins and minerals, with breast milk, folic acid included. Folic acid is beneficial to the infant’s nervous system and reduces the risk of anaemia, whose symptoms include general weakness and irritability, dyspnoea, and cardiac disorder. Should the new mother’s diet be rich in folic acid sources, supplementation is not necessary. Yet it is recommended in case of malnutrition, appetite disorder, or absorption issues (e.g. in case of selected medicines intake).

Folic acid is therefore important at different stages of your baby’s growth, not to mention its favourable effect on the health and wellbeing of the new mum.

For more information on correct folic acid supplementation, please visit http://www.swiadomemacierzynstwo.com/suplementacja