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Nutrition During Pregnancy

by Meredith Beil BPharm MNutr & Alice Downing APD, MDiet & BHumNutr

Nutrition During Pregnancy

Leading up to and throughout pregnancy it is vital that women eat a healthy diet for the proper growth and development of baby, as well as their own health. This is a time when it is especially important that women eat a wide variety of foods in accordance with dietary guidelines, such as those issued by the Australian National Health and Medical Research Council. Some nutritional requirements are increased during pregnancy, such as folic acid and iron, and it is recommended that women take these as supplements, in addition to a nutritious balanced diet. Discuss supplementation options and products with your GP or accredited practising dietitian (APD).

Folic Acid To Prevent Neural Tube Defects

It is vital that folate levels are adequate during the initial stages pregnancy, in particular for the development of the baby’s brain and spinal cord. It is recommended that all women take a folic acid supplement for at least one month before and for three months after conception. Folate is essential for DNA synthesis and the rapid growth of the foetus requires a high level of this vitamin, particularly during brain and spinal development in the first six weeks.

For women with a family history of neural tube defects a daily supplement of 5mg of folic acid will protect against neural tube defects (NTD) such as spina bifida or anencephalus. For women who have no family history of NTDs the current recommendation is 0.4mg daily of supplemental folic acid in addition to consuming dietary sources of folate. Australia introduced mandatory folic acid fortification of bread flour, except for organic products in 2009, which is expected to reduce the number of NTD affected pregnancies by up to 14% each year. Many breakfast cereals are fortified with folic acid, whilst leafy green vegetables are a good source of folate.

Calcium

The NHMRC currently recommends that pregnant women have a daily calcium intake of 1000mg. For teenage pregnancies the recommendation is 1300mg to support the continuing development of the mother’s bones. Calcium is essential for bone and tooth development as well as proper nervous system and heart function. Calcium requirements can be met by eating 3 serves of low fat dairy products or calcium fortified foods as part of a healthy and varied diet. One serve is equivalent to 250mL of milk or calcium fortified soymilk, two slices (40g) of cheese or a 200g tub of yoghurt. Check the nutrition information panel on products to check the amount of calcium you are consuming.

The calcium in dairy foods is easily absorbed, and diary has many other health benefits. Low fat and reduced fat dairy products are recommended for adolescents and adults. There are many other dietary sources of calcium, including canned fish with bones, dark green leafy vegetables, tofu, and almonds. Where dietary intake is inadequate a calcium supplement is recommended. Discuss supplementation with your GP.

Iron

Iron deficiency is a significant health problem in Australia, particularly during pregnancy, when daily requirements increase significantly to meet the needs of the placenta, baby and the mother. Adequate iron levels are essential to prevent anaemia, which compromises oxygen delivery to baby and adversely affects the health of the mother. It is recommended that pregnant women take an iron supplement throughout their pregnancy, as their iron needs are not likely to be met through dietary sources alone. Before taking an iron supplement women should speak with their doctor and an accredited practising dietitian (APD) to discuss a supplement that is appropriate for them.

Supplementation with 20mg of iron daily has been found to be effective in preventing iron deficiency without significant side effects. The recommended dietary intake is 27mg per day during pregnancy. There are two types of dietary iron, haem and non-haem iron. Heam-iron is more readily absorbed. The best dietary sources of heam-iron are red meats, such as lean beef and lamb. Chicken, game and fish also contain haem-iron but in smaller amounts. Non-haem iron in legumes, whole grains, fortified breakfast cereals, nuts and green leafy vegetables also plays an important role. Optimise the absorption of non-haem by having vitamin C rich foods in the same meal.

Iodine

Iodine is an essential part of the thyroid hormones required for normal growth and development of babies, including development of the central nervous system. Even mild iodine deficiency may result in mental impairment. There is concern that iodine intake is inadequate in Australia. Research has demonstrated that residents in Sydney and Tasmania may have mild iodine deficiency due to inadequate levels of iodine in our food supply.

Major food sources of iodine are fish, seafood, and iodised table salt. Salt added to processed foods is generally not iodised. If you are taking a multivitamin supplement for pregnancy, be sure that it contains adequate iodine. The recommended dietary intake of iodine in pregnancy is 220mcg per day.

Omega 3 Fatty Acids

Omega-3 fatty acids (EPA and DHA) are required for brain and visual development of the foetus. The best sources of EPA and DHA are fish oil supplements and oily fish such as salmon (canned or fresh), fresh tuna, mackerel, and sardines. During pregnancy, three serves of fish per week are recommended. Mercury toxicity is of concern in pregnancy and consumption of species such as shark (flake), tuna, marlin and swordfish should be limited to one serve once or twice per fortnight.

Cereals And Breads

During pregnancy most women will require up to 8 serves of breads, rice, noodles, pasta and cereals per day. You may require more or less than this, depending on your energy requirements. One serve is equivalent to 1 slice of bread or ½ a cup of cereal, rice, pasta or noodles.

Fruit and Vegetables

It is recommended that women eat 2 serves of fruit and least 5 serves of vegetables per day during pregnancy. One serve of fruit is equivalent to 1 medium banana or 2 small kiwi fruits. One serve of vegetables is equivalent to ½ a cup of cooked or 1 cup of raw (e.g. salad) vegetables. Fruit and vegetables are excellent snack foods. Choose fruit and vegetable snacks instead of energy dense, nutrient poor packaged and processed snacks.

Protein Foods

Most women should aim to include 3½ serves of protein rich foods each day to support the growth of the baby and maintenance of the mothers muscle mass. Protein rich foods include lean meats, fish, poultry, nuts and/or legumes. One serve is equal to 65 to 100g of cooked meat, 2 small eggs or 1 cup of legumes. Having a vegetarian day once weekly using legumes or beans as a meat substitute has many health benefits.

Alcohol, Caffeine And Other Drugs

Smoking during pregnancy has detrimental effects on the baby and mother and should be completely avoided. Alcohol and caffeine may be consumed in small amounts. Alcohol in excess causes permanent physical and intellectual disabilities (foetal alcohol syndrome) and even a moderate intake increases the likelihood of miscarriage. Many women chose to avoid alcohol completely during pregnancy. Caffeine has been found to be safe in amounts of up to 3 to 4 cups of instant coffee per day. The consumption of illicit drugs, as well as many prescribed and over the counter medications, including natural therapies, by a mother during pregnancy may be harmful to the foetus.

Enjoy eating a nutritious diet, during pregnancy knowing you are doing your best for your developing baby!

References

1. National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand; including recommended dietary intakes. 2006.

2. http://www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_066.pdf. Accessed 23/11/2007

3. National Health and Medical Research Council. Dietary guidelines for Australians. 2005.