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NUTRITION AND SUPPLEMENTS FOR PREGNANCY
Even before pregnancy begins, nutrition is a primary factor in the health of mother and baby. A well-balanced diet before conception contributes to a healthy pregnancy and will probably need few changes.
Pregnant women should increase their usual servings of a variety of foods from the four basic food groups to include a total of four or more servings of fruits and vegetables, four or more servings of whole-grain or enriched bread and cereal, four or more servings of milk and milk products, and three or more servings of meat, poultry, fish, eggs, nuts, and dried beans and peas.
These additional servings will help meet the recommended daily allowances (RDAs) of nutrients required to maintain good health. These RDAs from the National Research Council were updated in 1989. The accompanying chart outlines the requirements of vitamins and minerals during pregnancy.
Iron is needed in larger doses, especially in the later stages of pregnancy, and cannot be met by diet alone, according to the National Research Council. This mineral is essential to the formation of healthy red blood cells, and it is difficult for a woman to consume enough of it from foods to maintain an adequate supply for herself and her fetus. Without enough iron, the fetus will draw its supply from the mother, often leaving her anemic and exhausted. An iron supplement can alleviate this condition. Calcium supplementation is also very important.
Folacin has been shown to be important in preventing neural tube defects, such as spina bifida. The need for folacin also is essential to the formation of red blood cells.
Nutrition During Pregnancy
During pregnancy, try to eat as many fresh vegetables, whole grains, and legumes (peas or beans) as possible. Stay away from processed foods. Many women think that when they become pregnant, it means they can eat anything they want. This is not true. What you eat during pregnancy can really affect the health of your baby and your own pregnancy, actually making it easier. Your daily energy needs will increase by only 300 calories per day (100 calories equals one slice of bread and one small piece of fruit.) This is only during the second trimester.
Vitamin and mineral needs, on the other hand, are high from conception to delivery. So, you must eat more nutrients for the same (or slightly more) calories. The best way to do this is to eat foods that are as close to their natural, wholesome forms as possible. You must think before you eat and think before you do not eat, as any deficiencies caused by not eating will affect your baby as well as yourself.
As a pregnant woman, you will need more protein than at any other time in your life, particularly in the second and third trimesters. However, you will probably have no trouble eating plenty of it, as protein is the least likely nutrient to be lacking in the diet. In fact, most Americans eat twice as much protein as they actually need. As before, starches and carbohydrates should be the mainstay of your diet. In fact, they may even help fend off morning sickness. Fat adds calories without giving you many of the minerals and nutrients that you need. Try to limit it to 25% to 30% of your daily calorie intake. When trying to plan your meals, it helps to follow these three rules of thumb:
- 2/3 to 3/4 of your plate should be grains, fruits, vegetables and legumes. Another way to think of this is that for every serving of protein-rich or calcium-rich foods (meat or dairy products), you should be eating at least three servings of fruit, vegetables, grains or legumes;
- You should try to eat at least one fruit or vegetable in every snack; and
- Fat, sugar and salt intake should be reduced, but not completely eliminated. Fat helps in the absorption of fat-soluble vitamins (A, D, E and K) and supplies the essential fatty acid linoleic acid. Salt contains sodium, which is needed to regulate muscle and nerve functions and to maintain the body's natural fluid balance. Sugar adds taste and pleasure to foods.
Weight Gain During Pregnancy
Thirty years ago, the National Research Council's Food and Nutrition Board advised women to gain 20 to 25 pounds during pregnancy. Studies have since shown that underweight women, or those who gain fewer than 20 pounds during pregnancy, are at an increased risk of delivering low-birth-weight babies. It is now recommended that women gain 25 to 35 pounds during a normal pregnancy to decrease this risk. Adolescents and black women, who often have smaller babies, are now strongly advised to gain a greater amount. Check with your physician for latest information.
The recommended increase in weight gain does not give a green light for mothers-to-be to overeat. Although the extra nutrients are required, an increase of only 300 calories per day is recommended. Weight gain during pregnancy should be gradual. Women should gain 3 to 4 pounds in the first three months and 3 to 4 pounds per month during the rest of the pregnancy. Approximately 6 to 8 pounds of the total weight is the baby, and the remaining weight consists of an increased fluid volume, larger breasts and uterus, amniotic fluid, and placenta.
Contrary to popular belief, sodium, which helps to regulate water in the body, is needed in larger quantities during pregnancy. Larger than normal amounts of this electrolyte are needed because of increased fluid volume in the mother, the requirements of the fetus, and the level of sodium in the amniotic fluid. For those who do not have high blood pressure, salt restriction is not recommended. Those with medical problems that require salt restriction should consult their physicians. Trace minerals, such as iodine, usually needed in small amounts, are needed in greater quantities during pregnancy. Iodine can be obtained in iodized salt and spinach.
What About Caffeine?
Caffeine--a stimulant found in colas, coffee, tea, soft candies, chocolate, cocoa, and over-the-counter and prescription drugs--has been a controversial topic in pregnancy nutrition for more than a decade. A 1980 study by FDA found that caffeine, when fed to pregnant rats, caused birth defects and delayed skeletal development in their offspring. At that time, although the human implications were unknown, FDA advised pregnant women to eliminate caffeine from their diets.
Since then, more studies have been done to determine the effects of caffeine on the fetus. A study of women in Costa Rica, where coffee consumption is high, showed a significantly lower birth weight for infants and a lower concentration of iron in mothers who were coffee drinkers. This report indicated that maternal coffee intake may also contribute to maternal and infant anemia.
Consumed in large quantities, caffeine can cause irritability, nervousness, and insomnia. In addition to crossing the placenta and affecting the fetus, it is also a diuretic, dehydrating the mother's body of valuable water. After the baby is born, caffeine can also be transmitted through breast milk.
As mentioned, caffeine is an ingredient in some over-the-counter (OTC) and prescription drugs. Before taking any drugs, a pregnant woman should consult her physician.
Thomas G. Stovall, M.D.
Dr. Stovall is a Clinical Professor of Obstetrics and Gynecology at the University of Tennessee Health Science Center in Memphis, Tennessee and Partner of Women's Health Specialists, Inc.
Date Published: 2002-02-14
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