Nutrition in Pregnancy

Nutrition in Pregnancy

During pregnancy there should be an increase in all nutrients to meet the physiologic demands of maternal changes and fetal growth. The amount of increase in essential nutrients for each woman depends on a number of factors, such as

• the general nutritional status before pregnancy,
• current health status, age and parity,
• time interval between pregnancies
• height, weight and activity level

Adolescents who are pregnant before the cessation of their own growth do not have the physiologic maturity to withstand the additional stresses of pregnancy. They need greater nutritional requirements then do adults.

Calorie increase:

Calorie requirements must be increased between 10 and 15 percent during pregnancy to meet the increased energy demands of the women’ s body and the development of the fetus. The total energy cost during pregnancy is approximately 80,000 calories. Therefore, an increase of about 300 calories (kcal) per day is needed during pregnancy. A well balanced diet consisting of about 2500 calories a day will meet the nutritional demands of pregnancy.

A. Protein:

Protein should be increased from 45 to 50 gm per day in the non-pregnant women to 60 gm per day for the pregnant women. For adolescent pregnancy, the protein requirement is 1.5 g per kilogram of body weight.

Protein is needed to provide additional amino acids

1. to support rapid fetal and placental growth

2. growth of the breasts and uterus

3. expansion of maternal blood volume and

4. to meet the demands of labour, birth and lactation.

Sources of complete proteins:

Milk, cheese and eggs, meet, fish, poultry, grains, legumes and nuts. Vegetable proteins can be combined with complete proteins, (or) two vegetable proteins that complement each other’ s amino acid deficiencies can be eaten together to make a complete protein.

Example: Milk and cereal., Rice with beans.

B.  Carbohydrates and fats:

The role of carbohydrate and fats during pregnancy are to contribute to the total calorie intake required for maternal and fetal growth.

Sources of carbohydrates and fat:

Fruits, whole grains cereal, milk and bread. Fats are found in butter, cheese, oil and nuts.

C.  Vitamins

Vitamin intake should be maintained or increased during pregnancy and lactation. This intake should be obtained through a well balanced diet. The role of vitamins in the diet is to maintain the normal cell structure and function and to support the growth of new tissues. The fat-soluble vitamins A, D, E and K are stored in the liver in moderate amount. They are absorbed along with the dietary fats eaten.

1. Vitamin A:

Vitamin A is essential for cell development, tooth formation and bone growth. It plays a role in the metabolism of carbohydrate and deficiency causes night blindness.

Sources: Organ meat, egg yolk, butter, yellow fruits and vegetables, green leafy vegetables. Excessive amounts of vitamins A are toxic and during pregnancy could be teratogenic, causing congenital fetal malformations. Hence usually pregnant women are not given vitamin A supplements.

2. Vitamin D:

Vitamin D is needed to enhance the absorption and use of calcium and phosphorus, which are needed for fetal skeletal and tooth formation.

Sources: Liver, egg yolk, milk, fresh fruits and vegetables. Sun exposure causes Vitamin D synthesis in the skin.

3. Vitamin E:

The primary function of vitamin E is as an antioxidant. It takes on oxygen so that the substance will not undergo chemical change.

Source: Vegetable fats and oils, whole grains, greens and eggs.

4. Vitamin K:

It is essential for blood coagulation and prevention of hemorrhage. The RDA for pregnant women is 65 g/day. Intake of vitamin K is usually adequate in a well-balanced diet.

5. Vitamin B Complex:

The entire B complex of Vitamin B1 (Thiamine), B2 (riboflavin), B6 (pyridoxine), B12 (cobalamin) , niacin and folic acid have the important function in metabolic function and energy metabolism. Therefore the Vitamin B requirement increases as calorie intake increases to meet metabolic and growth needs.

·         Vitamin B1:

o   Vitamin B1 requirements increase from 1.1mg/day to 1.5mg/day.

o   Sources: pork, liver, milk, potatoes, bread and cereals.

·         Vitamin B12

o   Vitamin B12 requirement 1.6 mg/day.

o   Sources: Milk, liver, eggs, bread and cereals.

·         Vitamin B6:

o   Vitamin B6 is associated with protein metabolism, so that if the protein intake is higher than average, vitamin B6 intake should be higher.

o   Vitamin B6 plays a vital role in the development of baby’ s central nervous system. Requirement is 2.2mg per day.

o   Source: Fish, liver, port, potatoes, wheat germ, and yeast.

·         Vitamin B12:

o   Vitamin B12 is found only in animal source and it is essential for formation red blood cells.

o   Sources: Milk, meat, liver, eggs and cheese.

o   2.2 g per day

o   Deficiency leads to pernicious anemia

·         Niacin :

o   Niacin requirement of pregnant women is 17mg/day.

o   Sources: Meat, poultry, fish, liver, whole grains, bread, cereals and nuts.

·         Folic acid:

o   It is important for the promotion of adequate fetal growth.

o   Requirement during pregnancy is 400g/day.

o   Sources: Fresh green leafy vegetables, organ and bananas, kidney, liver, meat, dried bean. 80 percent of folic acid is lost in cooking.

o   Deficiency of the Folic acid leads to spontaneous abortion, fetal malformations neural tube effect. Supplementation of folic acid 400g / day, is recommended during antenatal period.

·         Vitamin C:

o   During pregnancy, Vitamin C aids in the formation and development of skin and vascular system of fetus. It enhances the absorption and storage of iron.

o   The Requirement is 70 mg/day.

o   Deficiency of Vitamin C: causes scurvy.

o   Sources: A well balanced diet provides the required amounts of vitamin C. Food rich in Vitamin C include citrus fruit, strawberries, tomatoes, potatoes, and green leafy vegetables.

D.  Minerals:

1. Iron:

Iron is essential in the synthesis of hemoglobin in maternal and fetal red blood cells. Unfortunately most Indian women enter pregnancy with low iron stores. Deficiency leads to iron deficiency anaemia. Women at risk for iron deficiency anaemia are

1. Women with frequent childbirth.
2. Women with multiple gestations.
3. Women with poor diets.

Requirement for pregnant women is 60 mg per day

Sources: Meat, liver, eggs, green leafy vegetables, bread and cereals.

The absorption of iron from vegetables sources can be enhanced by combining them with vitamin C sources. Pregnant women absorb only about 15-25 percent of available iron in food. A well-balanced diet with good iron- rich food will provide only about 15 to 18mg of iron per day. Therefore, a supplement of iron such as ferrous gluconate, ferrous fumarate or ferrous sulphate is needed.

2. Zinc:

Zinc is essential for normal fetal growth and development and uterine contractility for the initiation of labour. The RDA for Zinc during pregnancy is 15mg/day

Sources: Liver, wheat bran, milk.

Deficiency: Deficiency leads to infection, fetal malformation, low birth weight, and intrapartum hemorrhage.

3. Copper:

Copper is essential in the absorption, storage and release of iron. The RDA for copper in the non-pregnant women is 3mg/day. The exact requirement for pregnant women is not known.

Sources: Liver, meat, oysters, nuts, corn oil and dried legumes and drinking water.

4. Calcium:

Calcium is essential in pregnancy

• For the fetal skeletal formation
• Teeth formation and
• Regulation of nerve and muscle activity.

The RDA for calcium during pregnancy is 1200 mg per day. The RDA for pregnant teenager is 1600 mg per day.

Sources: Milk and milk products, green leafy vegetables, whole grains and bread.

4. Phosphorus:

Phosphorus is necessary for the rapid division and growth of new fetal cells. The RDA during pregnancy is 1200 mg per day.

Sources: Meat, chicken, eggs, milk and cheese.

5. Magnesium:

Magnesium is important during pregnancy for cellular metabolism and structural growth.

The RDA for pregnancy is 320 mg per day.

Sources: Milk, whole grains, legumes, nuts and tea.

6. Iodine :

Iodine is needed for the regulation of the metabolism.

Source: Sea foods including fish and oysters Iodine deficiency of a pregnant woman may lead to cretinism in infant.

E.  Water:

Fluid intake is an important component of a well-balanced diet to support the physiological changes taking place. An adequate intake helps by assisting with digestion and in prevention of constipation. Requirement of water: 2000-2500ml per day.

Weight gain in pregnancy:

Weight gain during pregnancy is an important indicator of maternal-fetal well-being. The amount of weight a woman should gain varies, depending on her pre-pregnancy weight and her health status. This body mass index (BMI) is a better indicator of maternal nutritional status than weight alone.

Body mass index = pre pregnancy weight (in kilogram) height (in metre)2

Common nutritional problems during pregnancy

1. Underweight during pregnancy

It is associated with maternal anemia, cardiopulmonary problems, interactive growth retardation and pre-term delivery. The underweight women should take 500 calories per day above the non-pregnant RDA. The protein intake should be increased to 20gm per day.

The weight gain recommendations by Pre - pregnancy Body Mass Index (BMI)

Weight - for –height category

Recommended total weight-gain during pregnancy (in kilograms)

• LOW ( BMI < 19.8)               ------------ 12.5 – 18

• Normal (BMI 19.8 –26.0)       ------------ 11.5-12.5

• High ( BMI > 26.0 – 29.0)      ------------ 7.0 – 11.5

2. Overweight during pregnancy:

It is associated with an increased risk for hypertensive disorders of pregnancy, diabetes, infection, large birth weight babies, and dystocias of labour. Women who are overweight should not attempt to lose weight during the pregnancy. During pregnancy, the goal should be to improve the quality of the diet.

Common nutritional risk factors in pregnancy

In addition to being underweight or overweight, a number of factors pose nutritional risks during pregnancy and threaten the well-being of the mother and infant.

i)                    Frequent pregnancies

ii)                  Women with medical or obstetric problems

iii)                Fad diets.

iv)                Eating disorders.

v)                  Adolescent pregnancies

vi)                Substance abuse.

vii)              Myths about foods.