Parenting Australia

Nutrition During Pregnancy

It is important to choose a wide variety of foods to ensure the nutritional needs of both mother and baby are met. Try to eat:

• Lots of fruit and vegetables, wholegrain breads and cereals
• Moderate amounts of low fat dairy foods and lean meats
• Small amounts of foods high in fat, sugar and salt
• Lean meat, chicken and fish
• Dried beans and lentils
• Nuts and seeds
• Low fat milk, cheese and yoghurt
• Green leafy vegetables

Folic acid (folate)

Folate (known as folic acid when added to foods) is a B-group vitamin found in a variety of foods. Some breakfast cereals, breads and juices are fortified with folic acid. This will be listed on the nutrition label of these products.

As well as a healthy diet, it is also recommended that a folic acid supplement be taken prior to conception and for the first three months of pregnancy to reduce the risk of neural tube defects such as spina bifida. Folate taken over this period can prevent up to seven out of 10 cases of neural tube defects.

If you are planning a pregnancy or are in the early stages of pregnancy, you should increase your folate intake by an additional 0.4mg (400mcg) per day above the recommended daily intake (RDI) of 0.6mg (600mcg) per day for pregnancy.

Folate in your diet

Excellent food sources of folate include:

• Asparagus
• Bran flakes
• Broccoli
• Brussels sprouts
• Chick peas
• Dried beans
• Lentils
• Spinach

Very good food sources of folate include:

• Cabbage
• Cauliflower
• Leeks
• Oranges
• Orange juice
• Parsley
• Peas
• Wheat germ
• Wholegrain bread

Good food sources of folate include:

• Hazelnuts
• Vegemite
• Parsnips
• Potato
• Salmon
• Strawberries
• Tomato
• Unsalted peanuts
• Walnuts

Although liver is high in folate, it should not be recommended to women who are, or could be pregnant, because of its high vitamin A content.

Iron

Pregnancy increases the need for iron in the diet. The developing foetus draws enough iron from the mother to last it through the first five or six months after birth so a woman has an increased need for iron during pregnancy.

Iron losses are reduced during pregnancy because women are no longer menstruating and so lose less iron from menstrual blood loss. It is useful to include foods that are good sources of iron in the diet every day (for example red meat) and to have foods that are good sources of vitamin C (like oranges) to help absorb the iron.

The recommended daily intake (RDI) of iron during pregnancy is 27mg per day (approximately 9mg per day more than that for non-pregnant women). The amount needed depends on the amount of iron the mother has ‘stored’ in her body prior to pregnancy. If a woman’s iron stores are very low, she may need to get more from supplements. However, iron supplements can cause constipation.

Vitamin A

Although vitamin A requirements do increase during pregnancy, vitamin A supplements are rarely recommended for pregnant women. This is because an excessive intake of vitamin A may cause birth deformities.

The best way to increase your intake of vitamin A, if it is low, is through food sources like milk, fish, eggs and margarine.

Multivitamin supplements

Multivitamin supplements may be recommended for the following groups of pregnant women:

• Vegetarians
• Teenagers who may have an inadequate food intake
• Substance misusers (of drugs, tobacco and alcohol)
• Obese pregnant women who are restricting their energy intake to prevent large weight gains

There is no need for extra calcium during pregnancy

Until 2006, Australian dietary recommendations advised increased calcium intake during pregnancy and lactation. This advice has since been revised. Although there is a large ‘shift’ of calcium to the baby during the third trimester of pregnancy, as it starts to develop and strengthen its bones, the mother’s increased capacity to absorb dietary calcium makes up for this loss without the need for extra intake.

The recommended dietary intake for non-pregnant women (1,000mg per day for women aged 19–50 years and 1,300mg per day for adolescents or those aged over 51) remains unchanged during pregnancy and breastfeeding. Dairy foods, such as milk, cheese and yoghurt, and calcium-fortified soymilk are excellent dietary sources of calcium.

Eating for two

There is no need to eat more food during pregnancy. Experts recommend that, for the first trimester, a woman’s energy (kilojoule) intake should remain about the same as it was prior to the pregnancy. During the second and third trimesters, energy requirements increase by about 600kJ a day. Increasing fruit intake to four serves each day (from the recommended two serves for non-pregnant women) will provide all the extra energy needed.

The dangers of dieting

Some women fear the extra weight gain of pregnancy and decide to eat sparingly to avoid putting on body fat. Restricted eating or crash dieting in any form while pregnant can seriously compromise your health and that of your baby.

Pregnancy in adolescence

Pregnant adolescents need more nutrients than adult women, because they are still growing. Adolescents may give birth to smaller infants because they are competing with the growing foetus for nutrients.

Anaemia is more common among adolescents than older women. Calcium intake is also important because young women have not yet reached their peak bone mass and inadequate calcium intake may increase the risk of osteoporosis developing later in life.

Nausea and vomiting

Nausea and vomiting, especially ‘morning sickness’, are common during pregnancy – particularly in the first trimester. Small carbohydrate snacks (a sandwich or fruit) every two to three hours may provide some relief. The following suggestions may also help:

• Eat some dry bread, biscuits or cereal before getting up in the morning. Get up slowly, avoiding sudden movements.
• Drink liquids between rather than with meals to avoid bloating, which can trigger vomiting.
• Avoid large meals and greasy, highly spiced foods.
• Suck something sour like a lemon.
• Relax, rest and get into the fresh air as much as possible. Keep rooms well ventilated and odour free.
• Slowly sip a fizzy drink when feeling nauseated.
• Try food and drinks containing ginger as these sometimes relieve nausea.

Heartburn

Heartburn is common in pregnancy because, as the baby grows, there is more pressure on the abdomen. Small, frequent meals may be better than large meals. Try to avoid:

• Eating late at night
• Bending, lifting or lying down after meals
• Excessive consumption of tea or coffee

You may also like to try sleeping with your bedhead raised a few inches. You can do this by putting a folded blanket or pillow under your mattress.

Alcohol during pregnancy

The safe level of alcohol consumption is unknown. Consuming alcohol during pregnancy increases the risk of miscarriage, low birth weight, congenital deformities and effects on the baby’s intelligence.

The National Health and Medical Research Council advises women that it is best not to drink during pregnancy. Australian Alcohol Guidelines recommend that women who are pregnant or who are considering pregnancy should never become ‘drunk’ and may like to consider not drinking at all. If you choose to drink, it is suggested to have less than seven standard drinks in a week and no more than two standard drinks on any one day.

Listeria infection

The bacteria Listeria monocytogenes can contaminate some foods. Healthy people may experience no ill-effects at all, but the risks are substantial for pregnant women. The greatest danger is to the unborn baby, with increased risk of miscarriage, stillbirth or premature labour. A listeria infection is easily treated with antibiotics, but prevention is best.

Some foods are more prone to contamination than others. Exclude these foods from your diet if you are pregnant:

• Soft cheeses, such as brie, camembert and ricotta – these are safe if served cooked and hot
• Precooked or pre-prepared cold foods that will not be reheated – for example, pre-prepared salads, pate, quiches and delicatessen meats like ham and salami
• Raw seafood such as oysters and sashimi or smoked seafood such as salmon (canned varieties are safe)
• Unpasteurised foods
• Soft-serve icecream

The organism that causes listeria is destroyed by heat, so properly cooked foods are not a risk.

Salmonella

Salmonella is a cause of food poisoning that can trigger miscarriage. The most likely sources of salmonella are raw eggs and undercooked meat and poultry.

Good food hygiene

Good food hygiene is the best way to reduce the risk of salmonella and listeria infections. Suggestions include:

• Always wash your hands before and after preparing food.
• Keep your kitchen surfaces clean.
• Do not let uncooked food contaminate cooked food.
• Wash fruit, vegetables and salad before eating.
• Cook food thoroughly.
• Keep pets away from kitchen surfaces.
• Wear rubber gloves when handling cat litter trays or gardening.
• Store food at correct temperatures.

Mercury in fish

It is suggested that pregnant women eat 2–3 serves of fish every week for good health. Caution should be exercised when choosing the type of fish you will eat.

There are a few types of fish that need to be limited because they contain high levels of mercury, which is dangerous for the developing foetus.

Pregnant women should:

• Limit to one serve (150g) per fortnight – billfish (swordfish, broadbill and marlin) and shark (flake), with no other fish eaten in that fortnight.
• Limit to one serve (150g) per week – orange roughy (deep sea perch) or catfish, with no other fish eaten that week.

Women should not be worried if they’ve had the odd meal of fish with high levels of mercury. It is only a potential problem when that type of fish is eaten regularly, which causes a build-up of mercury in the mother’s blood.

Where to get help

• Your doctor
• Midwife
• Obstetrician
• An accredited practising dietitian, contact the Dietitians Association of Australia

Things to remember

• A pregnant woman needs to boost her nutrient intake, rather than her kilojoule intake.
• Pregnancy creates extra demands for certain nutrients including iron and folate.
• Good food hygiene is particularly important during pregnancy.

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