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Pregnancy

Nutritional care during pregnancy (Mumbai Mirror:3 June 2010)

Dr Sunita Dube shares tips on how to take care of yours and your child’s nutritional needs when you are
pregnant

A well balanced diet is more important when you are pregnant, since what you eat has to meet your
unborn baby's needs as well as your own requirements. While nutritional needs and your own tolerance
for eating will change during the different trimesters of your pregnancy, there are some general guidelines
that will be important to follow throughout the nine months. For starters, eat balanced meals, do not skip
meals, eliminate caffeine and drink lots of water, eight to nine glasses a day.

Energy is needed during pregnancy for the growth and physical activity of fetus, the growth of placenta,
the normal increase in maternal body size, rise in basal metabolic rate during pregnancy. Calories intake
depends upon the BMI (Body Mass Index) of women. The average calories required in 24 hours during
pregnancy is 2500 to 2600 kcal, and proteins have to be increased. If a woman is obese then she will have
to increase her protein (milk, cheese, fish, meat) and complex carbohydrate and supplement it with iron,
calcium, folic acid, etc. She should take small, frequent meals if possible, and have some dry snacks or
dry fruits in the night to avoid early morning hypoglycemia.

Protein intake should be increased by 10 grams a day. It is necessary for growth and development of the
foetus. Some plant foods, such as legumes, seeds and cereal grains, can also provide high quality protein.
It is more beneficial if you combine one food from two of these categories in the form of such dishes as
split pea soup, or peanut butter sandwich.

Calcium is one of the most important minerals you will need during pregnancy. The current recommended
amount of calcium intake during pregnancy is 1,200 mg, an increase of 400 mg a day over your usual
needs. An increase in dairy products such as skim milk, cheese, yogurt, pudding and ice milk, is an easy
way to consume lots of calcium. There are also many good non-dairy sources of calcium, including
fenugreek leaves, broccoli, beans, ragi, nuts and calcium-fortified orange juice.

Folic acid is essential for a healthy baby and helps in the development of the foetal brain and spine. It is
also preventing macrocytic anemia of pregnancy and needed for synthesis of DNA and RNA. Women
should take 400 micrograms of folic acid every day throughout their pregnancy. Some excellent sources
of folic acid include dried beans, tofu, almonds, wheat germ, peanuts and peanut butter, as well as
fortified cereals. Folic acid can also be found in many dark green vegetables, lettuce, cabbage, cucumber,
corn, and beets.

GENERAL DIETARY PROBLEMS

Nausea & vomiting: During pregnancy, elevated levels of human chronic gonadotropin (HCG) are
thought to be one of the factors responsible in causing vomiting. Estrogen is also known to play its role in
triggering nausea or queasiness during pregnancy.
Morning sickness can be improved by small and frequent meals. Fairly dry and consisting chiefly of
easily digested energy foods such as carbohydrates are more readily tolerated. Liquids may best be taken
between meals instead of food. Skim milk is better option than whole milk. Yogurt is also an excellent
choice. Fruits, vegetable & pulses can be given. Avoid fried food, excessive seasoning, caffeinated and
carbonated drinks. Excessive vomiting may lead to dehydration. So, you must drink extra liquids to
compensate for the loss.

Constipation: In the first trimester, it is caused by progesterone which slows down intestinal activity. In
the later part of pregnancy the pressure of your uterus on your intestines and rectum makes your system
sluggish. Iron supplements, Stress and tension and lack of fluid and fiber in diet contribute to
constipation.
Solution – Increased fluid intake (10 glasses of water /day), naturally laxative such as high fiber grains
oats, grains, nuts fruits, & vegetable should include in your diet. Regular habit of exercise (with your
doctor’s advice) and enough sleep are essential for proper elimination.

Gestational Diabetes: This type of diabetes more seen with family history of diabetes. If this remains
unrecognised and untreated, it can increase the risk of health problems during pregnancy and the fetus is
at risk of high mortality. This type of diabetes is more common among obese women. Short, frequent &
low sugar diet is advised.

Hypertension: This can cause considerable maternal and fetal consequences. Nutritional therapy will
center on 1) prevention of weight extremes, underweight or obesity 2) correction of any dietary
deficiencies and maintenance of optimal nutritional status during pregnancy. Sodium intake may be
moderate but should not be unduly restricted, continuous monitoring & proper treatment has to be carried
out.

Oedema & leg crams: Mild physiologic oedema is usually present in last trimester. The swelling of lower
extremities may be caused by pressure of enlarge uterus on the veins returning fluid from the legs. This
normal edema requires no sodium restriction or other dietary changes.

The common occurrence of cramps during pregnancy is related to calcium phosphorus imbalance.
Magnesium is another mineral. Vitamin E supplement for reliving leg cramp. Elevation of feet also helps
to improve the circulation in oedema.