Pregnancy & Nutrition - Eating for Two, not Like Two.

"The life of a mother is the life of a child : You are Two Blossoms on a Single Branch."

• Nutrition plays a very significant role throughout life for growth, development and maintenance of good health and quality of life during all the life stages.   

• Adequate Nutrition before and during pregnancy has greater potential for a long-term health impact than it does at any other time.

• A Woman who has been well nourished before conception begins her pregnancy with reserves of several nutrients so that the needs of the growing foetus can be met without affecting her health. 

• Infants who are well nourished in the womb have an enhanced chance of entering life in good physical and mental health. 

• Mother's diet should produce adequate nutrients so that maternal stores do not get depleted and produce sufficient milk to nourish her child after birth. 

DIETARY GUIDELINES

Weight Gain in different trimesters in pregnancy :-

1st trimester : 10% of total gain, 0.6-1.0 kg actual gain

2nd trimester : 30% of total gain, 3.0-3.5 kg actual gain

3rd trimester - 60% of total gain, 6.0-8.0 kg actual gain

Gestational Weight Gain is influenced by environmental factors such as food intake, level of exercise, energy balance and medical condition (if any).
If the mother is thin and undernourished, she may need to gain more than 12 kg gain recommended for well-nourished mothers; whereas mothers who are overweight with a BMI of  >25-29.9 may gain weight upto 7-11.5 kg and those with a BMI of  >30 need to gain around 5-9 kgs.

Energy: 

• Adequate amount of calories should be taken so that enough fat is deposited during pregnancy which is also required for lactation.
• The ICMR recommends an intake of additional 350 calories per day to support the growth of fetus, placenta and associated maternal tissues as well as fulfill the increased metabolic demands of the pregnancy. Mostly there is increased requirements in the 2nd and 3rd trimesters.
• Small and frequent feedings should be taken. Fasting or missing meal should be avoided.
• Weight reduction regimens are not recommended because of the effect of ketosis on the foetus.

Protein :

• For growth & development of the fetus and good health of the mother, adequate protein should be taken.
• Consumption of eggs and other non-vegetarian foods like chicken, fish help in meeting increased protein requirements.
• For vegetarians, look for veg sources of protein rich foods like cereal-pulse combinations,  milk and milk products, nuts & oil-seeds.

Fats:

• Essential fatty acids relax muscles and blood vessels of the uterus and makes delivery easier.
• Omega-3 fatty acid help build baby's brain and hence fish, handful of walnuts, soyabeans & green leafy vegetables should be included in the diet.
• Corn, cottonseed, safflower and soyabean oils are good sources of Omega-6 fatty acid.

Fiber :

• More fiber should be included in the diet to prevent constipation which is a common problem during pregnancy.
• 5-6 servings of fruits and vegetables should be included in the daily diet.

Calcium :

• Diet should be rich in calcium to prevent osteomalacia.
• Vitamin D & calcium reduces muscular cramps of pregnancy.
• Dairy products are a primary source of calcium, Green leafy vegetables and gingelly seeds also contribute to calcium.
• A minimum of 3 glasses of milk should be taken.
• Calcium supplements may also be taken.

Iron :

• Iron rich foods should be taken to prevent anemia and to buildup iron stores in the foetal body.
• The actual increase in requirement of iron is only in 2nd and 3rd trimester.
• But a single large dose of iron at the beginning of pregnancy is an effective way of building up iron stores and to protect against depletion of reserves.
•  Haeme iron ( non-vegetarian sources) is better absorbed.
• Inclusion of liver, meat, dried fruits, green leafy vegetables, eggs, enriched cereals like wheat, ragi, jowar, and bajra and iron fortified salt provide additional sources of iron.
• Iron supplements may also be taken.

Folic Acid :

• Folic acid is needed for the synthesis of essential components of DNA and RNA which increase rapidly during growth  thereby increasing the requirements.
• Also folic acid is essential for the development of RBC's which must increase as the mother's blood volume increases.
• Foods such as dark green leafy vegetables, legumes, oranges, soya, wheat germ, almonds, and peanuts contain folic acid.
• In addition, women planning pregnancy, should begin preconceptional supplementation with folic acid at levels up to 400 to 800 mcg per day.
• It is difficult to provide 300 mcg of additional folic acid during pregnancy through diet and hence supplementation becomes very important.

Sodium & Iodine :

• Diet should contain optimum amount of sodium. In case of edema or hypertension, sodium is restricted.
• There are increased requirements of iodine as well, so consumption of iodized salt is recommended.

Vitamin C :

• Raw veggies and fruits like amla, guava, oranges, lemons, etc are to be included in the diet to meet Vitamin C requirements, since it helps in the rapid absorption of Iron.

Fluids :

• Plenty of water should be taken to keep the bowels regular.
• At least 8-10 glasses of water besides the other sources of fluid.
• It has also been found that infection of the tube connecting the kidney and bladder is less common among pregnant women who drink a lot of water.
• Fluids should be taken in between meals rather than along with meals.
• Too much of coffee or tea should be restricted. It should be limited to 2 cups in a day.

Other guidelines :

• Reduce intake of sugar and refined foods.
• Avoid skipping meals
• Avoid processed foods and consume freshly prepared foods
• Sedentary women should do regular exercise like walking. Before undertaking heavy exercises in a gym, the mother should consult her obstetrician. 

Usually a daily diet containing 3 cups of milk or its equivalent, 2 servings of meat,fish, poultry, eggs, or a source of complete protein, a dark green vegetable and a generous serving of citrus fruits will provide a foundation for a nutritionally adequate diet.

How to combat Leg Cramps,  Nausea, Vomiting and Heartburn during Pregnancy?

Leg Cramps - The possible reasons thought to be related is a decline in serum calcium levels related to a calcium phosphorus imbalance. Prevention or relief of this has been reported with reduction of milk ( a high phosphorus, high calcium beverage) intake and supplementation with non-phosphate calcium salts. Magnesium is another mineral with potential for relieving leg cramps.


Morning sickness of early pregnancy 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 with food.
• Skim milk is better tolerated than whole milk. 
• Fruits and vegetables can be given. 
• Fatty rich foods, fried foods, excessive seasoning, strongly flavored vegetables, or coffee in large amounts  may be restricted in case of nausea and gastric distress.
  
  
  Heart burn (acidity) is a common complaint during the latter part of pregnancy. In most cases, this is an effect of pressure of the enlarged uterus on the stomach which in combination with the relaxation of esophageal sphincter, results in occasional regurgitation of the stomach contents into the esophagus. This can be treated by :-

• Limiting the amount of food taken at one time
• Drinking fluids between meals
• Sitting upright after meals for at least 3 hours before lying down.