nutrition%20in%20pregnancy
NUTRITION IN PREGNANCY

Nutrition is the intake of food necessary for optimal health.

Choices regarding maternal nutrition & lifestyle affect maternal & child health.

The World Health Organization (WHO) recommends that women develop healthy dietary behaviors prior, during & after their pregnancy for optimal maternal & infant health outcomes.

The goal of prenatal nutrition is to provide for the optimal development of the fetus & to support maternal health.

Pharmacotherapy

  • Nutrient requirements during pregnancy are increased in order to support fetal growth; thus, inadequate nutrients at this time may affect fetal tissue development predisposing the infant to chronic conditions in later life such as bone health, cardiovascular disease, cognition, immune function, obesity and diabetes
  • In the 1st trimester of pregnancy, requirement for folic acid, vitamin A, iodine, vitamin B12, polyunsaturated fatty acids (PUFAs) is increased while in the 2nd and 3rd trimesters, demand for energy and protein, folic acid, vitamin A, iodine, iron, calcium, omega-3 fatty acids, zinc, copper, B vitamins, vitamin D is increased
  • Pregnant women who do not consume an adequate or balanced diet may be given multiple micronutrient (vitamins and minerals) supplementation
Macronutrients

Carbohydrates
  • Serve as fuel for growth
  • Low-glycemic index carbohydrates are preferred
    • During pregnancy, diets with low glycemic index are associated with improved glucose tolerance and less excessive gestational weight gain
  • Sources of low-glycemic index carbohydrates include whole grains, unprocessed rice, nontuberous vegetables, most fruits, dairy products, beans, nuts
Fats (Omega-3 Fatty Acids)
  • Preferred sources of fat are the PUFAs
    • Omega-3 fatty acids come from ALA, a type of PUFA
  • Improved infant cognitive and visual development is associated with intake of omega-3 fatty acids including DHA and EPA (eicosapentaenoic acid)
  • Sources of omega-3 fatty acids include salmon, sardines, eel, jade perch, yellow croaker
    • Vegetarians may consume ALA-rich foods such as canola oil, olive oil, walnuts and flaxseeds
  • Avoid high-mercury content seafood as prenatal mercury exposure may damage the developing brain of the fetus, as well as milder motor, psychosocial and intellectual impairment
    • Fish with high levels of mercury include shark, marlin, swordfish, king mackerel, tuna, orange roughy, bigeye, etc
Proteins
  • The building blocks of cellular structural and functional components
  • Both very low and excessive protein intakes are associated with restriction of fetal growth
  • Sources of protein are meat, fish, poultry, eggs, dairy products, legumes, grains, nuts
Micronutrients

Calcium
  • Essential for the development of bones and teeth
  • Pregnancy requirements for calcium is similar to that in nonpregnant women due to increased efficiency in absorption of calcium and mobilization of maternal bone calcium
  • The risk of gestational hypertension and preterm labor is increased with inadequate intake of calcium while pregnant
  • Increased dose of calcium intake leads to its decreased absorption, thus multiple small doses of calcium should be taken within the day
  • Various calcium compounds contained in calcium supplements have different amounts of elemental calcium
    • 1 g of elemental calcium equals 4 g of calcium acetate, 2.5 g of calcium carbonate, 5 g of calcium citrate, 11 g of calcium gluconate and 8 g of calcium lactate
  • Sources of calcium include milk, cheese, yoghurt, tofu, dark green vegetables, fruits, nuts, sesame seeds, dried fish or shrimps, sardines
Folic Acid (Folate)
  • Folic acid supplementation prevents neural tube defects in the fetus
  • It is recommended to take folic acid pre-pregnancy for 2-3 months and to continue supplementation throughout pregnancy until 3 months postpartum
  • Sources of folic acid include dark green leafy vegetables, nuts, beans, legumes, liver, fruits eg orange or cantaloupe
Iodine
  • Required for fetal brain development and growth
    • Iodine deficiency can cause maternal and fetal hypothyroidism while excessive intake can cause fetal goiter
  • Sources of iodine include fish, seafood eg mussels, oysters, and prawns, seaweeds, egg yolk, milk and milk products
    • Iodized salt may be used for cooking, however, try to limit salt use
Iron
  • For fetal brain development and growth and prevention of anemia during pregnancy
  • Risk for low birth weight, preterm labor and infant mortality is increased in iron-deficiency anemia during pregnancy
  • Iron- rich foods are usually also rich in zinc and zinc is essential for fetal growth, immune function and neurological development
  • Increased dose of iron intake leads to its decreased absorption, thus high amounts of supplementation are divided into several doses within the day
    • 30 mg of elemental iron equals 90 mg of ferrous fumarate, 150 mg of ferrous sulfate heptahydrate or 250 mg of ferrous gluconate
  • Sources of iron include beef, fish, pork, poultry, eggs, liver, dark green leafy vegetables, dried beans, nuts
    • Limit consumption of liver, particularly in early pregnancy, as liver contains a high concentration of preformed vitamin A and excessive vitamin A (>3000 mcg retinol equivalents/day) is teratogenic
Vitamin A
  • Important for vision, immune function and growth
  • Excessive supplementation with vitamin A can cause birth defects, ie abnormal development of the heart, lungs, eyes and skull
  • Sources of vitamin A include darkly colored fruits and vegetables, oily fruits, red palm oil
Vitamin B12
  • For neural tube formation and brain development
  • Sources of vitamin B12 include eggs, milk or cereals fortified with vitamin B12
  • Other B vitamins [vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B6 (pyridoxine), biotin, pantothenate] are also important for fetal growth and brain development
    • Sources include meat, fish, poultry, eggs, starchy vegetables, legumes, fruits, nuts
Vitamin C
  • Aids the body in absorbing iron from food
  • Sources of vitamin C include vegetables and fruits
    • When consuming iron-containing foods, iron absorption is enhanced when the following vitamin C-rich foods are also taken: Cantaloupe, grapefruit, kiwi, orange, strawberry, broccoli, bell pepper, tomato
Vitamin D
  • Important for bone development and aids in the absorption of calcium
  • Most vitamin D is formed endogenously in the skin when exposed to sunlight
    • Sunlight exposure for 5-15 minutes 2-3x/week during summer may be done but a longer sun exposure may be needed during winter, in dark-skinned individuals, in those whose skin is covered extensively with clothing
  • Sources of vitamin D include eggs, liver, milk and milk products fortified with vitamin D, fatty fish eg sardines, salmon
  • Daily Recommended Dietary Allowances of Micronutrients for Pre-pregnant, Pregnant and Lactating Women
    Micronutrient
    Pre-pregnant
    Pregnant
    Lactating
    Calcium 700-1000 mg 1000 mg 1000 mg
    Folic acid 400 mcg 600 mcg 500 mcg
    Iodine 150 mcg 200 mcg 200 mcg
    Iron 29-39 mg * 15-20 mg
    Vitamin A 1.1 mg 800 mcg 850 mcg
    Vitamin B1 1.1 mg 1.4 mg 1.5 mg
    Vitamin B2 1.1 mg 1.4 mg 1.6 mg
    Vitamin B3 14 mg 18 mg 17 mg
    Vitamin B6 1.3 mg 1.9 mg 2.0 mg
    Vitamin B12 2.4 mcg 2.6 mg 2.8 mcg
    Vitamin C 70 mg 80 mg 95 mg
    Vitamin D 5-10 mcg 5 mcg 5 mcg
    Zinc 4.4 mg 5-10 mg 7.2-9.5 mg
    *Iron tablet supplements are recommended for all pregnant women. Daily 100-mg iron supplements given during the 2nd half of pregnancy are adequate in the non-anemic pregnant woman. If the woman is anemic, higher doses should be provided.
    WHO recommends a daily oral supplementation of 30-60 mg of elemental iron for pregnant women.
    List shown above is not exhaustive and as recommendations may vary between countries, please refer to available nutrition guidelines from local health authority.
    Modified from: Barba CV, Cabrera MI. Recommended dietary allowances harmonization in Southeast Asia. Asia Pac J Clin Nutr. 2008;17 Suppl 2:405-408.
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