Pregnancy

Those of us concerned with the care of pregnant women usually find the process very rewarding: you start with one healthy patient, and are rewarded by the arrival of another.

The maintenance of health during pregnancy is, like everything, a joint responsibility - it's the responsibility of midwives and doctors to monitor the progress of the pregnancy - and to act promptly if things go awry. It's the responsibility of the mother to ensure she has the right intake of necessary nutrients, and none of the nasty agents that might affect the foetus - like cigarette smoke.

During pregnancy the women's nutritional needs increase because building a baby requires basic constituents. The developing foetus is very efficient at extracting the vitamins and minerals from the maternal stores - sometimes at the expense of the mother. So that, for example, you'll need to ensure you take in enough calcium, or the infant will take what it needs from your teeth - which is why pregnant women are provided with free dental care during pregnancy and for the first year of the baby's life. So what changes in nutrition are necessary for a healthy pregnancy?

Before Conception

Women planning pregnancy need to be well prepared; fit, as they say, for the fray. You should:

  • Ensure you eat a 'balanced' diet. This somewhat vague term means no constituent part of the diet - fruit, vegetables, protein, starch, dairy products - should be either in excess or absent. A crash diet pre-pregnancy (in order to prevent excess weight gain during pregnancy and subsequent difficulty in losing weight) will not only lead to possible deficiency during early pregnancy, it might also reduce the likelihood of you becoming pregnant. Make sure you have sufficient intake of foods containing iron, calcium and vitamins.

  • Folic acid taken pre-conception has been shown to reduce the likelihood of the development of so-called 'neural tube' defects. This occurs when the tube which will produce the central nervous system (the brain and spinal cord) fails to close, leading to conditions such as spinabifida. So women planning pregnancy should take a folic acid supplement: 400mcg tablets are available over the counter - some doctors prescribe 5mg.

  • Stop smoking. There is abundant evidence that cigarette smoking - even pre-conception rather than just during pregnancy - affects foetal development. Your baby will be smaller than it should be. This doesn't just mean it will weigh less at birth - low birth weight babies are more likely to develop diseases such as diabetes, heart disease and asthma in adult life, and die earlier. So if you want to produce a healthy, long-lived adult don't smoke before it's conceived - or after.

    During Pregnancy

    Protein and energy

    You might be eating for two - but one of you has a tiny appetite, so it's important not to over-indulge and gain too much weight, which might be difficult to shift after birth. It might also cause problems with raised blood pressure during pregnancy. The usual weight gain varies, depending on how big you are to start with, but is roughly 10kg to 13kg. Of this, very little occurs during the first trimester (about 12 to 13 weeks), roughly one-third during the second, and two-thirds over the last 3 months. The weight is distributed between the baby, the amniotic fluid (the 'waters'), the increased size of the uterus, the placenta, enlarged breasts and increased circulating blood volume in the mother. Any excessive intake over and above that needed will be deposited as our old friend fat - and it's this that will be stubborn when you try to get trim after the birth. In general terms you should:

    • Mostly in the second half of your pregnancy.

    Vitamins and Minerals

    Vitamins are chemical compounds that are essential for life. Those that were the first to be discovered were of a class called amines - and so were called 'vital amines': hence 'vitamins'. These are:

    VITAMIN A (RETINOL)

    Main purpose
     Used for formation and maintenance of skin and mucous membranes, bone growth, vision, reproduction, teeth.

    Good sources
    Liver, eggs, cheese, butter, fortified margarine, milk, yellow, orange and dark-green vegetables (e.g. carrots, broccoli, squash, and spinach) and fish liver oil.

    Reduced by
    Strong light, malabsorption.

    BIOTIN (ONE OF THE VITAMIN B COMPLEXES)

    Main purpose
     Formation of fatty acids, release of energy from carbohydrates. Works with vitamin B2, vitamin B6, niacin and vitamin A to maintain healthy skin.

    Good sources
    Nuts, fruits, brewer's yeast, egg yolk, liver, kidneys, dark-green vegetables, green beans, milk, and brown rice.

    Reduced by
    Cooking, baking soda, caffeine, alcohol, oestrogen (in oral contraceptives).

    VITAMIN B1 (THIAMIN)

    Main purpose
     Release of energy from carbohydrates; keeps nervous system, muscles and heart functioning normally; promotes growth.

    Good sources
    Whole grains and oatmeal, pasta and bread, wheat germ, brewer's yeast, most vegetables, milk, peanuts, pork (especially ham), liver and oysters.

    Reduced by
    Cooking, baking soda, caffeine, alcohol, oestrogen (in oral contraceptives).

    VITAMIN B2 (RIBOFLAVIN)

    Main purpose
     Release of energy to cells from carbohydrates, proteins and fats, maintenance of mucous membranes.

    Good sources
    Liver, milk, red meat, dark-green vegetables, cereals, pasta, bread, mushrooms, fish and eggs.

    Reduced by
    Light, especially UV radiation in sunlight.

    VITAMIN B3 (NIACIN)

    Main purpose
     Works with thiamin (vitamin B1) and riboflavin (vitamin B2) in energy-producing reaction in cells. Aids the digestive system.

    Good sources
    Liver, poultry, red meat, tuna, cereals, pasta, bread, nuts, vegetables, eggs, avocados, dates, figs and prunes. It is made in the body from amino acid tryptophan.

    Reduced by
    Cooking, sleeping pills, oestrogen (in oral contraceptives) and alcohol.

    VITAMIN B5 (PANTOTHENIC ACID)

    Main purpose
     Metabolism of carbohydrates, proteins and fats. Formation of hormones and nerve-regulating substances. Maintains normal growth and cell building.

    Good sources
    Liver, kidneys, whole-grain bread and cereals, nuts, eggs, dark-green vegetables, yeast. It can be synthesised in the body by intestinal bacteria.

    Reduced by
    Heat, caffeine, sulphur drugs, sleeping pills, oestrogen and alcohol.

    VITAMIN B6 (PYRIDOXINE)

    Main purpose
     Absorption and metabolism of proteins, use of fats, formation of red blood cells. It helps relieve nausea and muscle cramps.

    Good sources
    Whole-grain (but not enriched) cereals and bread, liver, avacados, spinach, green beans, bananas, milk, eggs and cantaloupe.

    Reduced by
    Cooking, alcohol, long storage and oestrogen.

    VITAMIN B12 (COBALAMIN)

    Main purpose
     Needs to be combined with calcium for maximum benefit. Building of genetic material, formation of red blood cells, preventing anaemia, maintaining health, nervous system, and improving concentration and memory.

    Good sources
    Liver, kidneys, meat, fish, eggs, milk, oysters and cheese.

    Reduced by
    Grilling on intense heat, oestrogen, sleeping pills, alcohol, sunlight, inability to absorb vitamin B12, fish tape worms in the intestines.

    VITAMIN C (ASCORBIC ACID)

    Main purpose
     Maintenance of health of bones, teeth, blood vessels; formation of collagen which supports body structure; antioxidant.

    Good sources
    Many fruits and vegetables including citrus fruits, tomato, strawberries, melon, green pepper, potato, dark-green vegetables.

    Reduced by
    Heat, light, smoking and oestrogen.

    VITAMIN D (CALCIFEROL)

    Main purpose
     Acquired through diet or the action of sunlight on skin. Combines with calcium to build strong bones and teeth. Helps body to assimilate vitamin A.

    Good sources
    Milk, egg yolk, liver, tuna, salmon, fish liver oils. It is made on the skin in sunlight.

    Reduced by
    Mineral oil, smog, oral contraceptives and malabsorption.

    VITAMIN E (TOCOPHEROL)

    Main purpose
     Stored by the body for a short period. It prevents oxidation of polyunsaturated fatty acids; prevents blood clots; applied externally it helps the healing of scar tissue.

    Good sources
    Vegetable oils, margarine, whole-grain cereal and bread, wheat germ, liver, soya beans, green leafy vegetables and eggs.

    Reduced by
    Heat, oxygen, freezing and malabsorption.

    FOLIC ACID (FOLACIN)

    Main purpose
     Assists in forming body proteins and genetic material, formation of red blood cells; aids lactation.

    Good sources
    Liver, kidneys, dark-green leafy vegetables, wheat germ, brewer's yeast, egg yolk, carrots, melon, apricots, avacados, beans and pumpkin.

    Reduced by
    Heat, sunlight, oestrogen (in oral contraceptives), storage at room temperature and certain drugs.

    VITAMIN K (MENADIONE)

    Main purpose
     Essential for normal blood clotting.

    Good sources
    Yoghurt, green-leafy vegetables, milk. It is made in the intestinal tract.

    Reduced by
    X-ray radiation, aspirin, pollution, prolonged treatment with antibiotics and sulphur drugs, and malabsorption.

    During pregnancy the requirements for virtually all vitamins and minerals increases - some more than others. The recommended daily allowance (RDA) for vitamins and minerals for an adult woman are:

    A healthy balanced diet should provide most of the requirements. During pregnancy, however, supplements may be needed - particularly of folic acid, vitamin D and iron. Adequate calcium intake is essential. Two-thirds of the requirement is usually provided by dairy products, so it's not a good idea to cut back on milk and cheese. If you do, because you want to avoid too much weight gain, then a supplement might be indicated.

    Things to avoid

    While vitamin A is essential for your baby's development (lack of vitamin A in the developing foetus can cause problems with vision), too much can also cause birth defects. Liver contains lots of vitamin A, so pregnant women should avoid eating liver - and products containing liver such as pate's.

    Pate's can also be a source of infection with a germ called Listeria. This can also be found in cheeses which contain blue mould - such as Stilton, Camembert, Danish Blue - and unpasteurised milk. If contracted during pregnancy it can affect the foetus, causing miscarriage or, if the baby is born alive, severe illness. Newborn infants suffering from listeriosis have a high mortality rate.

    Other infections can be caught from food and animals and may affect your child. Toxoplasmosis is an illness caused by a parasite found in cat faeces, raw meat, goat's milk and in soil contaminated by cat droppings. If this affects the baby it can cause later problems with the eyes, or fits. So cook meat thoroughly, and steer clear of cat litter.

    Salmonella food poisoning - and other causes of gastroenteritis such as campylobacter and E-coli infection - do not directly affect the foetus, but can lead to early miscarriage if severe. So wash your food - particularly salads - and wash your hands. Cook food thoroughly - especially when re-heating - and don't eat undercooked eggs.

    Fish, on the whole, is good for you but some can be problematic in pregnancy because they contain high levels of toxic chemicals such as mercury and cadmium. So avoid shark, marlin and swordfish - and don't eat too much tuna, either. Mercury and cadmium can affect the baby's developing nervous system.

    Caffeine, in high quantities, can affect the baby's growth - and in extreme cases has been linked to miscarriage. The advice is 'no more than 300mg per day' - roughly 3 mugs of coffee or 6 cups of tea. Don't forget that soft drinks also contain caffeine - as do chocolate bars.

    Nut allergy is increasing in the UK and the reason why is uncertain. What is certain is that it can be fatal. We know that the development of allergy is more likely in people who have a family history of allergy. So if you - or your baby's father - suffer from allergies, hay fever, asthma or eczema, it might be a good idea to avoid nuts during pregnancy, and also while breast feeding.

    Smoking seriously harms the health of your baby. It will lead to restricted growth, which in turn will leave the infant subject to many illnesses in later life - asthma, diabetes and heart disease. So don't smoke and avoid smoky atmospheres.

    Alcohol in excess can seriously harm your baby, producing so-called 'foetal alcohol syndrome'. There may be facial abnormalities with small eyes, and problems with intellectual development. A small amount of alcohol will not have this effect - restrict your drinking to 1 to 2 units, 1 to 2 times per week.

    Eat sensibly, enjoy your pregnancy - you'll reward yourself and the rest of us!


    - Tell me more about pregnancy and its problems.



    This information is licensed for use by Wellbeing Information Systems Ltd ("WIS"), and protected by international copyright law. All rights are reserved. (email info@wisinfo.co.uk).
    The information provided by WIS is for guidance only. Whilst it is based upon the expert advice of leading professionals, and extensive research, it is not a substitute for diagnosis by a qualified professional. Always consult your doctor, pharmacist or qualified practitioner before making any changes or additions to prescribed medication.