Healthy Expectations—Part One: Pregnancy NutritionSusannah Kent October 1, 2009
The relationship between diet and health is a crucial one. This is particularly true during pregnancy as all the nutrients essential to healthy growth and development are passed on to the baby through the mother’s diet. For example, insufficient protein, calories and omega-3 fatty acids during the third trimester can have a negative impact on the baby’s brain development. Inadequate amounts of iron, folic acid, and zinc have been linked to low birth weight, brain abnormalities and pre-term delivery. Researchers have also found that babies born to malnourished mothers smile less and are drowsier compared with babies born to well-nourished moms (Murkoff and Mazel, What to Expect: Eating Well When You’re Expecting).
Studies also continue to show strong links between deficiencies in diet and pregnancy complications. For instance, anemia is directly connected to iron deficiency. Some cases of preeclampsia (high blood pressure) have been linked to intake of high amounts of sugar and polyunsaturated fats, plus insufficient amounts of vitamins C, E and magnesium. Research has also linked deficiencies in zinc, vitamin A, vitamin C, and magnesium to an increased risk of premature labour (Murkoff and Mazel). On the other hand, good nutrition can prevent many unpleasant side effects of pregnancy, as well. Adequate complex carbohydrates can reduce fatigue. A diet low in fatty foods can decrease heartburn. A diet rich in fibre and fluids can prevent constipation, and adequate vitamin B6 can reduce nausea and vomiting.
The fact that childbirth and child-rearing requires lots of energy and stamina means that a body with a sufficient store of nutrients is much better able to thrive and perform. Remember too, that good eating habits will markedly reduce your chances of developing a wide variety of diseases in the future such as diabetes, hypertension and cancer.
PREGNANCY DIET GUIDELINES
“Am I eating right?” is probably the first question to consider if you are planning a pregnancy or are already pregnant. The following will provide some guidelines for pregnancy nutritional health.
Pregnant women should choose foods and beverages rich in nutrients. Selecting a variety of foods from all five food groups will help ensure that a woman gets the nutrition she and her growing baby need. (Note: recommended servings per day listed below are from Health Canada’s Food Guide for pregnant females age 19-50).
· Meat and alternatives (protein – 2 servings per day)
Protein helps maintain muscle and body tissue, helping the body to produce some hormones and antibodies. These foods also supply other key nutrients, such as iron, B vitamins and important minerals. Pregnant women should take 60 grams of protein every day, about 10 grams more than non-pregnant women. Lean meats, poultry, and fish are good sources of protein, as are dried beans, lentils, nuts, eggs, and cheeses.
However with regards to some protein foods, Irene Swedak, holistic nutritionist, RHN, RNCP, and instructor at the Canadian School of Natural Nutrition, waves some red flags for pregnant women. She advises avoiding large fish such as tuna, swordfish, and king mackerel, due to possible concentrations of toxins. Mercury and PCBs are particularly high in some of these fish. She adds that pregnant women should “avoid all raw shell-fish and crustaceans, and only eat them cooked on occasion (farmed in areas monitored for contaminants).”
Swedak also cautions pregnant women about deli meats, sushi and preserved (smoked) meats or fish, and soft (unripened) cheeses. These may be “contaminated with bacteria, which can cause serious food poisoning, even death. The preservatives used in smoked meat and fish have not been widely studied for their effects on the growing baby, although we do know these chemicals can promote stomach cancer in adults.”
To limit your unborn baby’s exposure to pesticides, herbicides and other chemicals, Swedak recommends that the meats and dairy that a pregnant woman consumes on a regular basis be organic and wholesome in nature. “Non-organic meats and dairy will have some level of hormone and/or antibiotic residue, and non-organic animals are raised in stressful, factory-farm environments which include the use of antibiotics. Hormones are also given to increase the growth rate and production quotas. These types of foods are not ideal for pregnant women.”
· Whole Grains (carbohydrates, 6-7 servings per day)
Pregnant women need plenty of complex carbohydrates every day as a source of B vitamins, fibre, and trace minerals such as zinc, selenium, chromium and magnesium. Pregnant women should emphasize whole grains and the breads, cereals and pastas made from them. Choose whole wheat bread, oatmeal, whole grain cereals and the like over white bread, commercial muffins and similar foods. These white foods – made with white flour, white sugar, and glucose-fructose (usually high-fructose corn syrup) are full of empty calories and have a high glycemic index, which wreaks havoc on blood sugar levels. And because they are quite low in fibre, they contribute to constipation.
· Fruits and Vegetables (7-8 servings per day)
Vegetables and fruits are a good source of many vitamins and minerals, including folate and iron which are important to prevent anemia during pregnancy. Vitamin C is needed both by you and your baby and cannot be stored in your body, therefore it is important to eat plenty of vegetables and fruits every day. And because vitamin C is lost during food storage and preparation, it is important to cook vegetables in a minimum amount of boiling water for only five to 10 minutes. Steaming or baking is a good alternative. Pregnant women should eat at least one dark green and one orange vegetable each day. Choose vegetables that have little or no added sugar, fat or salt (fresh, raw and organic is ideal). In addition, vegetables contain many protective components which help maintain health such as fibre, flavonoids and antioxidants.
· Milk and alternatives (2 servings per day)
Dairy products are a good source of calcium in your diet. Calcium is essential for the development of healthy bones and teeth of your baby. During lactation, it is important for the formation of your own breast milk. Dairy products are also a source of protein and other minerals and vitamins, such as some B vitamins and vitamin A. Milk, yogurt and cheese are good sources of calcium. Low-fat dairy products supply equal amounts of calcium with fewer calories than their higher-fat (2% and whole) counterparts.
(Note: if you have a dairy allergy or are lactose intolerant, excellent alternative sources of calcium are collard greens, kale, blackstrap molasses, and supplements.)
· Fats and Oils (30-40 ml/2-3tbs per day)
Like carbohydrates and protein, dietary fat is an important source of energy for the body. Certain foods that contain fat supply the body with essential fatty acids (fats that are not produced by the body, so they must be obtained through food). These fats are needed for proper development of the baby, and they should be derived from predominantly unsaturated sources: fish, vegetable oils (cold pressed olive, flax seed, safflower, and sunflower oils). It is best to stay away from hydrogenated oils, vegetable shortenings and other oil ingredients in packaged and processed foods. These overstress our detoxification systems and will likely be stored as excess fat, becoming another source of fat-soluble toxins which are known to have a damaging effect on the nervous system and brain in particular.
Water carries nutrients from the food you eat to your baby. It can also help prevent constipation, hemorrhoids, excessive swelling, and urinary tract or bladder infections. As your pregnancy progresses, drinking too little water can contribute to premature or early labour (Mayo Clinic, Pregnancy Nutrition: Healthy Eating for You and Your Baby). Pregnant women should drink at least six 8-ounce (237 millilitres) glasses of purified water a day. Non-caffeinated or unsweetened liquids can be added to your daily fluid intake.
Pregnant women should reduce or eliminate caffeine intake. Caffeine is a stimulant and a diuretic. As a diuretic, caffeine will pull minerals from the body, and these are needed for the bone, blood and tissue growth of the fetus.
Because of alcohol’s damaging effects on neural tissue, pregnant women, or those even trying to become pregnant, should avoid it altogether. There is no safe level, as there is no way of knowing what amount of alcohol each individual fetus can tolerate before damage to tissues occurs.
· Important Nutrients
Even if you eat well everyday, you may miss out on key nutrients. Folic acid (600-800 mcg per day) is an extremely important vitamin during pregnancy, especially in the early period and even before conception. A good intake of folate (a B vitamin) greatly increases the chance of your baby being born without any abnormalities. Thus, all women thinking about becoming pregnant, and throughout the first three months of pregnancy, should eat food sources rich in folate: spinach, lettuce, cabbage, green beans, cauliflower and fortified cereals.
You need iron (27 milligrams per day) to form the red blood cells for you and your baby. Iron helps carry oxygen from the lungs to the tissues. Your baby’s brain and body need iron and oxygen to grow. Too little iron leads to anemia, in which case your baby may not be getting enough oxygen for normal growth and development. The best sources of iron are organic lean meats, especially liver and kidney. Some vegetables (such as green leafy vegetables, cooked beans and peas) are also good sources of iron. To absorb more iron from vegetables (especially beans and peas), eat foods rich in vitamin C or acidic foods at the same time (such as apple cider vinegar, juice, bell peppers, tomatoes, and kefir).
Calcium (1,000 milligrams per day) is important for the healthy bones and teeth of both you and your baby. The best sources of calcium are organic milk, dairy products and some cereals. Many people assume that calcium is the most important vitamin or nutrient for bone health. However, vitamin D is necessary for the absorption and use of calcium. Therefore, vitamin D intake is also very important. Sunlight is one source of vitamin D. About five to 10 minutes of exposure to sunlight (without sunblock) can supply a day’s worth of vitamin D, depending on the season, latitude, and skin pigment. Dietary sources of vitamin D are limited, so supplementation is recommended.
To ensure there are no gaps in important nutrient intake, Swedak suggests a multi-vitamin/multi-mineral from a professional line. “Choose one which has 600-800 mcg folic acid, 5-10 mg of iron (10 mg or more is advised for vegetarians). A mix of anti-oxidants should also be included in the formula. Food-based supplements are preferable, such as those specifically for pregnancy from New Chapter.” (Editor’s note: You may want to take extra Vitamin D separately.)
She also suggests pregnant women take calcium / magnesium and vitamin D in the evenings or with dinner, as well as a professional grade DHA supplement. Recommended doses are as follows: 1200 mg calcium, 300 mg magnesium and 1000 IU vitamin D. DHA should have 5:1 ratio of DHA:EPA: 1200 mg – 2400 mg/day (total for the first and second trimesters), and 2400 mg – 3600 mg/day (total for the third trimester). These are optimal levels, and the 5:1 ratio is very important, because the fetus requires DHA for brain, nervous system and eye health at a much greater ratio than EPA. Finally, Swedak recommends that pregnant women take probiotics in divided doses just after meals (8 billion cfu per day).
A HEALTHY PREGNANCY BREAKFAST MENU
To help start the day off right, and deal with the dreaded morning sickness, here is a very appealing and healthy breakfast menu which Irene Swedak recommends to her pregnant clients.
Baby Shake (Makes about 1.5 cups total):
• 1/2 cup yogurt or kefir
• 1/2 cup berries
• 1/2 frozen banana
• 1 tsp ground flax or hemp seed
• 1-2 stoned dates for sweetness
• 2 Tbsp nut or seed butter of choice. Almond is great, and natural peanut butter is also fine – although limit your exposure to peanuts to two times per week, and avoid if sensitive.
Blend all of the ingredients with a hand-blender and enjoy immediately. Substitute yogurt with another milk of choice if desired, or water. Fruit is preferable to juice, because it contains fibre and gives the body more energy to make it through the morning. Freshly made vegetable or fruit juices are also fine if you can make these yourself. Wash all produce thoroughly, and choose the freshest available.
• Oatmeal (steel cut oats or large-flake rolled oats), preferably a gluten-free variety such as Bob’s Red Mill or other grain such as amaranth or quinoa made into a hot cereal (especially in the winter). In the summer: cold cereal with yogurt or almond milk, nuts and seeds (which have preferably been soaked overnight).
• Muesli is a great alternative to packaged cereals. Make your own by placing oats, nuts, seeds, and a few dried apricots or prunes, and raisins into a bowl and covering by half with Kefir or filtered water. Place in fridge overnight. In the morning, add cinnamon, honey or maple syrup, and more liquid (if desired).
Swedak goes on to say: “Some women need to have some crunchy type of food as soon as they wake up because the morning sickness is particularly bad at that time of day. For these ladies, I suggest keeping some of the Nature’s Path cereals in a small container – about a half cup or so, in their night table, so that they can snack on this if they have to. A small handful usually does the trick. Nut-thins, rice crackers, or other crisp bread are also fine. Low blood sugar and/or hormonal changes are usually the culprits. Eating five to six small meals per day, with a balance of protein and carbohydrate will help.”
SUMMING IT ALL UP
If you are pregnant, congratulations! This is an amazing, confusing and sometimes scary time, but the outcome is nothing short of miraculous. What you will need for yourself and your baby may seem daunting, but when it comes to nutrition, it can be summed up rather neatly. Remember, when you are pregnant you are technically eating for two, but this only means an increase of about 300 calories per day after the first trimester. Weight gain should be kept within a healthy range as well. The U.S. Institute of Medicine recently issued new pregnancy weight guidelines. They range from as low as 11 pounds for a person whose pre-pregnancy BMI (body mass index) was rated at obese, to as much as 40 pounds for someone who is considered underweight (www.iom.edu).
It is also important to remember that assortment, balance and colour are keys to a good pregnancy diet. Choose a variety of foods from all the food groups, taking care not to have too much or too little of any. Balance and moderation are the foundation to any healthy diet. For example you need fats and oils in your diet, but none of the hydrogenated variety. You also need vitamin A, but too much can be toxic. Finally, rich vibrant colours – carrots, red tomatoes, yellow peppers, strawberries and blueberries – indicate an abundance of nutrients. Eating a healthy, balanced diet when pregnant will offer countless benefits to you and your baby, not just for nine months, but for a lifetime.
· Irene Swedak, RHN, RNCP, Director of Nutrition and Product Development, Healthy Sprouts Foods Inc. (www.healthysprouts.ca, 1-888-686-BABY); Instructor – Canadian School of Natural Nutrition, (www.csnn.ca, (416) 482-3772); Registered Holistic Nutritionist – Meridian Naturopathic Clinic, (www.meridianclinic.com, (905) 238-9001).
· Johnson, Robert V., M.D. Mayo Clinic Complete Book of Pregnancy & Baby’s First Year W. Morrow and Co., 1994
· Murkoff, Heidi Eisenberg, Mazel, Sharon, What to Expect: Eating Well When You’re Expecting, Workman Publications, 2005
· Health Canada, http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/index-eng.php
· International Food Information Council, Healthy Eating During Pregnancy, www.ific.org
· Institute of Medicine of the National Academies, http://www.iom.edu/