Nutrition in pregnancy

How good is the UK & ROI diet?

• The diet of people in the UK and ROI is generally inadequate
• Fruit and vegetable intake is well below the recommended 5 a day especially in younger adults and those on benefits  
• Around 1/3 of women of child-bearing age have intakes of folic acid below the Reference Nutrient Intakes (RNI)
• Many women fail to meet the Lower reference nutrient intake (LRNI), for iron, magnesium, zinc, calcium, potassium, iodine, vitamin A and riboflavin
• Many women have marginal iron, vitamin D and folate status

Why is maternal nutrition important?

Clearly good maternal health is important in producing healthy babies. Being underweight or in poor nutritional health, along with poor diet, has an impact on all aspects of pregnancy:

• Reduced fertility and the ability to conceive
• Poor outcome of the pregnancy
• Contributes to congenital abnormalities
• Contributes to premature birth
• Contributes to poor growth rate and birth weight
• Negatively affects the long-term health of the child

 

The risks of poor maternal nutrition 

What an expectant mother eats affects her baby, both in the womb and after the baby is born. Many studies have demonstrated a link between foetal nutrition and:

• low birth weight¹
• risks of cardiovascular disease in adults¹
• hypertension in adults²
• impaired glucose tolerance in adults³

Studies suggest that disease prevention in the next generation partly depends upon improving the nutrition of the mother prior to and during pregnancy

The consequences of poor nutrition will depend on the time at which it occurs, its extent and the nutrients involved

 

How do nutritional needs change during pregnancy?

Nutritional needs increase very little during pregnancy and largely only in the third trimester.

• Physiological changes result in many nutrients being absorbed more efficiently
• Protein breakdown is reduced and nutrient stores are laid down
• Reduction in physical activity enables fat stores to be laid down
• Energy requirements increase only in the last trimester
• Emphasis should be placed on improving the quality of the diet rather than increasing the quantity of foods eaten

 

Healthy Eating – foods to eat

There are some foods expectant mothers should choose when they are planning to get pregnant or during their pregnancy.

• At least five portions of fruit and vegetables a day; these can be fresh, dried, frozen, tinned or juiced
• Wholegrain bread, pasta, rice, fortified breakfast cereals and potatoes
• Protein-rich foods – lean meat, poultry, well-cooked eggs and pulses
• Fish, but limit oil-rich fish (such as salmon, mackerel, herring, tuna or sardines) to two servings a week
• Dairy foods – pasteurised milk, hard cheese (but not blue-veined) and yoghurt
• Healthy snacks
• Foods containing Folate such as green vegetables, brown rice and fortified breakfast cereals
• 400 µg of Folic acid, daily until 12th week of pregnancy 
• 10 µg of vitamin D throughout pregnancy

 

Healthy Eating – foods to avoid

There are some foods that women should avoid if they’re planning to get pregnant and during pregnancy.

• Raw or undercooked eggs – risk of listeria
• Raw or undercooked meat – risk of listeria
• Liver, liver products – risk of listeria and excess Vitamin A (toxic to the baby in high amounts)
• Supplements containing Vitamin A
• Mould-ripened soft cheese, blue-veined cheese and unpasteurised dairy products – risk of listeria
• Shark, swordfish or marlin – high in mercury
• Paté (including vegetable) – risk of listeria
• Raw shellfish – may contain parasites
• Alcohol – best to stop drinking altogether, but women who do choose to drink should drink no more than 1-2 units of alcohol once or twice a week

Healthy Eating – foods to limit

Eating sensibly is the best advice for expectant mothers – some foods should be limited.

• Fresh tuna steaks limited to no more than twice a week or no more than 4 medium sized tins of tuna a week
• Fats, oils, spreads and fatty foods
• Sugar and sugary foods
• Caffeine such as in tea, coffee, cola and chocolate-limit to 200 mg a day
  For more information visit the Food Standards Agency website at www.eatwell.gov.uk
• In ROI please refer to www.irishhealth.com 

 

The Eatwell Plate

The Eatwell plate is a great way to show expectant mothers how much of what they eat should come from each food group. This includes everything they eat during the day, including snacks.

• Plenty of fruit and vegetables
• Plenty of bread, rice, potatoes, pasta and other starchy varieties
• Some milk and dairy foods
• Some meat, fish, eggs, beans and other non-dairy sources of protein
• Just a small amount of foods and drinks high in fat and/or sugar

 

  

 

Alcohol

Expectant mothers should be warned that alcohol is harmful to the foetus.
Facts about foetal alcohol syndrome (FAS):

• Associated with 5 units of alcohol per day: growth retardation, poor development 
• There are less marked symptoms with 1-3 units of alcohol per day
• National Institute for Health and Clinical Excellence (NICE) recommends no alcohol for the first three months
• Those who choose to drink: no more than 1-2 units, 1-2 times per week
• Avoid binge drinking

 

Caffeine

A high caffeine intake has been associated with spontaneous abortions and low birth weight.

• No harm has been shown with caffeine intakes less than 200 mg per day
• Pregnant women should keep their intake below this level

Mug of instant coffee	100 mg	Can of Cola	40 mg
Mug of brewed coffee	140 mg	50 g bar of plain chocolate	50 mg
Mug of tea	75 mg

 

‘Good’ fats

Omega-3 and 6 LCPs provide important nutrients that cannot be made easily by the body. These need to be provided by dietary sources.

• They are vital for normal brain growth, development and function
• Dietary intakes of omega-3 LCPs are often inadequate
• There is a high demand in the last trimester of pregnancy to supply the baby
• Oily fish are a good source of Omega 3 LCPs but limit them to two portions per week  (Oily fish include tuna, sardines, mackerel, pilchards, trout, kippers)

 

Iron deficiency and pregnancy

• Iron deficiency is common in the UK & ROI and is associated with poor pregnancy outcome
• The UK & ROI recommendations do not include an additional increment for pregnancy for women with adequate stores as it is assumed that needs are met via increased absorption and cessation of menstrual losses.
• Recommendations for women are high at 14.8 mg/day and many women do not achieve this
• If iron stores are low at the beginning of pregnancy (low Hb or ferritin), an iron supplement should be prescribed

 

Practical advice on iron intake 

Expectant mothers with low iron levels should be encouraged to eat:

• Iron-rich foods at each meal
• Foods with vitamin C to help with iron-absorption  

Foods containing easily absorbed iron
Meat	lamb, beef, pork, ham, bacon, sausages, burgers, chicken, turkey
N.B. Liver is a good source of iron but is not recommended during pregnancy as it is too high in vitamin A

 

Foods containing less easily absorbed iron
Bread	white, brown, wholemeal
Fortified breakfast cereals, wholemeal pasta
Baked beans, kidney, haricot and mung beans
Lentils and dhal, curry powder and pastes
Nuts, peanut butter, tahini, houmous, tofu
Egg yolk
Dark green vegetables (broccoli, spinach etc.)
Prunes, raisins, sultanas, dried fruit
Malt bread, fruit cake, ginger cake
Digestive and ginger biscuits

 

Folic acid in pregnancy

Folate (a B vitamin) is needed for cell division; a lack of folate during early pregnancy can lead to neural tube defects such as spina bifida.

• UK and ROI Governments recommend all women who may become pregnant should take a daily supplement of 400 µg of folic acid from at least 4 weeks (preferably 3-6 months) prior to conception until the 12th week of pregnancy
• The supplement should be in addition to the 200 µg per day of folate provided by foods in the diet

 

Good sources of folate

Recommend expectant mothers try to eat at least two portions each day from the following list:

• Broccoli
• Brussels sprouts
• Peas
• One serving of a fortified breakfast cereal can provide 1/3 to 1/2 of the dietary recommendation of 200 µg of folate
• Oranges
• Brown rice 

Vitamin D

Many women may be at risk of low levels of vitamin D during pregnancy. Most at risk are those who:

• Do not expose their skin to sunlight
• Live in an area of the country which gets less than average sunlight
• Have a poor dietary intake of Vitamin D (i.e. eat no meat or oily fish)
• Have a BMI over 30
• Are of Asian, origin may be particularly at risk

All pregnant women should take a daily vitamin D supplement of 10 µg per day. Good dietary sources of Vitamin D include meat, oily fish, margarine and fortified breakfast cereals

 

Calcium

Absorption of calcium is increased during pregnancy

• Women should ensure 500-700 mg daily
• Best sources of calcium are milk and dairy products 
• 500 ml milk (whole, semi-skimmed or skimmed) = 600 mg calcium
• Other sources include bread, pulses, hard water, green vegetables and canned fish

Vitamin A

Large amounts are harmful for the baby during pregnancy. In pregnancy, requirements increase by:

• 100 µg  of Vitamin A per day to 700 µg
• Dietary sources: milk, cheese, oily fish, egg, (carrots, red peppers, tomatoes and apricots contain beta-carotene which can be converted to vitamin A)