Pregnancy Nutrition

Question 1

Energy intake increase

Answer 1

10-30%

Question 2

Insufficient micronutrient intake

Answer 2

Low birth rate
Premature birth
Other foetal problems

Question 3

First trimester

Answer 3

Fundamentally a phase of rapid cell division, organ development and preparation for the demands of rapid foetal growth that occurs later in pregnancy

Critical nutrients during this phase include protein, folic acid, vitamin B12 and zinc.

Question 4

Second and third trimester

Answer 4

Energy intake is especially important since 90% of foetal growth occurs during the last half of gestation. Critical nutrients during this phase include: protein, iron, calcium, magnesium, B vitamins, omega-3 fatty acid, docosahexaenoic acid (DHA). Macronutrients provide energy and building material.

Question 5

Protein

Answer 5

Is the main ‘building block’ for the body’s cells. It helps produce extra maternal blood and energy stores.

Question 6

Carbohydrates

Answer 6

Provides energy for mother and foetus during pregnancy

Question 7

Fat

Answer 7

Provides long-term energy for growth. Should contribute <30% of daily calories.

Question 8

Essential fatty acids

Answer 8

Essential fatty acids are vital to the proper development of the CNS (brain and spinal cord), foetal tissue, visual development and help prevent preterm birth. Sufficient intake reduces the risk of heart disease and heart related death in infants.

The recommended daily intake is 300mg per day.

Good sources of omega-3 include (1) fish oil capsules, (2) certain fish such as salmon, trout, mackerel, sardines and fresh tuna; and (3) vegetable oils such as sunflower, rapeseed, flaxseet and walnut oil.

Question 9

Vitamin C

Answer 9

Promotes healthy gums, teeth and bones. Enhances iron absorption. Acts as an antioxidant.

Question 10

Vitamin E

Answer 10

Promotes the oxidation of unsaturated fatty acids, which make up the structure of cell membranes.

Question 11

Vitamin B6

Answer 11

Helps create red blood cells. Needed for amino acid metabolism, fatty acid metabolism and protein synthesis.

Question 12

Vitamin B12

Answer 12

Helps create red blood cells. Promotes normal growth and maintenance of the nervous system.

Question 13

Folic acid/folate

Answer 13

Needed for the production, repair and functioning of DNA. Needed to produce blood. Helps some enzymes function.

Adequate folic acid intake reduces the risk of having a baby with neural tube defect and reduces the risk of premature birth. The recommended amount of folic acid is 0.4mg (400 micrograms) per day.

Supplementation should be started at least one month before getting pregnant. It is recommended that women of childbearing age take folic acid supplements.

Some foods are voluntarily fortified with folate including breakfast cereals, fruit juice, yeast extracts and cracker biscuits. Fortification of bread has been introduced.

Good sources of folic acid include green leafy vegetables and fortified cereals.

Question 14

Calcium

Answer 14

Helps build strong bones and teeth by promoting adequate mineralisation. Involved in muscle contraction and relaxation, nerve functioning, blood clotting, blood pressure and immunity.

Question 15

Iron

Answer 15

Helps synthesise red blood cells. Helps prevent maternal fatigue. Needed by enzymes that make amino acid, collagen and hormones.

Iron reduces the risk of premature birth and low birth weight. Deficiencies in iron could cause anaemia which could (1) contribute to developmental delays and behavioural disturbances in the infant and poor health in the mother; (2) contribute to death and other disease development.

Iron is essential for normal infant development and helps create blood that is necessary for foetal demands and blood loss during delivery.

Good sources of iron include: (1) lead red meat, (2) green leafy vegetables; and (3) fortified breakfast cereals.

Question 16

Magnesium

Answer 16

Helps build strong bones and teeth. Helps regulate insulin and blood sugar levels. Helps maintain acid-base balance.

Question 17

Zinc

Answer 17

Helps form organs, skeleton, nerves and circulatory organs. Is a component of insulin and several enzymes. Helps synthesis DNA, RNA and proteins. Involved in wound healing.

Question 18

Calcium and Vitamin D

Answer 18

Calcium and vitamin D are needed for strong bones and teeth. Vitamin D is needed for the formation of foetal bones. The recommended daily intake is 10micrograms of vitamin D per day.

Good sources of calcium and vitamin D include (1) milk and other dairy products, (2) egg, (3) meat; and (4) certain fish such as salmon, trout, mackerel, sardines and fresh tuna.

Question 19

Vitamin A and Iodine

Answer 19

Vitamin A promotes healthy skin and mucous membranes of the gastrointestinal, urinary and respiratory tracts. Promotes vision and immunity. Assists with bone and tooth growth.

Vitamin A is needed in small amounts to protect the foetus from immune system problems, blindness, infection and death. In high doses, however, it can cause birth defects.

Iodine is important for brain development. Lack of iodine could contribute to stillbirth, birth defects, and decreased brain development.

Question 20

Alcohol and Caffeine

Answer 20

It is recommended that no alcohol be consumed during pregnancy, and limited caffeine. This protects the infant from foetal alcohol syndrome and other birth defects. High caffeine intake is linked to low birth weight and spontaneous foetal death. It is thus important to avoid food and beverages such as teas, coffee, colas, energy drinks and chocolate.

Question 21

Weight gain and caloric intake

Answer 21

The pattern of weight gain during pregnancy is much more important than the total amount of weight gained. It is better to gain the majority of your pregnancy weight during the last two trimesters.

Do not consume any more calories than normal per day during the first trimester.
340 additional calories/1470 additional kJ are recommended per day during the second trimester.
450 additional calories/2100 additional kJ recommended per day during the third trimester.

These extra calories are needed for adequate foetal growth and to support the higher maternal metabolism.

Question 22

Causes of inadequate nutrient intake and weight gain during pregnancy

Answer 22

(1) Nausea and vomiting
(2) Heartburn
(3) Constipation
(4) Food aversions - alcohol, caffeinated, vegetables and meat
(5) Food avoidances - milk, lean meats, pork and liver
(6) Poor pre-preganancy diet - innapropriate diet pattern or history of frequent dieting, weight cycling and/or eating disorders
(7) Excessive physical activity

Question 23

Nausea and vomiting

Answer 23

Nausea and vomiting is associated with increased levels of HCG which peaks at 12 weeks gestation.

Strategies for managing morning sickness include:

(1) Eat small, low-fat meals and snacks
(2) Drink fluids between meals, avoid caffeine
(3) Reduce citrus, spearmint, peppermint
(4) Limit spicy and high-fat foods
(5) Avoid lying down after eating or drinking
(6) Take a walk after meals
(7) Weak loose-fittig clothes

Question 24

Birth weight

Answer 24

2.5-4.5kg is considered healthy for a baby delivered at full term. Low birth weight (LBW) is a concern for short term and long term health outcomes.

Question 25

Barker hypothesis

Answer 25

Poor nutrition in early life is linked to a higher risk of hypertension, CDH and type 2 diabetes in middle age’.

Term infants who are small for their gestational age are predisposed to obesity and have an increased susceptibility to cardiovascular diseases and Type II diabetes in adulthood as a consequence of physiological adaptations to under-nutrition during foetal life.

Low birth weight is primarily low pre-pregnancy BMI and low gestational weight gain.

Question 26

Food to avoid

Answer 26

(1) Raw and highly carnivorous fish should be avoided (king mackerel, fresh tuna, shark, tilefish and swordfish).
(2) All dairy foods and juices should be pasteurised.
(3) Foods contaminated with heavy metals can have neurotoxic effects on the foetus.
(4) Listeria monocytogenes contamination in pregnancy develop into a serious blood borne, transplancental infection. It is thus important to (i) wash vegetables and fruits; (ii) cook meats; (iii) avoid processed, precooked meats (cold cuts); and (iv) avoid soft cheese (brie, blue cheese etc.)