Healthful tips for you and your little one!

You have just found out that you are pregnant - all excited and ready to let the world know that you are about to bring forth a new life! But once the initial excitement is over, you begin to ponder over what you should or should not be doing to ensure you have a healthy baby. Good nutrition plays a vital role for both the mother and the unborn child. An expectant mother should therefore be aware of the influence her nutritional choices will have on her and her little one. Here are some common questions and answers to help empower those moms-to-be!

  • How much weight should you gain?
  • Should pregnant women really be eating for two?
  • What kinds of foods should be included, limited and avoided?
  • How to manage nausea?
  • What about supplements?
  • What is gestational diabetes and how do you manage it?
  • What about high cholesterol levels during pregnancy?

How much weight should I gain?

The amount of weight gain will vary depending on your pre-pregnancy weight. If you are at a healthy weight (BMI between 18.5 and 25), your weight increase over the pregnancy period should be between 11-16kg. If you are overweight (BMI between 25 and 30), you should not gain more than 7-11kg. If you were underweight prior to conception (BMI less than 18.5), you should gain between 12-18kg. Adequate weight gain as well as following a healthy, balanced diet is required to ensure the health of your baby.

Should pregnant women really be eating for two?

Eating for two from the beginning of your pregnancy is a common myth which, if followed, can result in unnecessary weight gain. During the first trimester, you should only gain about one or two kilograms of body weight as nutritional requirements only increase from the second trimester onwards (i.e. from the fourth month). To put this into perspective, during the second trimester, energy intakes should increase by about 340kcal (equivalent to 2 dairy and 2 starch servings) per day and a further 112kcal (equivalent to 1 starch and 1 fruit serving) per day in the fourth trimester (this being for someone who had a healthy BMI prior to conception).

Note: energy requirements increase due to foetal growth and increased maternal body weight. Additional energy requirements will differ from person to person and is also dependent on the mother’s level of physical activity.

What kinds of foods should be included, limited and avoided?

The Heart and Stroke Foundation South Africa (HSFSA) recommends including a variety of foods from the different food groups (dairy, starch, protein, vegetables, fruit and fats) before conception as well as during pregnancy.

The minimum number of servings per food group should be as follows:

  • Low fat or fat free dairy (milk, yoghurt, cheese, buttermilk or maas) - to provide adequate calcium and protein (3 servings per day)
  • Unrefined starches (whole wheat bread, rolls, cereals, rice, pasta and potatoes) - to provide fibre, proteins and B vitamins (7 servings per day)
  • Lean proteins (meat, fish, chicken, turkey, ostrich, soya, eggs, legumes and lentils) - to provide protein, iron and B vitamins (7 servings per day)
  • Vegetables and fruit to provide vitamins and minerals (at least 5 servings per day)
  • Healthy fats (mono and polyunsaturated such as vegetable oils, soft-tub margarines, avocado, olives, nuts and seeds) (around 3 servings per day)

Note: the quantities of food should be adjusted to meet individual requirements to promote appropriate weight gain. Pregnant teenagers and underweight women may need greater quantities and should preferably consult a dietitian or health care professional.

Water: drink plenty of clean, safe water daily. Increasing fibre intake without drinking adequate water can lead to constipation.

Artificial Sweeteners: Moderate use of these sweeteners has been deemed safe even though some sweeteners can be transmitted over the placenta. It must be noted though that women with a rare metabolic condition, phenylketonuria (PKU) should avoid these sweeteners.

Caffeine: Caffeine intake should be limited to no more than 2 cups of coffee or 5 cups of tea per day.

Alcohol: No alcohol should be consumed during pregnancy as it can lead to fetal alcohol syndrome (resulting in slow growth, slow mental development, eye problems, face and skull abnormalities and low birth weight).

For food safety reasons, avoid:

  •  processed cold meats or deli meats unless they are reheated until very hot
  •  soft cheeses like feta brie, camembert and blue veined cheese unless they are labeled ‘made with pasteurised milk’. Other options like mozzarella, cheese spreads and cottage cheese can be safely consumed
  •  refrigerated paté or meat spreads. Canned or shelf-stable paté and meat spreads can be eaten
  •  eating smoked seafood that is refrigerated unless its an ingredient in a cooked dish like pizza
  •  raw/seared fish or shellfish as well as rare meat cuts
  •  unwashed vegetables

How to manage nausea?

Nausea is common during pregnancy and you can try one of the following possible solutions to help alleviate/manage it:

  • eat small, frequent meals
  • eat dry crackers or pretzels
  • drink enough fluids
  • drink clear, non-acidic liquids
  • choose foods that may be better tolerated including those that are cool or at room temperature, low fat or simple options like scrambled eggs, toast, mashed potatoes, bananas, custard and noodles

What about supplements?

Folic acid/Folate: It is not always possible to have a sufficient folate intake before and during pregnancy hence a folic acid supplement is advised prior to conception (400 micrograms) and during pregnancy (600 micrograms). Folic acid plays a vital role in helping to prevent neural tube defects (inherent defects where the nerves and brain develops abnormally).

Iron: If you specifically have low iron levels, an iron supplement may also be recommended.

Omega 3: It is recommended that a pregnant woman consume two to three servings of fatty fish per week (pilchards, sardines, tuna, herring, snoek or salmon). This fatty acid is essential as it can only be obtained from the diet. It plays an important role in the development of the baby’s central nervous system and evidence also indicates its significance in neurodevelopment and cognitive development in the child. If you do not consume fish regularly or at all, speak to a health professional about taking an omega 3 supplement.

Remember that supplements are usually prescribed according to your specific needs so you should not use one without checking with your doctor or dietitian.

What is gestational diabetes and how do I manage it?

Gestational Diabetes occurs during pregnancy (usually around 20 weeks) as a result of hormones released during pregnancy but usually disappears after childbirth. However women who have this type of diabetes are at risk of developing type 2 diabetes later on. Management for this is the same as for someone who has diabetes. If the mother has uncontrolled blood sugar during pregnancy the infant is at increased risk for prematurity or macrosmia (a baby with a birth weight of 4kg or more).

What about high cholesterol levels during pregnancy?

In some women, total cholesterol levels increase during pregnancy and during lactation and this is unrelated to the diet. This is due to the liver producing more cholesterol in response to the hormones of pregnancy. Normal levels for total cholesterol are between 3-5mmol/l, while typical values in pregnancy can range from between 5.2 - 8.5 mmol/l. It is advisable that if you have a high cholesterol level during pregnancy to get tested for cholesterol again once the baby has been weaned as, even during lactation, levels could be high. If you choose not to breastfeed, you should have your cholesterol tested after the baby is born.

Remember a healthy, nutritious diet prior to conception as well as during pregnancy can do wonders for you and your baby. It is only natural to be concerned about what you eat daily - whatever it is, ensure that it is mouthfuls of goodness.

Written by Ayesha Seedat, Registered Dietitian, the Heart and Stroke Foundation South Africa.

For more heart smart nutritional advice from a registered dietitian, please contact the Heart Mark Diet Line on 0860 223 222 or email heart@heartfoundation.co.za