We all know that during pregnancy, our energy needs increase. In the first trimester, women actually don’t require any additional calories – however this increases to an additional 1,400kj/day in the second trimester, and 1,900kj/day in the third trimester.
We also know that our requirements for most nutrients also increase – the most noteworthy being Iron, Iodine and Folate. But how can pregnancy related conditions be managed through nutrition?
Pre-eclampsia is a very serious condition, characterized by high blood pressure, sudden swelling, rapid weight gain (due to fluid retention), and proteinuria (protein in the urine).
Pre-eclampsia affects the placenta, and may affect the mothers’ kidneys, liver and brain. It is the leading cause of birth complications, including low birth weight, premature birth and stillbirth.
Nutritionally, eating a diet containing a wide variety of fruits and vegetables, which provide various antioxidants, may be beneficial to women suffering pre-eclampsia, given the inflammatory nature of the condition.
Consuming adequate omega 3 fatty acids has also been shown to be of benefit, whilst keeping overall kilojoule intake to those set out within guidelines and eating a high fibre diet can also assist in management of the condition.
Interestingly, a deficiency of Vitamin B2 (riboflavin) has been implicated in the development of pre-eclampsia, so ensuring adequate intake through diet or supplementation is suggested. Vitamin B2 can be found in meat & dairy, oily fish, edamame, avocado, asparagus and almonds.
Gestational Diabetes (GD) is a form of Diabetes Mellitus that develops during pregnancy and lasts the duration of the pregnancy. Developing GD increases both maternal and foetal risk of developing Type 2 diabetes later in life.
GD can cause severe complications, including high birth weight and an increased risk of birth trauma. The condition can affect the function of the placenta in late pregnancy, leading to serious complications. The condition is more likely to occur in women who have PCOS and are overweight.
Dietary management is sufficient in managing GD in many cases, provided the guidelines are followed correctly. These guidelines include:
Eating small, frequent meals
Including carbohydrates, protein and fat in every snack and meal
Eat a wide variety of nutrient dense foods
Avoiding sugary foods and drinks
Choosing lower Glycaemic Index (GI) carbohydrates for sustained energy and regulated blood sugar release
Being mindful of the Glycaemic Load (GL) of all carbohydrate foods eaten within the day
Ensure adequate magnesium and potassium are obtained from the diet, as these nutrients are required for insulin production. Magnesium rich foods include leafy greens, beets, banana, cacao. Potassium can be found in sweet potato, banana, watermelon, spinach, beetroot, white beans and black beans
Including foods in the diet that encourage the cellular take-up of glucose – cinnamon & foods rich in chromium (broccoli, green beans, beef, turkey)
Replacing saturated fats with Essential Fatty Acids, particularly Omega 3 fatty acids
Eating a high fibre diet – approximately 28-30gm per day
Regular exercise throughout, and following pregnancy
Breastfeeding / pumping for as long as possible
Around 80% of women will report feeling some nausea during pregnancy, with 50% of pregnant women reporting vomiting.
The severity of these bouts of nausea & vomiting is truly individual from woman to woman. In some cases, it can be debilitating, and impact on normal daily activities. In 1-2% of pregnancies, morning sickness develops into hyperemesis gravidarum, which is considered severe nausea & vomiting.
Some nutrients / herbs / foods that have been proven effective in reducing nausea and vomiting include Vitamin B6, ginger & peppermint. Vitamin B6 can be found in meat, liver, tuna, potato, carrot, chickpeas, salmon & chicken, or supplemented; Ginger can be consumed in tea, added to cooking, consumed as ginger ale, or used as an essential oil or extract; peppermint can be consumed in tea, mints, or peppermint essential oil can be smelt to reduce feelings of nausea.
During pregnancy, iron requirements increase due to the increased volume of maternal blood. By the end of a pregnancy, maternal plasma volume can increase by up to 50%, and red blood cell mass by up to 30%. According to the WHO, 22% of pregnant women in industrialized countries are affected by iron-deficiency anaemia.
Iron-deficiency anaemia can have some serious implications for both mother and foetus, including growth retardation, neurological & cognitive deficits, and intrauterine hypoxia (i.e. the foetus is starved of oxygen).
Increasing iron intake from the diet is the best option for avoiding deficiency, given the forms of iron in many supplements can contribute to constipation, increase iron levels to excess, and cause oxidative stress.
Red meat is the best option for obtaining iron from the diet, however some can be obtained form white meats (turkey, pork), and those following a vegetarian / vegan diet can obtain iron from green lentils, kidney beans, chickpeas and cashews. Vegan iron supplements are also available. Consuming Iron with Vitamin C aids its absorption.
Tea, coffee, other minerals (calcium, zinc, manganese), and phytates and oxalates (found in legumes, grains, soy) can all bind to non-animal iron (non-haem iron), reducing absorption. For this reason, these foods should be eaten at least 2 hours away from plant-based sources of iron or supplements.
During pregnancy, maternal requirements for iodine increase in order to maintain adequate production of thyroxine. This is due largely to an increase of iodine migration to the foetus so that the foetus can produce its own thyroid hormone.
Thyroid hormone is required for neuronal development and myelination of the brain (the formation of the fatty sheaths that protect the neurons in the brain). Low levels of thyroid hormone during foetal development leads to cretinism – irreversible brain damage and mental retardation, which cannot be corrected through supplementation post birth.
All pregnancy / conception / breastfeeding multivitamins contain iodine to ensure this is avoided. Iodine can also be provided from the diet, via seafood – fish, shellfish, seaweed and sea vegetables, and it is also present in cheese and eggs to a lesser extent.