Last week the emphasis was on the “vital first 1000 days” of pregnancy, which is receiving increasing amounts of attention as scientists discover just how important this period of almost three years is in determining the future health and life of your child.
Factors such as the mother’s body weight; nutrient intake particularly of folic acid; omega-3 fatty acids; iron and vitamin B12; exposure to toxins; smoking; drinking and excessive intake of caffeine can all have pronounced effects on the future of your baby’s health and mental development.
This week we will take a look at some of the indicators of healthy nutrition during pregnancy and best practices that lead to greater success in achieving a healthy pre-pregnancy weight, as outlined by Prof Kelly Tappenden in her definitive lecture, “Eating for Two”.
Achieving a healthy pre-pregnancy weight
In my previous article, I listed the suggested weight gains for pregnant mothers in kg per month and per week, in terms of pre-conception BMI. These guidelines were compiled in 2009 by the Institute of Medicine in the USA, and their suggested weekly gains may well have many prospective mothers worried.
The fact that a woman who has a BMI of less than 18,5 is encouraged to gain half a kg per week during pregnancy, while an obese woman with a BMI of 30 or more, is cautioned not to gain more than 0,2 kg (or 200 gram) per week, may seem unrealistic and difficult to achieve.
According to Prof Tappenden, there are certain steps that can be taken to ensure that thin women gain more weight and obese women gain less weight during the 9 months of their pregnancy to ensure that they and their babies have the best chance for future health.
Prof Tappenden suggests the following:
- Early and frequent motivational counselling which emphasises how much weight each individual woman should try to gain and what diet these women should use to achieve their target weights.
- The use of dieticians to provide personalised dietary advice as well as group counselling if resources are stretched to the limit (e.g. meetings at clinics where one diecitian can reach a larger group of pregnant women and still answer individual questions).
- Great emphasis must be placed on early counselling and advice so that pregnant mothers receive the correct dietary advice during the important first trimester when so many developmental processes take place in the womb.
Most pregnant women are not sure if they should continue to exercise or to take time off from physical activity for most of their pregnancy and during breastfeeding. In view of the obesity crisis, Prof Tappenden recommends supervised group and/or home exercise programmes.
Provided mothers are declared fit and healthy by their medical doctors, they should be encouraged to keep fit and continue with moderate exercise for their entire pregnancy. Pregnant women are advised to avoid contact or collision sports which have a high risk of falling (e.g. horse riding, skiing, netball, and other contact sports).
A sensible approach is required, and no woman who suffers from any pregnancy complication should do vigorous exercise. However, gentle walks, swimming or cycling on a stationary bicycle may still be suitable to help to keep the expecting mother fit and well.
The following conditions are classified as pregnancy complications which are a contraindication to exercise:
- High blood pressure (hypertension)
- Foetal growth retardation (signs that the foetus is not developing adequately)
- Preterm labour (if you experience contractions, stop all exercise and consult your doctor)
- Incompetent cervix – women who have problems with carrying to term or have been provided with a cervical cerclage or stitch to ensure that the cervix does not open prematurely
- Persistent bleeding during the 2nd and 3rd trimesters
Energy intake during pregnancy
The recommended energy intakes during pregnancy that are recommended may also come as a surprise to those mothers who believe in “Eating for Two”. Prof Tappenden recommends that during the first trimester pregnant mothers who are not seriously underweight, should stick to their pre-pregnancy energy intake and not add additional kilojoules to their diet.
In the second and third trimesters the energy intake of women of normal weight can be increased by 1430 kJ and 1900 kJ respectively. Therefore most pregnant women who are not overweight or obese should have a daily energy intake of 9,240 to 12,180 kJ derived from a wide variety of foods.
The recommended fluid intake is 10 cups or 2,5 litres per day. “Fluid” includes water of all types which is clean and safe, rooibos tea, moderate quantities of diluted fruit juice and milk (cow’s milk or soy milk for mothers with lactose intolerance). All alcohol should be avoided for the period before and during pregnancy and when breastfeeding your baby. Decaffeinated tea and coffee can be included in moderate amounts of 2 to 4 cups a day.
Pregnancy protein intake
Protein intake should, if possible, be increased by 25g per day per baby, which means that mothers expecting twins require 50g of extra protein per day. The following foods would increase your protein intake by about 25 g per day:
- 80g of meat, chicken, or fish (these foods are also rich in iron and vitamin B12)
- 2,5 glasses of milk (milk and dairy products are rich in protein, calcium and vitamin B2)
- A serving of a liquid meal supplement that is suitable for pregnancy which is prescribed by your dietician or doctor which you buy at your pharmacy and not at the gym. Supplements purchased at gyms may contain high levels of certain nutrients that can be harmful to the developing baby (for example excessive doses of vitamin A can be teratogenic [an agent that can disturb the development of an embryo or fetus] to a foetus).
It is a good idea to eat 2-3 cooked fish meals a week to provide omega-3 fatty acids for the development of the baby’s brain, nervous system and eyes.
Despite encouraging pregnant women to moderately increase their protein intake, this does not mean that using a high-protein, high-fat diet during pregnancy is advisable. The emphasis is always on eating a balanced, varied diet that should include all the food groups, particularly low-glycaemic index (GI) whole grains and a wide variety of vegetables (not just the zero carb vegetables that are currently the rage because of “Banting”).
- Tappenden KA (2015). Eating for Two. Best Practices for Maternal Nutrition. Paper presented at the Nutritional Solutions CNE Event, 16 April 2015, Johannesburg.
- Institute of Medicine (2009). Report Brief: Weight gain during pregnancy: Reexamining the Guidelines. May 2009.
Image: Pregnant mom on scale from Shutterstock