"Maternal nutrition – what the mom-to-be eats – is a key factor that affects birth outcomes and has long-term effects on the health of children," says Johannesburg gynaecologist Dr Kiran Kalian.
Dr Candace Howe, an obstetrician/gynaecologist at HM Medical in Newport Beach, USA, concurs. She says that there's substantial scientific research to show that metabolic programming happens in the womb, so a mother's healthy nutritional status is extremely important.
So what foods should we be eating to help our babies grow strong while they're in the womb?
"Building a healthy baby starts from before pregnancy," Cape Town-based nutritionist and midwife Jacky Bloemraad-de Boer points out.
"Eating a balanced, healthy, nutritious diet improves fertility, helps boost energy and fights early-pregnancy nausea."
Pre-pregnancy, Bloemraad-de Boer recommends a diet high in fresh whole foods that includes fruit, vegetables, complex carbohydrates, proteins and unsaturated fats.
If this describes you, read on. If not, Dr Kalian advises that you consult with a trained specialist in maternal nutrition, and especially if you have an eating disorder, are overweight or obese, if you’re on a special diet or avoid certain foods or skip meals.
"The mother's body undergoes huge changes and it needs extra nutrients in the first trimester," says Bloemraad-de Boer.
"The most important macronutrients to support this are proteins, because they're the body's building blocks, essential for the growth and development of the placenta and the extra blood volume needed in pregnancy."
Pregnant women need a minimum of 65-85g a day of protein, and up to 100g a day if they're extremely tired and to help alleviate certain symptoms like nausea.
"Although the baby has developed all its organs and systems by the second trimester, it will now begin to grow in length and weight, and needs nutrients to support this essential stage in its development," says Bloemraad-de Boer.
"Besides eating a balanced, healthy diet, it's especially important to eat foods rich in calcium, magnesium and vitamin D to help the baby grow strong bones. It's also beneficial to eat foods containing omega 3 fatty acids, which are vital for the baby’s nervous system and brain development."
As the growing baby crowds out other internal organs, the mom may feel hungry but get full very quickly. "Eat six small meals a day rather than three bigger ones," Bloemraad-de Boer advises.
Don't eat the doughnut
If you had morning sickness in your first trimester, it may feel like a blessing to want to eat all your favourite things again during your second trimester. But what if your cravings include nutrient-empty chips and burgers, ice cream and chocolate?
USA neuroscientist and nutrition expert Dr Nicole Avena, author of What to Eat When You're Pregnant (Ten Speed Press, 2015), says that research (albeit mostly in rats) has found that not only can an in-utero diet high in fat or sugar lead to the child growing up obese.
Maternal diet "can have a long-lasting impact on the child's risk of developing mental health disorders, impaired social behaviours, lower cognitive abilities and increased response to stress."
The Magic Bullets
Supplementation is always a good idea during pregnancy and should include folic acid, iodine, vitamin D and iron to ensure adequate intake. In the third trimester, some women may need to add extra iron or vitamin B12, and a calcium supplement. Speak to your medical practitioner about your supplement needs.
Folic acid: Folate is a B vitamin (B9) found in leafy green vegetables such as asparagus and broccoli, liver and kidney, nuts, lentils and seeds, and oranges. It's critically important very early in pregnancy (in the first 28 days) when the brain and spine of the baby are developing.
All the B vitamins are water-soluble, which means your body doesn't store them – you have to top up your B9 levels every day. In South Africa, all bread and maize are fortified with vitamins and minerals, including folic acid, which is the synthetic form of folate.
Dr Soha Said, a consultant obstetrician at Corniche Hospital in Abu Dhabi, United Arab Emirates, advises women to begin taking folic acid a month before they conceive and to continue for the first three months of pregnancy.
Iron: "If you're at high risk of iron deficiency, take supplementation from around 16 weeks of pregnancy, when the demands of the foetus for iron start to increase," says Dr Kalian.
Omega 3s: Dr Deborah Pufal, a senior lecturer in nutrition at Huddersfield University in the UK, notes that a woman's diet during pregnancy is critical for the baby's brain development. For this reason, she says, you must get enough omega 3 fatty acids, which are involved in brain development.
Fish oils are the best and most easily available source, but because so many marine fish have high levels of contaminants, current advice is that we should eat no more than two to three portions a week. Alternatives are soya and linseed oils, walnuts and enriched eggs.
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