NUTRITION AND PREGNANCY

Good nutrition during pregnancy will help to keep a developing baby and its mother healthy. The need for certain nutrients, such as iron and folate, is increased at this time but only a small amount of extra energy (kilojoules) is needed.

If you are pregnant, a good approach is to eat to satisfy your appetite and continue to monitor your weight. A normal weight gain over the course of a pregnancy is around 10–13kg for women who have a healthy pre-conception weight.

A varied diet generally provides our bodies with enough of each vitamin and mineral each day. However, pregnant women may need supplements of particular vitamins or minerals. Be advised by your doctor before taking supplements.

Pregnant Women


This information is based on the Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes, the Australian Dietary Guidelines, and The Australian Guide to Healthy Eating. These recommendations are for healthy women with standardised weight, height and estimated energy requirements and may not meet the specific nutritional requirements of individuals. Specific advice for individual needs should be sought from a qualified dietitian.

Healthy Eating Guidelines for Pregnant Women

The Australian Guide to Healthy Eating recommends the following servings per day:

  • 4 - 6 servings from the bread, cereals, rice, pasta, noodles group.

An example of one serve is 2 slices bread; 1 medium bread roll; 1 cup of cooked rice, pasta or noodles; or 1 1/3 cups of breakfast cereal flakes.

There is an allowance of about 15g a day for poly or monounsaturated fats and oils that can be used to spread on breads or rolls or used elsewhere in the diet.

  • 5 - 6 servings from the vegetables, legumes group.

An example of one serve is 75 grams of 1/2 cup cooked vegetables; 1/2 cup cooked dried beans, peas, lentils or canned beans; 1 cup of salad vegetables; or 1 small potato.

  • 4 servings of fruit.

An example of one serve is 1 medium apple; 2 small pieces (150g) of fruit (apricots, kiwi fruit, plums); 1 cup of diced fruit pieces or canned fruit; 1/2 cup of fruit juice; or 1 1/2 tablespoons of sultanas.

  • 2 servings from the milk, yoghurt, cheese group.

An example of one serve is 250 ml of milk; 250 ml of calcium fortified soy beverages; 40 grams (2 slices) of cheese; or 200g (1 small carton) of yoghurt.

  • 1 1/2 servings from the meat, fish, poultry, eggs, nuts and legumes group.

An example of one serve is 65-100 grams cooked meat or chicken; 2 small chops; 2 slices of roast meat; 1/2 cup of cooked dried beans; 80-120 grams of fish fillet; 1/3 cup peanuts (almonds); or 2 small eggs.

Note: You get plenty of fats and oils from the amount used with cereal foods and from meat, eggs, cheese, peanut butter, margarine, etc so fats and oils aren’t included separately. 

For more information check out the Australian Guide to Healthy Eating at: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-food-resources.htm#consumers

Energy requirements (kilojoules /day)

Energy requirements are increased with pregnancy to allow growth of the unborn baby and placenta.
For more information on energy requirements see a dietitian or follow this link to the Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes

In a multiple pregnancy, where the mother is expecting twins or triplets for example, an even higher extra kilojoule intake is required.

Physical Activity

Doing regular physical activity has health benefits during pregnancy and also helps to prepare the body for childbirth. However, it is important to modify or choose a suitable exercise program because pregnancy affects the body's response to exercise

Be sensible about the level of physical activity undertaken. Consult a doctor, physiotherapist or health care professional to make sure the exercise routine is not harmful for pregnant women or unborn babies.

If the pregnancy is complicated (such as expecting multiples, having high blood pressure, heart disease, pre-eclampsia, or risk of premature births) it is best to talk to a doctor.

Healthy Eating for Pregnant Women

Healthy eating is important for pregnant women and their unborn babies. There are many nutritional issues to consider ensuring good health of both the woman and baby, during and after pregnancy. A wide varied diet is vital in supporting the growth and development of the foetus and the maintenance of the woman’s own health.

During pregnancy, there are increased requirements for most nutrients. Some of the important ones for discussion are:

  • Energy (kilojoules)
  • Iron
  • Folate
  • Iodine
  • Zinc
  • Vitamin C

Hormonal changes and the baby's growth during pregnancy may also affect the mother's response to food. Common concerns include:

  • Constipation
  • Morning sickness or nausea
  • Indigestion

For the safety of the unborn baby, a pregnant mother should be mindful of:

  • Listeria
  • Mercury
  • Alcohol
  • Caffeine
  • Artificial sweeteners

The Dietary Guidelines for Australian Adults are:

  • Enjoy a wide variety of nutritious foods
    • Eat plenty of vegetables, legumes and fruits
    • Eat plenty of cereals (including breads, rice, pasta and noodles), preferably wholegrain
    • Include lean meat, fish, poultry and/or alternatives
    • Include milks, yoghurts, cheeses and/or alternatives.
      Reduced-fat varieties should be chosen, where possible
    • Drink plenty of water

and take care to:

    • Limit saturated fat and moderate total fat intake
    • Choose foods low in salt
    • Limit your alcohol intake if you choose to drink
    • Consume only moderate amounts of sugars and foods containing added sugars
  • Prevent weight gain: be physically active and eat according to your energy needs
  • Care for your food: prepare and store it safely
  • Encourage and support breastfeeding

For individual nutrient requirements such as those described below, the Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes provides an average nutrient intake requirement for individuals and a value that would meet the needs of most individuals in the population. Because it is difficult to assess an individual’s exact requirement for a particular nutrient, you might like to aim for the upper figure to maximise the certainty that a sufficient amount of the nutrient is obtained from food. For more information go to: Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes

 

Healthy Weight Gain

A healthy weight gain during pregnancy can vary between individuals and may depend, for example on the pre-pregnancy weight of the mother. It may be suitable for overweight women to gain less weight during pregnancy than women who are a healthy weight, as long as nutrient requirements of the mother and unborn baby are met. Women who are underweight should aim to gain more. Specific advice for individual needs should be sought from a qualified dietitian or health professional.

Healthy weight gain is mostly seen in the second and third trimesters (after the first 3 months) of pregnancy. This is the time of pregnancy when mother's energy (kilojoule) requirements increase. However, it is best to focus on food quality rather than quantity to meet the nutritional needs in pregnancy. There is no reason to increase food quantity to the point of ‘eating for two’ as this is likely to lead to extra weight gain.

Pregnancy is not a suitable time to be dieting or trying to lose weight. Dieting can have a negative impact on the unborn baby.

Iron

Pregnancy can deplete a mother's iron stores. Therefore, it is important to have an appropriate intake of iron to help build and maintain these stores. Low iron levels in early pregnancy have been linked to premature birth and low birth weight.

The average requirement for iron in pregnancy is 22mg/day but some women will need 27mg/day or more. A mixed diet of animal and plant foods can help you achieve your iron intake. Absorption of iron is better from animal foods compared to plant sources and the recommended dietary intakes are based on a mixed western diet.

Red meat is the best source of iron as well as also being a good source of protein and zinc. Other meats like chicken and fish also contain iron but not as much as red meat. Iron can also be found in leafy green vegetables, legumes and iron-enriched breakfast cereals.

Adding a glass of fruit juice or other foods rich in vitamin C (such as tomato, broccoli or capsicum) to a meal will increase the amount of iron the body absorbs. In contrast, tea, coffee and unprocessed bran can inhibit iron absorption.

Some women may benefit from taking an iron supplement if they are iron deficient, but it is best to take them according to your doctor' advice as supplementation may cause symptoms like constipation and be harmful in excessive amounts.

Folate

Folate is a B vitamin that is needed for healthy growth and development. Its requirements are increased during pregnancy for normal growth of the unborn baby. Adequate folate intake helps to prevent birth defects in the baby, such as spina bifida.

The recommended intake of dietary folate for pregnant women is 600µg/day throughout pregnancy. However, to reduce the likelihood of neural tube defects in the baby, it is recommended that women consume an additional 400µg/day folic acid through a supplement or in the form of fortified foods for at least one month before and three months after conception in addition to consuming food folate from a varied diet. (It should be noted that the folic acid used in supplements or used to supplement foods is almost twice as potent as dietary folate from natural sources)

Women who have a family history of neural tube defects may benefit from higher levels of supplementation and should consult their doctor during the planning of the pregnancy or as soon as possible. The nutrition information panel on food packages indicates how much folate is in a food, especially if extra folate has been added to the food product.

Discuss folate supplementation with your doctor, as it is best to use a folate supplement especially designed for pregnancy. Trying to meet folate needs from a regular multivitamin and mineral supplement may mean you take higher than recommended levels of other vitamins and minerals in order to get enough folate.

Good sources of folate include leafy vegetables, whole grains, peas, nuts, avocados and yeast extracts (eg marmite, promite, vegemite etc).

For more information, http://www.foodstandards.gov.au/foodmatters/folate.cfm

Iodine

Iodine is an essential mineral that we get from the food we eat. The developing baby in the womb, babies and young children are at greatest risk from a diet deficient in iodine. Iodine is needed in very small but essential amounts by the human body. Iodine is essential to the production of thyroid hormone, which regulates body temperature, metabolic rate, reproduction, growth, blood cell production and nerve and muscle function. Thyroid hormone is produced in the thyroid gland, which is in the neck.

Mild to moderate iodine deficiency can result in learning difficulties and affect development of motor skills and hearing.

While seafood is a good source of iodine, the amount of iodine in other food like milk and vegetables, depends on how much iodine is in the soil.

The recommended intake of iodine throughout pregnancy is 220µg/ day. From September 2009 all bread, except organic, will be fortified with iodine which may improve iodine intake for most Australians, however pregnant and breastfeeding women are recommended to take a supplement of between 100 and 200 µg per day. You may wish to discuss any supplementation needs with your doctor.

Zinc

Zinc is a component of various enzymes that help maintain structural integrity of proteins and help regulate gene expression, so getting enough is particularly important for the rapid cell growth that occurs during pregnancy. The average requirement for zinc during pregnancy is 9mg/day but some women will need as much as 11mg/day or more. Zinc can be found in lean meat, wholegrain cereals, milk, seafood, legumes and nuts.

Vitamin C

The need for vitamin C is increased in pregnancy due to larger blood volume in the mother and the growth of the unborn baby. Vitamin C is important for the formation of collagen which is especially important in blood vessels.

The average requirement for vitamin C during pregnancy is 40mg/day but because of individual variation, some women may need 60mg/day or more. Excellent dietary sources of vitamin C include fruit and vegetables.

Fibre & Fluids

Some women experience constipation especially during the later parts of pregnancy. A high fibre intake combined with plenty of fluid is encouraged to help prevent this.

High fibre foods include wholegrain breads and cereal products, legumes, nuts, vegetables and fruit.

Multivitamin supplements

Apart from the recommended folate supplement, it is best to obtain nutrients from a healthy diet. Multivitamins not designed for pregnancy should be taken with care as there are dangers associated with excessive doses of nutrients such as Vitamins A, D and B6.

Morning sickness and Nausea

Morning sickness is a common symptom of early pregnancy and, in many cases, goes away by the end of the first 3 months. It is caused by changes in hormones during pregnancy and may make eating difficult. Although it is called 'morning sickness', nausea (with or without vomiting) can happen at any time of the day.

Morning sickness does not usually cause any problems for the unborn baby. However, if a pregnant woman experiences severe and ongoing vomiting, it is important to contact a doctor.

Some food and eating suggestions that may help manage symptoms of morning sickness or nausea include:

  • Eat smaller meals more often. Missing meals can make nausea worse.
  • Avoid large drinks. Have frequent small drinks between meals.
  • Limit fatty, spicy and fried foods.
  • Food has a stronger odour or smell when it is heated, which may make nausea worse. If possible, have other people help with cooking, or prepare your food at times of the day when you feel better
  • Try eating a dry biscuit before you get out of bed in the morning.
  • Eat a healthy snack before you go to bed at night. This might include fruit (fresh, tinned, dried), crackers with hard cheese, or yoghurt.
  • Avoid foods if their taste, smell or appearance makes you feel sick.

If vomiting, it is important to drink enough fluids. It may be easier to have lots of small drinks than to try and drink a large amount in one go. Try a variety of fluids such as water, fruit juice, lemonade and clear soups. Sometimes it can be helpful to try crushed ice, slushies, ice blocks, or even suck on frozen fruit such as grapes or orange segments.

Note: The stomach acids in vomiting can soften teeth enamel. It is best not to use a toothbrush to clean the teeth straight after vomiting as this may damage them. Have a drink of water to clean your mouth.

Indigestion

A pregnant woman may experience reflux or indigestion as the unborn baby grows, because it places more pressure on the mother's internal organs, including the digestive system.

To manage symptoms of indigestion try to:

  • Eat small meals and nutritious snacks often.
  • Separate drinking from eating. Drink outside of meal times.
  • Limit high fat foods and highly spiced foods.

Listeria

Listeria is bacteria carried in some foods that can cause an infection called listeriosis, and may lead to miscarriage if it is transmitted to the unborn baby.

The best ways to avoid listeria infections include hygienic preparation, storing and handling of food. Foods should be eaten fresh, or thoroughly cooked, or well washed if eaten raw (fruit and vegetables). Leftovers can be eaten if they have been refrigerated immediately and stored for less than 24 hours.

The foods most likely to carry the bacteria, increase the risk of infection and therefore should be avoided, include:

  • Soft and semi soft cheeses eg, brie, camembert, ricotta, blue, feta
  • Soft serve ice cream
  • Unpasteurised dairy products
  • Pate
  • Chilled seafood
  • Salads - fruit / vegetable eg. prepared, prepackaged, smorgasbord/ salad bars
  • Cold meats, including chicken eg. deli, sandwich bars, and packaged ready-to-eat

For more information, 

http://www.foodstandards.gov.au/_srcfiles/Listeria.pdf

Pregnant women need to be especially mindful of food safety.

Healthy tips:

  • Always wash hands before preparing or serving food and after handling animals or visiting the toilet
  • Animals can carry the toxoplasmosis parasite which can cause disease in humans so keep them out of the kitchen, avoid touching faeces and wear rubber gloves under garden gloves.
  • Wash cook ware and utensils well after use
  • Store raw foods down low in the fridge and check fridge temperature regularly
  • Foods and left-overs that belong in the fridge should always be returned there as soon as possible
  • Thaw frozen meats in the fridge
  • Once cooked, pasta and rice should be stored in the fridge
  • Look for "best before" and "use by" dates on packaged foods

Mercury

Advice in Australia about avoiding mercury poisoning, has been specifically developed for the Australian population. It is based on information about our diets, the fish we commonly eat and their mercury content.

Food Standards Australia New Zealand (FSANZ) advises pregnant women, and women planning pregnancy, to eat a variety of fish as part of a healthy diet. However, they should limit their intake of certain types of fish including:

  • Shark (flake), broadbill, marlin and swordfish to 1 serve per fortnight (with no other fish to be consumed during that fortnight).
  • Orange roughy (sea perch) and catfish to 1 serve per week (with no other fish being consumed during that week).

For more information

http://www.foodstandards.gov.au/newsroom/factsheets/factsheets2004/mercuryinfishfurther2394.cfm

Alcohol

Drinking alcohol during pregnancy can affect the unborn baby by damaging the development of the baby's brain and slowing down physical growth. Babies affected by alcohol tend to have low birth weights. They may also have physical and behaviour problems at birth and throughout childhood.

It is not currently known what level of alcohol is safe to drink during pregnancy. Therefore, it is best to avoid drinking alcohol during pregnancy as much as possible.

For further information regarding alcohol consumption for women planning pregnancy or who are pregnant or breastfeeding:


http://www.nhmrc.gov.au/publications/synopses/ds10syn.htm

Caffeine

Caffeine is a chemical found in many foods and drinks, including coffee, tea and cola. It affects the nervous system and can cause irritability, nervousness and sleeplessness.

While having large amounts of caffeine does not appear to cause birth defects, drinking high amounts of caffeine may make it more difficult to become pregnant and may increase risk of miscarriage or having a baby with low birth weight.

It is best to limit the daily amount of caffeine to:

  • 1 regular espresso style coffee, or
  • 3 cups of instant style coffee
  • 4 cups of tea, or
  • 4 cans of diet/regular cola drink.

Energy drinks are not recommended during pregnancy as they may contain high levels of caffeine, and other ingredients not recommended for pregnant women.

Decaffeinated varieties are an option which contains little caffeine however safe levels of decaffeinated products for pregnant women are unknown. For more information about the caffeine content in food and drink,

http://www.foodstandards.gov.au/foodmatters/caffeine/index.cfm

Artificial Sweeteners

Food Standards Australia New Zealand (FSANZ) approves the use of food additives in food where the scientific evidence demonstrates that no harmful effects will result from their use. Pregnant women are included by FSANZ in its assessment of the safety and suitability of all food additives including artificial sweeteners. FSANZ approved artificial sweeteners are included in the list of permitted food additives contained in the Australian New Zealand Food Standards Code and can be found at:

 http://www.foodstandards.gov.au/consumerinformation/additives.cfm

Content provided by www.health.gov.au 

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