Diet and Nutrition

Nutrition during Pregnancy

Pregnancy is considered a significant life stage that is related to women’s nutritional status. Both the dietary intake and the nutritional status of pregnant women, before and during pregnancy, affect fetal development and pregnancy outcome.

A well balanced diet from all food groups is highly recommended to ensure having sufficient macronutrients (carbohydrates, proteins and fats) and micronutrients (vitamins and minerals). Food groups include fruits, vegetables, healthy proteins, whole grains, dairy and healthy fats.

In addition, having small frequent meals (5-6 meals) a day might be more comfortable for pregnant women compared to three large meals.

Energy Requirements

Although energy intake does increase during pregnancy, you don't need to eat more calories each day until the beginning of the second trimester. The estimated energy requirement (EER) in kilocalorie (kcal) during single- fetus pregnancy differs among the three trimesters as below:

First Trimester (1-13 week): EER (kcal/day) = non-pregnancy EER + 0

Second Trimester (14-27 week): EER (kcal/day) = non-pregnancy EER + 340

Third Trimester (28-40 week): EER (kcal/day) = non-pregnancy EER + 45

In the second trimester, the additional 340 kcal can be translated to the patient’s daily diet as an additional 1 to 2 servings of fat-free or low-fat dairy and an additional 1- to 2-oz protein servings. In the third trimester, the 450 kcal can be one to two servings of fat-free or low-fat dairy, 1 to 2 oz. protein, and one serving of whole grain bread.

However, additional 500-600 kcal/day is suggested from the first trimester in case of multifetal pregnancy.

Weight Gain

The mean weight gain during pregnancy depends on body mass index (BMI) before pregnancy. Pre-pregnancy BMI can be calculated by dividing pre-pregnancy body weight in kilograms by the square of height in metres.

Guidelines for Pregnancy Weight Gain 

Water Requirements

During pregnancy you should drink 8 to 12 cups (2-3L) of water every day. Adequate water intake will help in digestion, forming amniotic fluid around the fetal, circulation nutrients in the body and waste disposal out of the body.

Macronutrients need (protein, fat and carbohydrates)

• Protein
  Protein is an essential building block for cells, muscles and organs. Usually, protein needs are around than 0.8g/kg/day. But starting from the second trimester, protein needs will be increased to become 1.1g/kg/day Meat, fish, poultry, dairy products, eggs, legumes and tofu are all excellent sources of protein. In general, 5-6 ounces of protein sources are recommended during pregnancy. Each ounce equal 1 ounce meat, fish, or poultry, 1 large egg, ¼ cup tofu, or ½ cup cooked beans.
• Fats
  The recommended daily fat intake should be 20-35% of daily required calories, which is similar to non-pregnant women. It is valuable to focus more on the type of fats and select healthy fats like olive oil, avocado and unsalted nuts.
  One of the most critical fats for fetal brain development and vision improvement are omega-3 fatty acids. Omega-3 fatty acids are abundant in fish. However, some types of fish are high in mercury that can cause deficits in memory, learning, and behavior. Ideally, pregnant women need to consume fish types that are low in mercury and high in omega-3 fatty acids like salmon, sardines, and anchovies. While high mercury fish like shark, swordfish, tilefish, and king mackerel should be avoided. 
• Carbohydrates
  Although the requirement for carbohydrates increases only moderately during pregnancy, carbohydrates should be 45% to 64% of the overall energy need. It is recommended to consume at least 5 to 7 ounces of grains such as whole grain bread, cereal, or pasta. Each ounce equals 1 slice whole wheat bread, 1 cup ready-to-eat cereal, ½ cup cooked cereal, rice, or pasta, ½ bun, small bagel, or English muffin. At least half the consumed grains should come from whole grains. In addition, selecting cereals and bread products that are fortified with iron will meet your iron needs during pregnancy along with the prenatal vitamins.

Other Food Groups needed during pregnancy

It is important to have daily:

• At least 3 cups of dairy foods for adequate calcium and vitamin D intake. 1 cup of dairy equal 1 cup milk, 8 ounces yogurt, 1½ ounces cheese and 2 ounces cheese
• At least 3 cups of vegetables (including at least 1 cup of dark-green or orange vegetables that are high in vitamin C). 1 cup of vegetables equal 2 cups raw, leafy vegetables, 1 cup cooked vegetables and 1 cup (8 fluid ounces) juice
• At least 2 cups of fruit. Limit juice to 100% fruit juice and only 1 cup a day. 1 cup of fruits equal 1 medium piece of fresh fruit, ½ large fruit like grapefruit or mango, 1 cup chopped, cooked, or canned fruit, 1 cup (8 fluid ounces) 100% fruit juice and ½ cup dried fruit.

Micronutrients need (vitamins and minerals)

During pregnancy the need for certain vitamins and minerals increases. To avoid vitamin deficiency, you should take care to include sufficient quantities of the following:

• Folic acid
  It is very important for the development of the fetal central nervous system and it reduces the risk of neural tube defects. Folic acid is the synthetic form of the naturally occurring B vitamin Folate. Folate rich food sources are citrus fruits, dark green leafy vegetables, nuts and liver. It is recommended to take folic acid from fortified food or supplement (as prescribed by the doctor) in addition to consuming folate rich food.
• Calcium and Vitamin D
  Both are necessary for the formation of bones and teeth in the growing fetus. Calcium and vitamin D can be found in dairy products such as milk, yoghurt and some beverages and food products that are fortified with calcium and vitamin D. Vitamin D cannot be ignored because it is very essential for calcium absorption in the body.
• Magnesium
  It can reduce cramps in the calf muscles and premature labour pains. Magnesium sources include, nuts and seeds, legumes, dark chocolate, banana, avocado, and leafy vegetables.
• Iron
  It is needed important for the formation of red blood and muscle cells for both mother and baby. Iron is found in meat, chicken, fish, legumes, egg yolk, whole and enriched grain meal products, fortified cereals and dark green leafy vegetables.
• Multivitamin Preparations
  Many people find it difficult to eat and drink enough to supply the body with adequate vitamins and minerals needed during pregnancy. The reasons behind that differ from person to another, one of the main reasons is having morning sickness. Thus multivitamin supplements can be used as prescribed by the gynecologist.