WHY OVEREATING DURING PREGNANCY IS NOT GOOD?

Healthy diet during pregnancy is very important because it affects proper foetal growth. Basal metabolism increases by 25% during pregnancy and therefore it is important to increase calorie intake only by about 200 calories a day. This eliminates advice given to pregnant women – “it is good to eat for two.” In the infirmary, during each control, we measure pregnant woman’s body weight (BW). Optimal gain weight is about 10-12 kg throughout the entire pregnancy, although that recommendation is very individual and is determined by a pregnant woman’s BMI (the ratio of body height and body weight of a pregnant woman), especially according to activity of each pregnant woman. Lower gain of BW different from the predicted one is not a problem if the ultrasound pregnancy is developing properly. On the contrary, the bigger problem is excessive weight gain that sometimes amounts to more than 20 kg. Such a change can complicate both pregnancy and childbirth, not to mention common very demanding weight loss after the childbirth. Due to all above mentioned, rational diet during pregnancy requires both care of the diversity of food products, as well as the quantity. Recommendation- eat more often during the day and with smaller portions.

COMPOSITION OF THE DIET DURING PREGNANCY?

It would be good to increase the protein intake of both plant and animal origin (milk, cheese, white meat, fish- small fish contain less mercury). Daily need for meat is around 180-250g. Smoked meat and processed meat products should be completely eliminated.

ADDITIVES IN THE DIET

Additives in the diet for pregnant women are made respecting the special needs for nutrients during pregnancy. Although there are differences in the composition of such preparations, same fundamental determinants of these preparations should be satisfied. For instance, it is desirable that the proportion of vitamin A does not exceed the recommended dose and that critical nutrients such as folic acid, iron, calcium and magnesium are present in adequate amounts.

Prenatal preparations can be taken even before the conception, during pregnancy and lactation. What is more, needs for some vitamins and minerals are even higher during breast-feeding than during the pregnancy, so taking additives in diet during that period is of particular benefit. It is recommended vitamin B12 supplement to pregnant and nursing woman who are vegetarians, especially vegans, in order to have sufficient supply of this vitamin to transfer it to the foetus with the purpose of preventing delays in development. Preparations which in the same dosage forms contain more essential nutrients, are preferred because of the convenience of application- for example, a preparation which ensures a required dose of omega-3 (al least 250 mg), folic acid (at least 400 mcg), and the majority of vitamins and iron, will ensure much necessary nutrients in a practical form. Omega-3 fatty acids are usually in the oily form which makes them difficult to be compatible with other essential ingredients. Due to that, innovative dose forms are being developed nowadays, so called capsule inside a capsule, which enables creating preparations contain omega-3 fatty acids, vitamins and minerals all in one capsule. Additional calcium and magnesium should usually be ensured from separate preparations concerning the fact that daily recommended doses are really high and amount 375 mg for magnesium and additional 300-600 mg for calcium – depending on nutrition habits of a pregnant or a nursing woman.

FLUID INTAKE

On a daily basis, a fluid intake should be around 2-2,5 l- the intake should be adjusted to a season. Excessive fluid intake can be harmful as well because it burdens the kidneys of a pregnant woman.

It is the best to drink water without CO2 (bubbles), unsweetened and unflavoured and it is smart to avoid herbal drinks too- teas which sometimes stimulate uterus muscles or affect the nervous system of a pregnant woman.

INTAKE OF HARMFUL SUBSTANCES DURING PREGNANCY

It would be smart to eliminate alcohol during pregnancy because a continuous consumption of alcohol (20-40 g) on a daily basis affects complete foetal development (although a glass of beer or wine after the 12th week of pregnancy shouldn’t negatively affect the foetus). However, already 3 glasses of alcoholic beverages on a daily basis are related to foetal alcohol syndrome- it includes facial malformations, mental disorders- psychological and neurological disorder of foetal growth depending on whether the exposure was during I, II or III trimester.

Smoking- pregnant women should stop smoking even before the pregnancy. Risks- preterm birth, amniotic fluid leakage, stagnation in the growth of the foetus, increased risk of miscarriage, higher perinatal mortality, 50% less chance of nesting of a fertilized oocyte, further development of the new-born (asthma…)

Caffeine- one or two cups of coffee or tea won’t disturb your foetus’s development.

Several inportant information about nutrition during pregnancy:

1. A healthy pregnant woman for satisfying her additional metabolic necessities, as well as for growth and development of her baby, needs from 2200 to 2500 calories a day. For pregnant women who need bedrest, the recommended amount is 1900 calories a day.
2. Body weight gain during pregnancy should be from 12 to 13 kg.
3. Most pregnant women at the beginning of pregnancy, first two to three months, loses the appetite and has a repulsive feeling towards the food. During the first 12 weeks of pregnancy, those pregnant women keep their previous body weight and some of them lose weight due to vomiting and nausea.
4. After first 12 weeks, the nausea and vomiting stop and the second phase of nutrition during pregnancy starts. The way that hormonal changes of the organism during first weeks of pregnancy had caused nausea and/or vomiting, the same way, during the II or III trimester of pregnancy, a new distribution of hormones in the organism causes increased secretion of the pancreatic hormone insulin. Insulin reduces blood glucose level and leads to a feeling of hunger.
5. At pregnant women with excessive body weight gain, there is an extremely increased number of those who have high blood pressure, with giving preterm childbirths, miscarriages both in the first and the second trimester, risk for foetal malformation is 2 times higher, pregnancy diabetes is more common, the pregnancy more frequently ends in a surgical way with a Caesarion section or with vacuum extraction and it more often occurs with new-borns who exceed the average body weight for their age
6. Ideal 13 kg of body weight gain is divided in a mother’s organism in this way: 3,5 kg got to foetus; around 2,9 kg go to reproductive organs (uterus, amniotic fluid, placenta, breasts); the volume of mother’s blood increases for about 1,3 litres (kg); mother’s body water in the subcutaneous tissue and elsewhere increases for about 1,8 litres and adipose tissue for about 3,5 kg
7. All excess body weight is adipose tissue. All that a pregnant woman eats excessively, is not used in the exchange of matter, but it transfers to the foetus and foetal fat reserves.
8. Complete food quantity, according to the need (from 1900 to 2500 calories a day, should be arranged into five daily meals: breakfast, brunch, lunch, snack and dinner.
9. A pregnant woman on her menu consisting of 2500 calories, needs about 400 calories for breakfast which is for example a cup of milk, one slice of bread, 10 g of butter, 25 g of marmalade and or one egg.
10. Brunch is lighter and the intake shouldn’t excess 300 calories: a slice of buttered bread, two pieces of fruit.
11. Lunch usually contains about 900 calories and consists of soup with noodles or rice, about 100g of meat, 200 g of potatoes, a slice of bread and spices.
12. Snack is again lighter: a slice of bread with marmalade and one yoghurt (up to 300 calories) are sufficient.
13. It is better to make dinner more scarcely, not over 400 calories. It can consist of cooked vegetables or of dairy products (fresh cheese, sour cream, bread) and before going to bed it should be supplemented with about 200 calories (a slice of bread, one piece of fruit, fruit juice).
14. The rest of calories should be obtained with carbohydrates (50-60%) and fats (30-35%)
15. The best diet regulator is daily measurement of body weight, or at least once a week
16. As a rule, a pregnant woman has no body weight gain until 12th week or if she has it- it is minimal, a kilo or two, and there are also many women who reduce their initial weight.
17. Weight gain starts after the 12th week and it amount 500g weekly, or 2kg monthly and it lasts until the last four weeks of pregnancy, when it starts to reduce.
18. If a pregnant woman gains more than 500 g weekly, it means that a caloric intake is too high.
19. Pregnant women who excessively gain weight, should do a glucose tolerance test because they often can have a hidden diabetes. It is very common that a diet of about 1800-1900 calories is prescribed to pregnant women with excessive weight gain.
20. A pregnant woman is allowed to eat pasta and wheat preparations, but only in permitted amounts. 100g of pasta or rice contain about 400 calories. It is important to know that 100g of boiled potato contain only about 80 calories. Boiled potato is excellent for nutrition during pregnancy because it contains resistant starch that causes satiety, it is difficult to resorb, contains higher quantities of potassium than bananas and is also rich in vitamin C. Be careful, 100g of bread contain about 220-250 kcal.
21. Pasta and cereals contain around 10% of proteins which are important and necessary for nutrition. The basic structure of each cell is built from proteins.
22. Meat and fish contain the most proteins. 100g contains 15-20 g of proteins.
23. There are a lot of proteins in cereals, dairy products and eggs.
24. A pregnant woman needs one gram of proteins for every kilogram of her own weight, which means around 70g a day. She will achieve that if she eats 100g of meat, 2 eggs, 200g of bread, 2 dl of milk and 50g of cheese a day.
25. Processed meat like prosciutto ham, ham, sausages and similar food contain large amount of salt which in addition burdens already burdened kidneys. A pregnant woman should eliminate such groceries from her diet.
26. Eggs are nutrient concentrates. In one egg, there are about 6g of proteins and about 5,5 g of fat, it contains iron, vitamins A, E and B. Its caloric value is about 75 calories. One egg a day, which means seven eggs a week, will not do any harm to a pregnant woman. It is better to eat them soft-boiled because preparation with addition of fat (frying) represents an additional source of fat.
27. Milk- 100 g of 3,2% whole milk contains 66 calories, while 0,9% milk has only 40 calories or yoghurt 40 kcal. It contains enough proteins and skimmed milk has fats too, and the sugar content is not negligible. It is important that it contains vitamins A, E and B and it has a perfect balance of calcium and phosphorus which are important for tissue growth and normal functioning of cells.
28. Milk is a liquid, a water solution, but is not water. It quenches thirst and hunger, but with half a litre of whole milk, the caloric intake is over 300.
29. Cheeses are protein concentrates and as well as concentrates of full-fat and fatty substances and because of that they can have high caloric value with up to 400 calories on 100g of cheese, so the cheese consumption has to be calculated into the caloric balance.
30. Vegetables is extremely important in a pregnant woman’s diet. It is low caloric, on 100g gives 15-20 calories and it is voluminous so it produces a felling of full stomach with pregnant women who often feel hungry.
31. Vegetables with green leaves (lettuce, spinach, chard) are rich in folic acid, but in iron as well. Both substances are important for the formation of blood cells, for placenta development and for the development of foetal spine. Low level of mother’s folates is a risk factor for development of neural tube defects at foetus, cleft lip, cardiac defect, anomalies of extremities and urinary tract, repeated miscarriages and preterm childbirth. Human body is not capable of producing folic acid and is dependent on its food intake. Useful effect is achieved with additional daily intake of at least 400 μg of folic acid during at least one month before the conception and three months after the conception. Women who could benefit from increased dose are those who smoke, who have diabetes, obese pregnant women, or those with above mentioned complications during some previous pregnancies. Sun-bathing also lowers the folate concentration in a pregnant woman’s body.
32. It would be the best for a pregnant woman to eat at least one piece of fruit for brunch and one for snack.
33. Fruits- intake of 6-7 fruit servings and fruit juices on a daily basis during pregnancy would be related with 6-7 points higher IQ of children and it means better cognitive abilities of children in the first year of life. Caution- if you overeat, this can be a cause of excessive weight gain during pregnancy. Consumption od four apples or only two bananas will give equally 200 calories. This means that fruits which contain higher amounts of sugar should be avoided (banana- 100 kcal, grapes 70 kcal, apple 50 kcal, watermelon 24 kcal)
34. Fruit juices may contain vitamins and minerals, but it is important to know that one decilitre of juice has about 60 kilocalories. Due to that, we recommend fluid intake in the form of plain water.
35. Chocolate and concentrated sugar are not appropriate for diet during pregnancy. Chocolate is high caloric and its disadvantage is that as a sugar, it quickly resorbs, so insufficiently satisfies hunger.
36. Tea and coffee contain caffeine, which belongs to the group of drugs, so called stimulants that excite central nervous system. Caffeine from mother’s blood transfers through placenta into the baby. There are no proofs that it harmfully affects the foetus, so one to two cups of mild tea or coffee during the day will not do any harm to baby.
37. Alcohol is harmful for the foetus. Due to that, concentrated alcoholic beverages like brandy, cognac, whiskey and similar, are strongly forbidden during pregnancy. It seems that one smaller glass of wine or beer during lunch or dinner does not represent danger for the child.
38. Proteins are necessary for forming new cells and for the baby’s growth, but also for the growth of placenta, uterus, breasts, increasing the amount of mother’s blood.
39. Fats, in a body of a pregnant woman, are formed from carbohydrates. It is still necessary to consume unsaturated fatty acids through food (omega fatty acids), which can be found in oily fish, nuts or in cold-pressed vegetable oils- olive oil and linseed oil (for example one spoonful add to yoghurt or kefir with times a week consumed meal of oily fish) and they serve for the foetal development of brain cells and peripheral nerves and studies show that they also increase cognitive abilities during the 1^st year of life. Omega-3 fatty acids, as well omega-6 fatty acids, are essential polyunsaturated fatty acids. Everyday diet is rich in omega-6 fatty acids, primarily from vegetable oils rich in linolenic acid. However, our body does not have necessary enzymes for converting omega-6 fatty acids into omega-3 fatty acids, so omega-3 have to be taken through nutrition. Flax contains linolenic (omega-6), oleic (omega-9) and palmitic fatty acids, and more than half fats that flax contains are formed by alfa-linolenic acid (omega-3) which makes flax seed the richest vegetable source of omega-3 fatty acids (twice as richer than fish oil), but with slightly lower efficiency. Olive oil contains essential fatty acids, linoleic and linolenic acids and phytosterols. Oily fish like mackerel, salmon, sardine and sea trout are rich sources of omega-3 fatty acids- EPA and DHA and two to three meals a week provide approximately 1g/a day omega-3 fatty acids. Fish like hake contain lower quantities.
40. Vitamin C enables iron absorption and is involved in growth and development of foetal cells which is very important- It is involved in the preservation and stabilisation of the coating membranes of the water bag. It is mostly contained in lemons, oranges, berries, cauliflower and cabbage, tomatoes and potatoes.
41. During some months of the year, in winter and early spring, there is usually lack of C and D vitamins in the food. Due to that, during pregnancy is often recommended taking multivitamin preparations parallel with iron preparations.
42. Iron is essential mineral for the production of haemoglobin in red blood cells, which is the carrier of oxygen. Mother has around 5g in her body, out of which a foetus takes 1g, which means that a replacement during pregnancy is necessary. It is mostly contained in liver, eggs, meat, green vegetables, cereals.
43. Calcium is essential for formation of bones and teeth of the foetus, but also for the functioning of all the cells, especially for nerve stimulation and for the prevention of development of high blood pressure in pregnant women. The most calcium can be found in milk, cheese and other dairy products. Du to the rapid development of the skeleton during the III trimester of pregnancy and due to the possible mother’s osteoporosis, it is recommended as addition to the nutrition together with vitamin D during the III trimester of pregnancy and during breast-feeding up to 9 months. In cases of heparin therapy or nutrition without milk and milk-derived products, we advise taking calcium and vitamin D during the entire pregnancy. Pregnant women with low level of vitamin D in their blood, are exposed to higher risk of preterm childbirth. Preparations of both iron and calcium should not be taken at the same time.
44. Magnesium is necessary for tissue development, it regulates muscle stimulation and in that way calms contractions of the uterine muscles. It is mostly contained in lentils, pasta, spinach, legumes, bananas and fish.
45. Optimal mother’s nutrition during pregnancy (which means 200 calories less than before the pregnancy) satisfies optimal child’s development.
46. A woman during pregnancy eats for two, for herself and her child, but she is not allowed to eat double quantity.
47. Puerpera should eat various food consisting of meet or fish, cereals, vegetables, milk and dairy products. Liquid, the best plain water, she should drink excessively, two to three litres a day. Calorie intake should be the same as during pregnancy. During the puerperia period and breast-feeding, she should avoid strong spices and when it comes to vegetables, she should avoid beans, lentils, peas and cabbage.