Pregnancy is one of the most beautiful experiences of a woman's life and such a sweet period full of hope, dotted with questions about how to do the 'right things' and make the 'best choices', often leading to just 'too much' advice that can confuse us or add pressure without reason.
Let's see what there is to expect, and what research recommends for lifestyle and nutrition during this exciting part of our lives.
TL;DR - The Overview
Daily Nutritional Needs
While we realize how critical this period of our lives is, due to the lack of focus and scientifically-backed advice that we receive, studies consistently report deficiencies in vegetable, cereal grain, or folate intake, as well as iron and calcium, while exceeding fat intake in preconceptual and pregnant women.
As such deficiencies can have adverse effects on birth outcomes and the health of the baby, guidelines on the nutritional needs of women during pregnancy focus on the daily intake of various needed nutrients, including:
Folate and Folic Acid (800μg) for the normal development of the brain and the spinal cord, as well as the reduction of preterm delivery risk. Sources include fortified cereals, green leafy vegetables, legumes and supplementation.
Calcium (1000mg) for the development of the bones of the fetus, and the normal function of the nervous, muscular and circulatory system of the pregnant woman. Sources can include dairy products, broccoli and fortified cereals.
Vitamin D (600 IU) for the development of the baby’s bones and teeth. Sources may include fatty fish and fortified products or supplementation.
Protein (70-100g) for the growth of the fetus, particularly important during trimesters 2 and 3. Sources may include legumes, fish, lean meat and dairy.
Iodine (150mcg) prefer iodized instead of mineral salts if you add any to your meals, or make sure that your prenatal supplement provides 150mcg of potassium iodide
DHA (200mg) from uncontaminated sources such as algae oil
Iron (27g) for the baby’s blood supply and the creation of additional hemoglobin for the mother, that is necessary to cover the increased need for oxygen transfer to tissues. Additionally, it helps reduce fatigue and the risk of infections. Sources include legumes, fortified cereals and lean meat. (Mayo Clinic, 2016)
Some further tips:
Stay hydrated, while pregnant, the body needs even more water to sustain all its processes, so it's important to drink enough fluids every day. -- check my article on water & hydration
Energy needs will be increased during the 2nd trimester by 340kcal/day, and during the 3rd trimester by 450kcal/day.
As an aside, make sure to thoroughly wash fruits, vegetables and cook food well to avoid infections of listeria and toxoplasma. It is also good practice to consult your dietitian and learn how to avoid high mercury containing fish.
How early does healthy eating become important for the next generation?
While pregnant women already know to avoid smoking and alcohol, researchers have observed fatty streaks, early signs of atherosclerosis in almost all children above the age of 10 in the US. These fatty streaks, with the wrong lifestyle choices, can turn into plaques in our 20s and 30s, and lead to serious heart conditions in our 40s and 50s.
Atherosclerosis may actually start even before birth, as studies have found more signs suggestive of atherosclerosis in the arteries of fetuses whose mothers had high LDL cholesterol.
Protecting our children from future health conditions appears to then be important even before birth, by taking good care of ourselves during pregnancy.
What steps can we take in achieving that?
Adding plant protein sources
Increased animal protein intake of more than 40g out of the total 70-100g needed daily during pregnancy has been associated with worse birth outcomes, including “very early premature births and associated [infant] deaths,” and “significant growth retardation”, since the Harlem Trial in 1976. Even after birth, the mother’s animal protein consumption during pregnancy has been linked with a higher likelihood of their children becoming overweight and having higher blood pressure later in life.
These effects are related to chemical pollutants that accumulate in meat products and raise the growth hormone IGF-1 and the stress hormone cortisol. Being under chronic stress from animal protein consumption increases blood pressure, and levels of insulin, triglycerides, cholesterol and some estrogens, while reducing testosterone levels. A drop in testosterone may increase the risk of gaining body fat and weight.
Even beyond having higher body fat and stress levels, the adult children of mothers who consumed more animal protein during pregnancy appear to react more negatively to life events and to do worse on the Trier Test, which checks the performance of public speaking and math problem solving under observation.
Studies have also shown that fumes from frying and grilling have similar effects to those of secondhand smoking on our lungs. Especially during the third trimester, try to avoid not just grilled meat, but also the frying and grilling fumes as they have been associated with birth-weight deficit.
Overall, animal protein consumption has to be in moderation. Substituting animal for plant protein sources including legumes, beyond just helping to avoid negative effects of animal protein, also appears to offer protective benefits.
Avoiding industrial pollutants
A relevant concern is contamination of food by industrial pollutants, these include heavy
metals, PCBs, endocrine-disrupting chemicals, pesticides among others.
Pregnant women have been found to have detectable levels of about 50 different chemicals in the bloodstream or the umbilical cord even decades after some of these pollutants have been banned. As these accumulate in the body and take very long to clean up, it is important to prefer smaller fish, and prefer wild-caught instead of farmed fish & seafood whenever possible, as they appear to have even half the pollutant levels of those farmed.
Is there anything to do about 1st trimester Morning Sickness?
Evidence suggests that ginger is a safe and effective treatment.
The recommended dose is 1 gram of powdered ginger a day, that’s about:
1/2 teaspoon of powdered ginger or
1 teaspoon of fresh grated ginger per day -- or 4 cups of ginger tea.
The maximum recommended daily dose is four grams, no more than two teaspoons of powdered ginger a day.
Third trimester and preparing for delivery
While during the rest of our life it is very beneficial to pile on such anti-inflammatory foods as berries or ginger, from about 28 weeks until birth pregnant women may want to cut back on anti-inflammatory foods until we know more on how they may affect this last part of pregnancy.
Preparing for giving birth, a randomized, controlled trial of hundreds of pregnant women found that eating about 6 dates per day for the last few weeks leading to delivery, can noticeably improve the readiness of the cervix and lead to more successful deliveries.
A previous study also noted dates to reduce labor time by 2 hours or more, and to reduce blood loss after delivery, with dates having ‘oxytocin-like’ effects, more potent than the drug, but without its potential side-effects.
Other studies have also not associated this date fruit consumption with premature labor, though women on the ‘date-eating group’ were about 20% less likely to need to induce labor through drugs.
Following research-backed recommendations over well-meaning, but many times confusing advice, will give you the peace of mind that you need over this beautiful period. Consult with your doctor and dietitian for safe health recommendations.
Heartfelt wishes for becoming.. 'Mom'! :)
REFERENCES
ACOG Committee on Obstetric Practice, 2015. The American College of Obstetricians and Gynecologists. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Physical-Activity-and-Exercise-During-Pregnancy-and-the-Postpartum-Period
Al-Kuran O, Al-Mehaisen L, Bawadi H, Beitawi S, Amarin Z. The effect of late pregnancy consumption of date fruit on labour and delivery. J Obstet Gynaecol. 2011;31(1):29-31.
Caut, C., Leach, M., & Steel, A., 2019. Dietary guideline adherence during preconception and pregnancy: A systematic review. Retrieved from Wiley Online Library: Maternal & Child Nutrition / Vol 16, Issue 2: https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.12916
Cleveland Clinic, 2018. Pregnancy: Nutrition https://my.clevelandclinic.org/health/articles/12593-pregnancy-nutrition
Greger, M.,2013. Animal Protein, Pregnancy, & Childhood Obesity. Retrieved from NutritionFacts.org: https://nutritionfacts.org/video/animal-protein-pregnancy-and-childhood-obesity
Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington DC: The National Academic Press
Kiel, D. W. et al., 2007. Gestational weight gain and pregnancy outcomes in obese women: how much is enough?. Obstetrics Gynecology, 110(4), pp. 752-758.
Mayo Clinic, 2019. Pregnancy diet: Focus on these essential nutrients. http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-nutrition/art-20045082
M Ding, M Leach, H Bradley., 2013 . The effectiveness and safety of ginger for pregnancy-induced nausea and vomiting: a systematic review. Women Birth. 2013 Mar;26(1):e26-30.
MedlinePlus, 2014. Managing your weight gain during pregnancy. https://medlineplus.gov/ency/patientinstructions/000603.htm
National Health Service, 2015. Overweight and pregnant. http://www.nhs.uk/conditions/pregnancy-and-baby/pages/overweight-pregnant.aspx#
NutritionFacts, 2020. Pregnancy. http://nutritionfacts.org/topics/pregnancy
Picciano, M. F., 2003. Pregnancy and Lactation: Physiological Adjustments, Nutritional Requirements and the Role of Dietary Supplements. Journal of Nutrition, Volume 133.
U.S. Department of Health and Human Service, Office on Women's Health, 2009. Healthy Pregnancy: Food Don'ts. https://www.womenshealth.gov/files/assets/docs/charts-checklists-guides/pregnancy_food_donts.pdf
V Kapadia, D Embers, E Wells, M lemler, C R Rosenfeld., 2010. Prenatal closure of the ductus arteriosus and maternal ingestion of anthocyanins. Journal of Perinatology (2010) 30, 291–294; doi:10.1038/jp.2009.140.