Alarming research prompts Jo Wadham to seek the latest thinking on nutrition in pregnancy.
Eating for two
Last week new research was published showing that 41 per cent of pregnant Emirati women are deficient in folic acid and also pinpointing worrying levels of anaemia in pregnant women and obesity in married couples. The research had been undertaken for the Ministry of Health as part of its five-year nutrition strategy. Good nutrition in pregnancy is essential not only for the mother's general well-being, but also to prevent pregnancy complications. Morning sickness and increased levels of hunger when pregnant can make it difficult for women to acquire the levels of good nutrition they need, but sensible eating, combined with knowledge of where those essential nutrients can be found, can ensure a happy, healthy pregnancy and birth.
Here, we scotch some myths and set out some helpful guidelines for a healthy pregnancy. Alongside the physical changes that occur, many women find they are hungrier when they are pregnant. As Dr Gowri Ramanathan, a consultant obstetrician and foetal medicine specialist at the Corniche Hospital in Abu Dhabi, explains: "Pregnancy and the demands of the foetal placental unit require a woman to increase her calorie intake; however, you only need to increase what you eat by a small percentage. People think they need to eat double because they are feeding an extra person, but this is actually wrong."
Ramanathan, who is known professionally as Dr Gowri, says that during pregnancy the recommended increase above the average intake of calories is 150 kcal/day in the first trimester, 350 kcal/day in the second and third trimesters and 500 kcal/day during breastfeeding. Many pregnant women, faced with a rapidly expanding girth, will be concerned about how much weight is the right amount to put on. According to Ramanathan, if your pre-pregnancy weight was normal, then over the entire length of the pregnancy you should expect to gain between 11kg and 15kg. If, before you fell pregnant, you were overweight then you should gain no more than seven to 11kg and only 7kg if you were obese to start with.
She argues that mothers are more likely to encounter problems during pregnancy, labour and postnatally if they are obese. "There is an increased risk of developing diabetes and high blood pressure. During labour, there can be problems monitoring the baby and labour not progressing well. There is a slightly higher risk of caesarean section and then postnatally a risk of blood clots developing, wound infection and postnatal depression."
Being obese can also affect the growth and development of the foetus. Obese pregnant women are more likely to have babies with certain birth defects including neural tube defects and spina bifida. A study published in the American Journal of Clinical Nutrition this year found that obese women were at significantly increased risk of bearing children with a range of congenital heart defects, with that risk rising as the mother's body mass index increased. All of this means that it's sensible for women planning on having a child to try to reach a healthy weight before they are pregnant. However, if you are already pregnant and worried about your weight, it's not a good time to embark upon a restricted diet. Instead, discuss any concerns with your doctor.
The other issue highlighted by the Ministry of Health's research was that nearly half of pregnant Emirati women were deficient in folic acid. Folic acid has been shown to reduce the rate of spina bifida in babies by 40 per cent. Women are recommended to take 400mcg of folic acid a day, ideally starting three months before conception, either by ensuring they eat plenty of folate-rich foods such as whole wheat bread, broccoli, leafy green vegetables, carrots, potatoes, lentils and asparagus, or by taking a pharmaceutical supplement. Women with a history of spina bifida in their families may need to take a slightly higher supplement, as may women on epileptic medication. Again, consult a doctor.
The foetus takes what it needs in terms of iron from the mother. At first these needs are small but by the time the foetus is 30 weeks, this increases. If the mother is well and has a balanced, healthy diet, this should have little impact, but if she is already physiologically anaemic, her doctor may prescribe iron supplements. For those women whose diets lack iron, this can lead to problems for both them and their babies. Iron deficiency can lead to anaemia, which occurs when the level of haemoglobins - the oxygen-carrying part of red blood cells - falls below 10 grams per decilitre of blood. Ramanathan says low haemoglobin can affect a baby's development. "If you have an iron deficiency then your risk of becoming anaemic is increased during pregnancy. The consequences can be seen in the baby's growth due to less oxygenation."
Iron can be taken in supplement form but anaemia can be prevented by eating a diet with plenty of foods that contain iron. An example of an iron-rich meal plan to prevent anaemia would be: breakfast of either iron-fortified cereal with milk, whole wheat bread, vegetable omelette, low-fat cheese and fresh fruit; a midmorning snack of some almonds and a fruit salad; lunch of grilled lean beef steak with grilled onions, peppers and tomatoes, rice, a mixed salad and a fruit juice; then having lentil and vegetable soup, followed by grilled fish with either roast potatoes or whole wheat bread and a mixed salad for dinner.
There are also foods to avoid during pregnancy. Some bacteria associated with certain foods can be particularly harmful for the unborn child. The listeria bacterium can be found in soft cheese, unpasteurised milk, pâtés, ready-prepared coleslaw and improperly prepared or undercooked meat, so mothers are usually advised to avoid these during pregnancy as listeriosis can lead to stillbirth and miscarriage.
Raw eggs and undercooked chicken should be avoided to minimise the chances of the mother contracting salmonella. Eating raw meat increases the likelihood of toxoplasmosis which can cause brain damage or blindness in the foetus. Once you know which foods to avoid and which nutritionally rich ones to seek out, you are on the road to having a healthy and happy pregnancy and to being in good shape after the birth, as well as giving your baby the best possible start in life.