Nutrition in Pregnancy
August 20, 2021 | Dr Ruqaiya Shabir

Nutrition in Pregnancy

Does nutrition for pregnant women come with lifestyle changes? Nutrition has always been a vital part of managing a pregnancy. We come across various myths related to this topic and often find ourselves wondering about their truths.

Does pregnancy mean that you must eat for two? Does it give you a license for weight gain?  Can you eat anything at any time you like? Are there any foods you need to avoid?

Surprisingly there is a lot more than what meets the eye. More than half of the complications during pregnancy can be lend to obesity and a poor nutritional diet. Pregnancy demands a balanced intake of macro and micronutrients.

Let’s start at the beginning stages of pregnancy where the optimal intake of micronutrients becomes quite important.

Folic acid

The dietary intake of folic acid begins before pregnancy since the neural tube formation in the fetus occurs in the 3rd week of pregnancy. It is the time when most women are not yet aware of being pregnant. This means, they have not skipped their period at that point. Hence folic acid supplementation is advisable to all women of childbearing age.

Usually, folic acid of 400ug to 800ug is more than enough for a pregnant woman. However, this demand increases if the mother is suffering from any diseases such as diabetes, obesity, epilepsy etc. So, the preferred intake for a mother would be one tablet of 5mg daily preconception and, throughout the first trimester.

Iron Supplementation

Iron is another important micronutrient for the health of the mother and baby. An increased number of women in our country are anemic and pregnancy worsens this situation. The reason for the increased demand for iron lies in the fact that a mother’s body needs more blood than a normal person. In order to make more blood cells, the body demands for an increase in iron as it is the basic ingredient for the recipe of hemoglobin, the oxygen carrying component on our red blood cells.

Ever wondered where the pregnancy glow is coming from?            Well, its only because the blood rushing through the veins of a pregnant woman is at least 2-3 liters more than ours. To sustain the number of cells in your blood, you will be prescribed an iron supplement.

There are other ways to improve the iron content in our bodies. However, a person finds it difficult to adhere to a strict diet containing iron rich foods on a daily basis. That’s where a supplement steps in. It becomes a bigger problem for people who strictly adhere to a vegan diet as plant based diet is often poor in iron and Vitamin B12. The reason for this is that absorption of iron from plant sources requires ascorbic acid (also known as vitamin C). If the ascorbic acid is taken in an adequate amount, the absorption of iron shall also be adequate. The richest sources of iron are chicken liver, beef liver, turkey, sea food, bran cereals, oat cereals, whole wheat bread, lentils, tofu etc.

However, it is difficult to keep up with the increasing demand of iron during pregnancy, so physicians prescribe the iron supplements.

The best form of iron supplementation is oral, but women find it quite difficult to adhere to iron tablets in the beginning. They feel a variety of gastrointestinal symptoms like bloating, constipation, or diarrhea and even nausea at times. To address this, we have supplements available with different tastes. Along with that, the body gradually starts to accommodate to the daily iron intake and the person taking the tablets gets used to the effects.

Regarding the oral intake of iron, there are a few more things that pregnant women must keep in mind. Some foods decrease the iron absorption from gut e.g., tannins which are present in tea in a large amount, calcium carbonate (hence, it would be wise to take calcium supplement at a different time and not take iron with milk products) and alcohol. There are also a few other diseases that decrease absorption of iron from gut but in those scenarios, your physician shall advise you according to your history.

In case of persistently low Hb, which usually happens mostly because of noncompliance to the supplementation advised, doctors have no choice but to advise intravenous iron supplements. These are to be administered strictly in a hospital setting and have many complications. In case the patient is unable to tolerate the intravenous infusions, the only choice is transfusion of blood. Transfusion of blood and blood products might appear a simple solution to the problem at hand, yet it is a process full of complications and side effects. All these problems can be avoided just by one tablet of iron daily. Let’s choose the smarter way.

Calcium/ vitamin D

Calcium is an element we all recognize very well. We all know its importance in the development of body, especially bones. However, adequate intake of calcium pre-pregnancy and during pregnancy leads to a decreased risk of pregnancy induced hypertension, preeclampsia and eclampsia which is a major cause of maternal and fetal mortality in the developing countries.

The daily requirement of Calcium in pregnancy increases to 1000-1300mg daily and one normal glass of milk contains approximately 300mg of Calcium. Therefore, you can calculate your daily demand and fulfill it either with additional calcium supplementation or increased amount of intake of calcium rich foods. The foods most rich in calcium are dairy products, green leafy vegetables, sardines, anchovies (with bones), fortified cereals, Ca hydroxide-soaked flour.

An important thing to remember about calcium absorption is the availability of Vitamin D in our bodies in regard to its correlation with calcium uptake in the body. Vitamin D is another micronutrient that is endogenously formed in our body when we are exposed to sunlight. Apart from that, it is found in egg yolk, oily fish and liver. Our bodies need 400IU of Vitamin D daily.

Along with these micronutrients, Iodine and Vitamin B complexes also play an important role. Both these are vital for the development of nervous system of the body and vitamin B12 is essential for the development of blood cells as well. We usually use iodine fortified salt as a part of our diet in Pakistan so Iodine deficiency is less common. Apart from that, iodine is rich in seafood. Vitamin B-12 is found in beef, chicken, liver and sea food. Plant sources are a poor source of vitamin B12 so it is important for vegans to take adequate supplementation.

On your first visit to the gynecologist and obstetrician, your doctor is going to prescribe a combination of the above-mentioned micronutrients. I hope that this blog has helped you to understand why these supplements are so important. Our next blog will deal with the macronutrients, weight gain in pregnancy and some of the food items that need to be totally avoided during pregnancy.

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Dr Ruqaiya Shabir

Dr Ruqaiya Shabir is a nutritionist.