The nutrients that deserve special attention during pregnancy

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1 Nutrition during Pregnancy Eating well before and during pregnancy helps to ensure that your baby has a healthy start. There is no magical formula for pregnancy nutrition, in fact, during pregnancy the basic principles of healthy eating remain the same plenty of vegetables, fruits and whole grains and lean sources of protein. The nutrients that deserve special attention during pregnancy Folate and folic acid Folate is a B vitamin that helps prevent neural tube defects, serious abnormalities of the brain and spinal cord. A lack of folate may also increase the risk of preterm delivery, low birth weight and poor foetal growth. The synthetic form of folate found in supplements and fortified foods is known as folic acid. About how much do you need: 600 micrograms / ug of folate or folic acid a day before conception and during pregnancy. Good sources: Fortified cereals are great sources of folic acid. Leafy green vegetables, citrus fruits, and dried beans and peas are good sources of naturally occurring folate. Food Serving size Folic acid content (ug) Cereal 1 cup of fortified ready-toeat cereal 125 Spinach ½ cup boiled spinach (90g) 22 Beans ½ cup cooked sugar beans 189 Asparagus 4 large spears (100g) canned asparagus 150 Oranges 1 small orange 30 Source: MRC Composition of South African Foods In addition to healthy food choices, taking a daily vitamin containing 1mg (1000ug) of folic acid ideally starting three months before you get pregnant can help to ensure that you are getting enough of this essential nutrient. Calcium

2 You and your baby need calcium for the development of strong bones and teeth. Calcium also helps the circulatory, muscular and nervous systems run normally. If there's not enough calcium in your diet, the calcium your baby needs will be taken from your bones. About how much do you need: 1,000 milligrams /mg a day. Good sources: Dairy products and canned fish with bones are the richest sources of calcium. There are also some breakfast cereals that are fortified with calcium. Food Serving size Calcium content (mg) Yogurt 1 cup plain, low-fat yogurt 450 Milk 1 cup skim milk 302 Cheese Salmon A matchbox serving of cheese (45g) 100g canned pink salmon with bones Spinach ½ cup cooked spinach 98 Source: MRC Composition of South African Foods Protein Protein is crucial for your baby's growth, especially during the second and third trimesters. Protein also repairs your cells as your body changes. About how much do you need: 71g a day. Good sources: Lean meat, poultry, fish and eggs are great sources of protein. Other options include dried beans and peas, tofu, dairy products and peanut butter. Food Serving size Protein content (g) Poultry 100g chicken breast 29 Fish 100g salmon 25 Cottage cheese ½ cup low-fat cottage cheese 15 Milk 1 cup low-fat milk 8.3

3 Peanut butter 2 Tbs. (30g) 7 Eggs 1 large hard-boiled egg 7 Source: MRC Composition of South African Foods Iron Your body uses iron to make haemoglobin, a protein in the red blood cells that carries oxygen to the tissues. During pregnancy when your blood volume expands to accommodate changes in your body and your baby must make his or her entire blood supply your need for iron nearly doubles. If you don't get enough iron, you may become fatigued and more susceptible to infections. The risk of preterm delivery and low birth weight also may be higher. About how much do you need: 27 mg of iron a day. Good sources: Lean red meat, poultry and fish are good sources of iron. Ironfortified breakfast cereals, nuts and dried fruit are other options. The iron from animal products, such as meat, is most easily absorbed. To enhance the absorption of iron from plant sources and supplements, eat the food or take the supplement with a food or beverage high in vitamin C such as orange juice, tomato juice, cantaloupe, strawberries, tomatoes or bell peppers. Food Serving size Iron content (mg) Cereal 1 cup of fortified ready-toeat cereal (bran flakes) 7 Beans 1 cup boiled kidney beans 4 Spinach 1/2 cup boiled spinach 2 Meat 100g beef 3 Poultry 100g chicken breast 1 Source: MRC Composition of South African Foods It is strongly recommended that iron is supplemented during pregnancy. Most pregnancy vitamins typically contain iron, but check with your doctor as a separate iron supplement may also be necessary.

4 Foods to avoid during pregnancy Mercury-rich seafood Seafood is a great source of protein and iron, and the omega-3 fatty acids in oily fish such as pilchards and salmon can help promote your baby's brain development. However, some fish and shellfish contain potentially dangerous levels of mercury, too much of which may damage your baby's developing nervous system. The bigger and older the fish, the more mercury it may contain. Some fish that pregnant women should avoid eating include swordfish, shark and king mackerel. However, some types of seafood contain very little mercury, such as shrimp, canned tuna and salmon. Undercooked meat and poultry During pregnancy, changes in your metabolism and circulation may increase the risk of bacterial food poisoning. To prevent any food-borne illnesses, fully cook all meats and poultry before eating, and be careful with undercooked burgers, sausages, hot dogs and deli meats. These can be a source of a rare but potentially serious food-borne illness known as listeriosis. Unpasteurised dairy products Dairy products such as skim milk, mozzarella cheese and cottage cheese should be encouraged as part of your diet. But anything containing unpasteurized milk is not recommended, as these products may lead to food-borne illness. Unless soft cheeses such as brie and camembert are clearly labelled as being made with pasteurized milk, don't eat them. Caffeine Caffeine can cross the placenta and affect your baby's heart rate and breathing. For this reason, some doctors recommend avoiding caffeine during the first trimester and limiting the intake of caffeine during the second and third trimesters. Alcohol One drink isn't likely to hurt your baby, but no level of alcohol has been proved safe during pregnancy. The safest bet is to avoid alcohol entirely, as even moderate drinking can impact your baby s brain development.

5 Pregnancy weight gain Gaining the correct amount of weight during pregnancy can support your baby's health and make it easier to shed the extra kilo s after delivery. How much weight you need to gain depends on various factors, including your health, your pre-pregnancy weight and body mass index (BMI), so work with your health care provider to determine what's right for you. Here are some general guidelines for pregnancy weight gain: Pre-pregnancy weight Underweight Normal weight Overweight Obese Recommended weight gain kg kg 7 11 kg At least 7 kg Source: If you're carrying twins or triplets, you'll need to gain more weight often kg. Although excess weight carries risks such as gestational diabetes and high blood pressure pregnancy isn't the time to lose weight. Even women who are overweight should gain some weight during pregnancy. If you're underweight, it's essential to gain a reasonable amount of weight while you're pregnant especially during the second and third trimesters. Without the extra weight, your baby may be born earlier or smaller than expected. Coping with morning sickness Morning sickness can actually strike at any time of the day or night. Most women who experience morning sickness notice a dramatic improvement after the first trimester at roughly 13 weeks. Morning sickness may be more severe if it is your first pregnancy or if you're carrying more than 1 baby. Some simple steps that may be helpful in relieving nausea and vomiting: Eat smaller meals or snacks frequently throughout the day. Before getting out of bed in the morning, eat a couple of dry crackers or a dry piece of toast. Have a small snack at bedtime or when you wake up to go to the bathroom in the middle of the night. Avoid greasy, rich, fatty and spicy foods.

6 Suck on hard sweets. Because you lose fluids when you throw up, it is important to stay hydrated. Try sucking on ice and take frequent small sips of water instead of drinking a whole glass of water all at once. Some women find that taking small sips of ginger ale or peppermint tea relieves their symptoms. Check with your doctor before using any natural remedies alleged to relieve nausea and vomiting during pregnancy. Planning healthy meals Carbohydrate-rich foods Carbohydrates are your body's main source of energy. Many whole-grain and enriched carbohydrate-rich products also contain fibre, iron, B vitamins, various minerals and protein. Plan 6-9 servings a day 1 serving: ½ cup breakfast cereal ½ cup cooked porridge, pasta or rice 1 slice bread 1 small potato 3 crackers Vegetables and fruit Vegetables and fruit provide a multitude of vitamins and minerals, as well as fibre. Vitamin C helps you absorb iron, while dark green vegetables have vitamin A, iron and folate other important nutrients during pregnancy. Plan 3 or more servings of fruit and 4 or more servings of vegetables a day. 1 serving of vegetables: Cooked / raw, ½ cup Leafy raw, shredded or chopped, 1 cup Cooked legumes, drained, ½ cup Juices, ¾ cup / 200ml 1 serving of fruit: Whole, e.g. apple 1 medium, approx. 100g Grapefruit, ½ a fruit Melon, watermelon, pawpaw, 1 wedge, approx. 100g Juices, ¾ cup / 200ml Berries or small fruit, ½ cup Diced, cooked, drained or canned, ½ cup Dried, ¼ cup or 30g Avocado, 1 heaped Tablespoon pulp or ¼ medium Olive, 3 olives or 30-50g

7 Meat, poultry, fish, eggs and beans Foods in this group have plenty of protein, as well as B vitamins and iron. Protein is crucial for your baby's growth, especially during the second and third trimesters. Plan 2 or more servings a day. 1 serving: 100g of cooked lean meat, poultry or fish (about the size of the palm of your hand) ½ cup cooked dried beans 1 egg ½ cup tofu 1/3 cup nuts 2 Tbs. peanut butter Dairy products The calcium in dairy products and calcium-fortified soy milk helps build your baby's bones and teeth. Dairy products also have vitamin A, vitamin D and protein. Plan 4 or more servings a day. 1 serving equals: 1 cup skim or low fat milk 1 cup yoghurt 45g cheese (size of a matchbox) Meal-planning ideas

8 Breakfast A small cup of oats porridge cooked in low fat milk and half a pawpaw with lemon A cup of bran flakes + a cup of low fat milk or yoghurt and 1 sliced small banana 1 slice of brown toast with 1 poached or boiled egg with a grilled tomato + an apple Smoothie blend 1 cup fat free yoghurt or milk with 2 fruits and 1 Tbs smooth peanut butter Snacks A piece of fresh fruit and a small tub of low fat or fat free fruit yoghurt 4 ryevitas with cottage cheese and cucumber or hummus or peanut butter A slice of anchovy or peanut butter seed loaf toast A cup of low fat or fat free milk (Nesquik or Milo optional) Light meal 1-2 thin slices of brown bread with tuna in brine / skinless chicken / lean beef / cottage cheese + salad vegetables with ½ small avocado or 5 olives 2 mini pitas filled with egg mayonnaise (2 boiled eggs with 1 Tbs lite mayo) A bowl of split lentil vegetable soup and grated mozzarella cheese + 1 slice of brown toast 1 tin sardines on 2-4 rye crackers with a mixed green salad and ½ small avocado Main meal A small baked sweet potato or a small cup of cooked brown rice + 1 palm sized portion of skinless chicken / lean beef / pork fillet / fish + vegetables or salad with ½ small avocado or 5 olives Stir fry vegetables with 1 palm sized portion of beef, pork or chicken strips with 1 Tbs sesame oil and soya sauce served with a small cup of brown rice mixed with split peas or spaghetti 2 Pilchard fish cakes with sweet chilli sauce and 2-3 boiled baby potatoes and steamed vegetables

9 Mushroom and tomato omelet (2 eggs) served with roasted vegetables Optional dessert A small piece of fruit with some low fat or fat-free yoghurt Note portion sizes are estimated and are to serve only as a guide. Contact a private dietitian for an individualised meal plan and portion guide. Vitamin D supplementation During pregnancy, the active form of vitamin D increases significantly, particularly in the second and third trimesters. During this time, the baby's bones are developing, as are the brain, the nervous system, and the other organs. Recently, there has been a great deal of research about vitamin D and maternal, fetal, and infant health. Although much more research is required, it appears that vitamin D contributes to improving pregnancy outcomes, such as decreasing the risk of pre-eclampsia, and improving length of gestation, birth weight, and infant bone mineralization. It also appears that sufficient vitamin D in early life may decrease the risk of health problems later in life such as schizophrenia, brain tumours, asthma, multiple sclerosis, and autoimmune diseases such as type 1 diabetes. These findings don't mean you should run to the local pharmacy for a mega dose of vitamin D. In fact, there are potential adverse effects of too much vitamin D on the cardiovascular system and allergies. Much is still to be learned and hopefully gained from further research. So, if you are pregnant take a pregnancy vitamin and look for one with at least 200 international units (IU) of vitamin D.