A Dietitian’s Guide to Pregnancy Nutrition- Feed the Belly the Right way

Pregnancy is a time when the mother's resources go into the life within her, building it and making the life healthy. This calls for an increase in macronutrients (carbs, protein, fat) and micronutrients (vitamins and minerals) requirements.

You may need to fine-tune your diet even if you were eating healthy before pregnancy. You need more amount of healthy protein, vitamins like folic acid and minerals like iron and calcium. These should be part of healthy nutritious meals. In addition to the healthy nutrition you take, you may need to take the nutrition supplements recommended by the doctor. Sometimes eating healthy gets confused with eating a lot. So, here I am Senior Consultant Dietitian Dhanalakshmi, to help you to understand the essential nutrients during pregnancy.

Essential Nutrients:

Complex Carbohydrates
The first trimester is generally when you will be struggling with nausea, so healthy carbohydrates are a good option for such conditions and will be a good source of energy. Load up on whole grains like whole wheat or multi-grain bread and pasta, oats, sweet potato, brown rice, ragi (finger millet) porridge or other Indian millets like Bajra (pearl millet) and Jowar (sorghum), which are great for rotis. Millets are easy to digest when it is soaked overnight and are rich in niacin, B6, folic acid, calcium, iron, potassium, magnesium and zinc, all the nutrients that are important for a pregnant woman. The fiber content in them also helps prevent constipation and reduces the risk of preeclampsia and gestational diabetes. So, consume whole grains for all three meals instead of refined carbohydrates.

Whereas, refined carbohydrates like white rice, maida, bread, and biscuits make you gain excess weight and shoot up your sugar levels too.

Protein
Protein needs increase during pregnancy. As the baby grows in the second and third trimesters, adequate protein is needed to keep up. Protein requirements range from 40-70 g depending upon the mom’s body weight. Eating a variety of protein-rich foods (both vegetarian and non-vegetarian) during the day will supply all of the amino acids you and your baby need. You need 3-4 servings of protein for a healthy pregnancy and to help nourish the growing baby.

Lean meat, poultry, and fish are animal proteins and contain all nine amino acid components which is a complete protein. Vegetarians can get it from nuts, low-fat dairy, eggs, beans, legumes like rajma, whole moong sprouts and boiled chickpeas, and soy products like soya milk, soya nuggets, soya flour and tofu. Vegetarians should choose a varied range of protein sources to meet their needs. Food combinations are also important as they can also make the protein complete (ex. Rice and dhal combination along with vegetables as in Khichadi)

Weight loss, muscle fatigue, frequent infections and severe fluid retention can be signs that the protein in your diet is insufficient.

Fiber
Constipation is a common complaint during pregnancy, a fiber-rich diet will help prevent this. Fruits and vegetables are good sources of fiber along with whole grain carbohydrates which we discussed in the complex carbohydrates portion above.

Calcium
This is needed for the healthy development of the baby's bones and teeth which start developing by around week 8. Calcium is also needed to sustain a healthy heart, nerves and muscles and plays a role in normal heart rhythm and blood clotting. Your calcium intake needs to double, if your stores are not sufficient the foetus uses calcium from its mother's bones, making her more susceptible to osteoporosis later on in life.

1000 mg of calcium per day is needed during pregnancy. Good sources include fortified dairy products like cheese, milk, curd, yoghurt, buttermilk and paneer. Green leafy vegetables are also good sources of calcium as are small fish in which the bones can be eaten. Since dairy products tend to be high in fat, try and choose a low-fat or skimmed version wherever possible. All dairy needs to be pasteurized, green leaves should be cooked or lightly steamed and fish should also be well cooked.

Along with calcium Vitamin D is also important as it helps absorb calcium; deficiency can lead to skeletal abnormalities and rickets. Your doctor can prescribe a Vitamin D supplement. Fortified foods, fish and egg yolk contain Vitamin D.

Vitamins & Minerals
You can find myriad ways of getting the required vitamins and minerals from the regulation 5/6 servings a day of fruits and vegetables. They also provide antioxidants and the all-important folic acid. A simple way to ensure that you get all these nutrients is to try and incorporate all the colours in your daily diet. It could be in the form of fruit smoothies, salads, sabzis, fruit salads and juices.

Vitamin C
Vitamin C helps build strong immunity as during pregnancy a mother's immunity is lowered. Vitamin C also helps in iron absorption. Vitamin C-rich sources include red and green capsicum, tomatoes, citrus fruits, strawberries, and green leafy vegetables. Vitamin C is lost on prolonged exposure to the environment and by cooking. Its best to have these sources raw after being well washed. For example, have one orange daily during the season. Squeeze lemon on your green leafy vegetable preparation just before having it.

Folic Acid
Folic acid is one of the most important vitamins you need to be consuming during pregnancy. It helps prevent Neural Tube Defects (NTD) like spina bifida and anencephaly. The neural tube is where the baby's spine and brain develop from. It is good to start on a folic acid supplement 3 months before conception Folic acid also supports the mother as it is shown to prevent preeclampsia. It also helps in the formation of normal red blood cells and prevents anemia. It is also important for the functioning of our DNA, the growth of the placenta and the baby.

400 mcg of folic acid are recommended while trying to conceive and for at least 1-2 months after conception. Along with a supplement, eat foods rich in folic acid like lentils, pulses, green leafy vegetables, nuts, citrus fruit juices and butter fruit (avocado).

Iron
The baby needs to build up iron stores to sustain itself after birth, this is why the maternal blood volume increases by 50%. The extra blood requires iron to carry oxygen to the body's cells and tissues. Myoglobin is a protein that helps supply oxygen to your muscles, collagen is a protein in bone, cartilage and other connective tissue and many enzymes all require iron, it also helps maintain a healthy immune system. Without sufficient iron, problems like iron deficiency anemia can occur which are associated with low birth weight, preterm delivery and infant mortality.

Iron exists in 2 forms:

Non-heme iron, which is found in plants and vegetarian sources. Iron-fortified foods and supplements provide non-heme iron.

Heme iron, which is found only in animal products. Heme iron is best absorbed by the body. To meet your iron needs, make sure you eat a variety of iron-rich foods every day.

Red meat is a good source of iron for pregnant women. The liver is also rich in iron but it also contains high levels of Vitamin A which is harmful to the developing fetus and hence it should be taken in limitation after consulting with the dietitian.

Vegetarian sources of iron can be obtained from legumes, vegetables, and grains.

Omega-3s
Omega-3 fatty acids are good for the developing brain and heart of the baby. Since our human body cannot make omega-3, outside sources are necessary. The best source for this is fish and that includes salmon, sardines and fish oil supplements. But be sure of the source of your fish, as mercury content is something that you need to watch out for. Vegetarians can opt for walnuts and flaxseed.

Water
Water is an essential requirement for a pregnant woman. Water is the carrier of all the nutrients to the cells for absorption and without this vital ingredient, all the previously mentioned food groups are of no use. Dehydration could also trigger early labor so make sure to have 8 to 10 glasses of water per day. But do take small sips if you feel nauseous or full.

Balanced and healthy nutrition thus helps for a healthy pregnancy and normal delivery. A proper pregnancy nutrition plan helps to prevent any complications like gestational diabetes, high blood pressure and other health conditions which may lead to preterm delivery.