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A healthy pregnancy and great birth have their foundations in your health and diet during pregnancy. Nutrition has a great impact on the health of your baby from its life as it grows inside you through to adulthood. ANY improvement you can make to your diet during pregnancy will benefit both you and your baby.

Even if you are far into your pregnancy, there is still much to be gained from reviewing and improving your diet as the nutrient requirements of your pregnancy increase significantly during the second and third trimesters with the baby’s rapid growth. Nutrient deficiencies could still be avoided or their impact on the birth and the post-partum period lessened even at this late point.

A well balanced diet during pregnancy is also good preparation for successful breastfeeding. Changes made to eating patterns late in pregnancy will place you in an even stronger position to meet the physical demands of breastfeeding and life with your newborn baby.

What is a balanced diet?
A balanced diet includes a variety of foods from all 5 food groups described in the Food Pyramid, which also describes the recommended number of daily servings. It should provide enough calories to ensure a desirable weight and should include all the necessary daily nutrients.

On a balanced diet, supplements are not required. However increasing your intake of folate a month prior to conception and for the first 2 months after conception can reduce the risk of your baby developing neural tube defects.

The neural tube is that part of the developing fetus from which the skull, brain and spine develop. Neural tube defects include spina bifida, anenchephally and encephalocoele. A daily folic acid supplement of 400mcg for the first two months of pregnancy (or the first month only if the date of conception is known) is recommended.

Dietary supplements may also be required if you have a pre-existing dietary deficiency, are expecting more than one baby, are a heavy smoker, or regularly use drugs or alcohol. You should consult your medical practitioner for advice.

How to get the nutrients your body needs during pregnancy

The table below gives the Recommended Dietary Intakes for energy, protein, calcium, iron and folate during pregnancy.

Energy: Additional energy is required in pregnancy to allow for the increased needs of the growing baby and the changes to your body. Energy is the major nutrient determining the baby’s weight gain. Energy requirements are greatest between 10 and 30 weeks gestation, when your body is depositing larger quantities of fat. Sufficient energy is a primary dietary requirement of pregnancy. If energy needs are not met, available protein, vitamins and minerals cannot be used effectively for various metabolic functions.

After the first 3 months of pregnancy, your additional energy required can be met by eating an extra two slices of wholemeal toast and a banana, or one cup of rice or pasta and an apple each day.

Protein:Additional protein is required during pregnancy because your body is making new body tissues. Protein provides for the growth and development of the baby, the placenta, the uterus, breast tissue and increased blood supply.

After the first 3 months of pregnancy, your additional need for protein required can be met by drinking an extra glass of milk or calcium enriched soy milk (200ml) daily or eating an extra half a peanut butter or cheese sandwich.

Calcium: Additional calcium is required by your baby for the formation of bones and teeth; the functioning of nerves and muscles; and the development of heart rhythm and normal blood clotting. The majority of extra calcium is required in the last three months of pregnancy. Calcium is also required for the production of breastmilk. Dairy foods, such as milk, cheese and yoghurt are excellent sources of calcium.

The additional calcium required during pregnancy can be obtained by eating or drinking:

• an extra glass of milk or calcium fortified soy milk (250ml);
• a wedge of cheese (40g);
• 1 carton of yoghurt (200g);
• or 1 cup of mashed pumpkin (240g) and ¾ cup of cooked spinach (115g).

Iron: Additional iron is required to meet the needs of your growing baby and placenta and for the increase in your blood supply. Iron also builds bones and teeth. It is particularly important in the 3rd trimester when there is a large shift of iron to the baby for its development. Iron deficiency can lead to anaemia as your iron stores depleted in favour of the baby. Blood loss during the birth also needs to be compensated for by increased iron intake.Iron found in animal foods (haem) is more readily absorbed by the body than the iron found in plant foods (non-haem). Ideally the diet should combine haem and non-haem sources of iron.

*Liver products should be avoided during pregnancy since they may contain excessive Vitamin A.

Foods rich in vitamin C (citrus fruit, strawberries, green capsicum, kiwi), when eaten alongside iron-containing foods, increase the body’s absorption of iron. Milk, tea, coffee and antacids inhibit the absorption of iron and should not be taken with meals.

Folate: The main function of folates is to preserve the integrity of genetic material while it is being transferred from one cell to another.It is possible to increase your consumption of folate by taking a low dose folate tablet, normally called ‘folic acid’, 0.5mg or 500mcg, by eating foods rich in folate every day and by choosing foods that have added folate. By eating several serves of folate rich foods every day it is possible to reach the RDI of 500mcg. The 1999 Victorian Folate Campaign recommended that women do all three of the above.

Attention to food preparation is important as folate is very sensitive to high temperatures so fresh green vegetables should only be cooked for a short time in as little water as possible. Folate is also destroyed by cooking food in bicarbonate of soda. Best cooking methods include steaming, microwaving and stir frying.

The additional folate required pre-conception and during pregnancy can be obtained by eating an extra ½ cup of cooked spinach (100g); or an extra vegemite sandwich each day.

Women are at increased risk of experiencing a neural tube defect affected pregnancy if:

• They have had a baby with spina bifida, anencephaly or other neural tube defect;
• They themselves have, or have had, a neural tube defect;
• They have a close relative who has, or has had, a neural tube defect.

Women taking medicines for epilepsy or seizures are also at increased risk as these drugs can interfere with the body’s ability to absorb folate.

The Department of Human Services recommends that women at higher risk need to have a folate intake about 10 times higher than the average recommended daily dose, at 5mg per day (Department of Human Services 1999).

Early Pregnancy Sessions can further develop your skills and build your knowledge around:

• Reducing pregnancy discomforts through nutrition;
• The advantages and disadvantages of vitamin supplementation;
• Managing special diets during pregnancy e.g. vegetarian and vegan;
• Recipe and menu ideas for healthy eating.

References
- Australian Nutrition Foundation Inc.(1994). Nutrition for Pregnancy – Stepping up your nutrition. Adelaide: Finsbury Press

- Bennett, VR & Brown, LK (1999). Myles Textbook for Midwives. London: Churchill Livingston.

- Department of Human Services & Family Planning Victoria (1999). Folate – A guide for primary health care professionals.

- Institute of Medicine (1990). Nutrition During Pregnancy: Part 1 – Weight Gain. Part 2: Nutrient Supplements. Available at http://books.nap.edu/books/0309041384/html/index.html [Accessed 24.3.03]

- Sanitarium Nutrition Education Service. Leaflet: Give your baby the best start in life. Wahroonga: Australia.

- Sears (2003) Eating right for two. Available at http://www.askdrsears.com/html/1/t011400.asp [Accessed on 16.3.03]

- Story, M. & Stang, J. (eds) (2000). Nutrition and the pregnant adolescent – A practical reference guide. Available at http://www.epi.umn.edu/let/nmpabook.html [Accessed 27.3.03]

- US Department of Agriculture 2003 Food Pyramid. Available at http://www.nal.usda.gov:8001/py/pveg.htm [Accessed on 19.3.03]