Nutrition for Pregnant Women
Program:Nutrition for Pregnant Women
Heading: Diet and nutrition for pregnant women
Pregnant woman: During pregnancy, what and how much should I eat to get enough nutrients for my baby? Should I take vitamin supplements? And what sort of food should I avoid?
Nurse: It’s good to know you’ve thought about the diet during pregnancy. Let me talk you through some key issues, including the importance of diet at different stages of your pregnancy; your changing nutritional needs in different stages; how to achieve a balanced diet; some important nutrients in pregnancy such as iron, zinc, folic acid, omega-3 fatty acids, iodine and calcium. I will also talk about some common queries about pregnancy diet, foods to avoid, food hygiene and lastly how cigarette smoking affects your baby.
Heading: Importance of diet during pregnancy
Nurse: During pregnancy, you have higher metabolic rate. You have to supply nutrients for the baby too. It is important to consume a nutritious diet.Poor diet not only affects baby’s development but also put your own health at risk. It could lead to anaemia and other health problems.
Pregnant woman: Does this mean that a pregnant woman should eat for two?
Nurse: Pregnant women need some extra nutrients, but you do not need to “eat for two”. Over-eating will lead to excessive weight gain during pregnancy, which is associated with postpartum weight retention and high blood pressure. We need to achieve a healthy balanced diet. Good nutrition is a good foundation for babies’ health. The foods you’re eating today actually influence your babies’ food preference in the future. Research found that kids are more likely to eat vegetables if their mothers consumed more vegetables during pregnancy.
Heading: Nutrition during pregnancy
Pregnant woman: What is the healthy diet and good nutrition for pregnant women?
Nurse: Women have different nutritional needs at different stages of pregnancy. In the early pregnancy, weight gain should be little but you need some nutrients to support your baby’s organ development. During this early stage, you need an extra 100 Kilocalories each day - eating one slice of bread, or drinking one glass of low-fat milk in a day will help you to meet this requirement.Your body demands more folate at this stage. You need to take a daily supplement of folic acid and consume foods which are rich in folates to protect your baby against neural tube defects including spina bifida.
Pregnant woman: What is spina bifida?
Nurse: Spina bifida is a birth defect of the spine. It happens if the spinal column of the foetus doesn’t close completely during the very early stage of pregnancy, leaving part of the nerve and spinal cord exposed and they can be damaged. In severe cases, the affected person cannot walk and cannot control the bowels and bladder. Adequate folic acid intake is an effective way to prevent spina bifida.
Pregnant woman: What kind of foods are rich in folate?
Nurse: Folate-rich foods include dark green vegetables such as spinach, Pak Choi, and asparagus; beans and peas; and fruits such as papayas, bananas, melons, grapefruit, strawberries and oranges. Some breakfast cereals are fortified with folic acid too, but remember to choose a low-sugar version.Pregnant women should take folic acid supplements during the first 3 months of pregnancy.
Pregnant woman: What should I eat during the mid- and late pregnancy?
Nurse: In the middle and last stages of pregnancy, the baby grows rapidly and has a faster weight gain; your body therefore requires more energy. You may need to eat slightly more than what you had before getting pregnant. For example, having an extra glass of low-fat milk, a slice of bread, a tael of meat, plus half an orange a day would supplement the extra need. Another example is to include an extra glass of low-fat milk, extra half bowl of rice, one tael of fish and half an orange. At the same time, your body needs more nutrients including folate, calcium, iron, zinc and iodine. In short, you may need very little extra energy. Do not over-eat; try not to put on too much weight during pregnancy; consider the nutrients content of foods but not merely energy content.
Heading: Balanced and healthy diet
Pregnant woman: How should I eat so that I get the sufficient nutrients that I need but without eating too much?
Nurse: Having a healthy balanced diet is the key. The healthy eating food pyramid shows you the types of food and their proportions. Include all 5 food groups in every day eating. They are grains, vegetables, fruit, meat, fish, eggs and alternatives like beans, also milk and alternatives. Grains should be the main part of every meal. Eat plenty of fruit and vegetables. Eat some meat, fish, eggs or alternatives and milk and dairy products every day. But you should limit taking foods that are high in sugar, fat and salt. And, remember to have adequate fluid intake throughout the day.
Heading: Balanced and healthy diet – Grains
Pregnant woman: Why should grains be the main part of my diet?
Nurse: Grains provide energy to your body. They are good source of fibre, vitamin B and minerals. Eat wholemeal varieties such as wholemeal bread, brown rice, red rice, oatmeal and wholegrain breakfast cereals. The wholemeal version contains higher content of vitamins and dietary fibre than the processed varieties. Dietary fibre helps prevent constipation.
Heading: Balanced and healthy diet – Vegetables and Fruits
Nurse: Also, eat plenty of fruit and vegetables because these provide vitamins and minerals like carotene or pro-vitamin A, folates, calcium and iron. These are important nutrients for the foetus’s growth. Dietary fibres in fruits and vegetables improve your bowel movement and prevent constipation. During pregnancy, eat at least two servings of fruits and four servings of vegetables a day. Go for fruits and vegetables of different varieties and colours.
Pregnant woman: What is a “serving” of fruit and vegetables?
Nurse: A serving of fruit is around one medium-sized piece of fruit such as apple, orange; 180 ml glass of unsweetened fresh fruit juice; or 30 g unsweetened dried fruits such as raisins or dried prunes. But fruit juice or dried fruits are relatively high in sugar content, so you should watch the intake portion and prevent over-consumption. One serving of vegetables is about half a bowl of cooked vegetables or guard.
Heading: Balanced and healthy diet– meat, fish, egg & alternatives
Pregnant woman: People keep telling me I should eat more meat and eggs, is it true?
Nurse: Meat, fish, eggs and beans provide protein, iron, zinc and vitamins. These nutrients are essential for you and your baby. Aim for about 5-7 servings of these foods each day. One serving example is about a tael of meat, just like a size of a table-tennis ball; or a quarter block of firm tofu; or one chicken egg; or about half a bowl of cooked beans.
Pregnant woman: How can I achieve the recommendations on fruit and vegetables and meat or alternatives in a day?
Nurse: Well, you can try including one egg and a glass of unsweetened fruit juice in breakfast; these would make one serving of meat and one serving of fruit. If you don’t like eating fruit in the breakfast time; then you could consider eating fruit as snack during break time. For lunch, one piece of pork chop, one bowl of cooked vegetables, and some rice is an easy example. In terms of rice, your need may be just slightly more than the quantity you had before becoming pregnant. You would need more if you are very active physically. Then have an apple during afternoon break. For dinner, you can have 2 taels of fish, 1/3 block of firm tofu, a bowl of Pak Choi; and some rice. In this example, throughout the three main meals, you have included 6 to 7 servings of meat, fish, eggs and alternatives, as well as 6 to 7 servings of fruit and vegetables. This is just an example, remember it is so important to eat a balanced and diverse diet.
Pregnant woman: I understand now. I think I can do it.
Heading: Important nutrients in pregnancy
Pregnant woman: You mentioned pregnant women need nutrients such as iron. Why is that so important?
Nurse: Iron is essential for the production of red blood cells. Your body needs more iron in the middle and last stages of pregnancy; it also helps to build up your baby’s iron store which is so important for his growth in the first few months after birth. Prolonged iron deficiency is a common cause of anaemia in pregnancy. It may delay baby’s growth and brain development. So, doctors will advise the pregnant women who are at risk to take iron supplements.
Pregnant woman: What foods are rich in iron?
Nurse: Iron from animal sources is more easily absorbed by the human body. Examples are red meat like pork and beef, poultry, fish and shrimp. Choose lean meat to limit animal fat intake. Liver has high iron content. However, it is high in vitamin A too. Too much vitamin A is toxic to the body. Therefore, you should not eat animal liver more than once a week, and should not consume more than 100 g each time. It is about 5 tablespoons portion. Green vegetables and dried beans are good source of iron too. Try to eat these foods with fruits which are rich in vitamin C, such as strawberries and kiwi fruit. Vitamin C helps your body absorb the iron from plant sources. Choose breakfast cereals which are fortified with iron. Remember to read the nutritional labels; and choose products with high iron and low sugar.
Pregnant woman: What is zinc?
Nurse: Zinc plays a central role in immune system. It helps the baby grow and wound healing. Meat, poultry, fish, shrimp, and dried beans are good sources of zinc.
Pregnant woman: People say omega 3 fatty acids are good for baby’s growth and development, is it true?
Nurse: Omega-3 fatty acids are required for the development of the brain of your baby. Fish is the main source of omega-3 fatty acids. Fish oil is great source of omega-3 fatty acids. Be careful when you choose fish as some fish contain methylmercury which is harmful to the baby’s brain. Examples of Fish that are low in methylmercury and rich in omega-3 fatty acids are: farmed salmon, sardines, threadfin bream, big eyes, and Pacific saury. You can also choose a variety of fish that are lower in methylmercury such as grass carp, mud carp, flathead mullet, mottled spine foot, horse head and mandarin fish. To reduce the risk of methylmercury poisoning, it is better to eat from a variety of fish and avoid eating too much.
Pregnant woman: Are there any other nutrients required for baby’s brain development?
Nurse: Yes, iodine is another important nutrient for you. It is essential for healthy brain and thyroid development. However, most foods are relatively low in iodine. Seaweeds, nori, seafood and sea fish are main sources of iodine. You could try including kelp and seaweed in your usual meals, such as making kelp soup and seaweed topping on rice. In addition, you can replace table salt with iodised salt to top up some iodine intake. It is difficult to get sufficient iodine from food alone when you are pregnant. You should consider taking a prenatal multivitamin/multimineral supplement that contains iodine. Please consult your doctor or pharmacist.
Pregnant woman: I also heard the pregnant women should drink a large volume of milk to ensure calcium intake. But I don’t like drinking milk, what should I do?
Nurse: Women have increased calcium requirement during pregnancy. Calcium is vital for making your baby’s bone and teeth. Adequate calcium intake reduces risk of pre-term labour. Milk, cheese and yoghurt are the most common example of calcium sources. Choose the low-fat version of dairy products to reduce energy consumption. If you don’t drink milk or don’t eat dairy products, you can still get calcium from other food sources such as dark green vegetables. Try choy-sum, chinese kale, pak choi. Calcium from these vegetables is easily absorbed by the human body. Chinese firm tofu, calcium-fortified soymilk are great sources of both calcium and protein. Some other Asian food ingredients are also rich in calcium, such as sesame, nuts, prawn??? dried oyster, dried shrimps and sardines.
Pregnant woman: How much calcium do I need?
Nurse: You need 1,000 mg of calcium a day in middle stage of pregnancy. And, your requirement increased to 1,200 mg a day in the third trimester.
Pregnant woman: What should I eat to reach this requirement?
Nurse: Here are two examples for you to get 1,000 mg of calcium in a day. The first is to have a carton of low-fat milk in breakfast, a bowl of cooked choy-sum for lunch, and at dinner you have another half bowl of cooked choy-sum plus one block of firm tofu. Second example is to eat a piece of low-fat cheese or 1 glass of calcium-fortified soymilk for breakfast, and include a tablespoon of dried shrimp at lunch, then have a small carton of yoghurt as snack during the day, plus a bowl of cooked pak choi and 3 sardines for dinner. To get the amount needed during late pregnancy, just add some sesame in rice, or have a small amount of nuts as snacks.
Heading: Common queries about pregnancy diet
Pregnant woman: Thank you for your explanations. But I have a further question about calcium. Do I need to take calcium supplements?
Nurse: Your guts absorb calcium much better when you are pregnant. If you choose the calcium-rich foods and have balanced varied diet, you do not need a calcium tablet. For your bone health, you need to pay attention to Vitamin D. It helps your body absorb calcium. Egg yolk and liver contain vitamin D. Exposing your skin to sunlight helps your body produce vitamin D that you need. Stay active and having regular exercise both bring positive impact to your bones; and it is even better than taking a calcium tablet.
Pregnant woman: Oh, you mentioned that fish oil has Omega-3 fatty acids. Does it mean cod liver oil capsules are similarly good for me?
Nurse: Fish oil and cod liver oil capsules are totally different. Cod liver oil contains mainly vitamins A and vitamin D, but not omega-3 fatty acids. There is insufficient evidence to conclude that taking fish oil capsule or cod liver oil capsule could benefit baby’s brain development. Instead, research findings tell us excessive intake of vitamin A from supplementation is harmful for liver and affect baby’s organ development. The best way to obtain omega-3 fatty acids is still from the natural food sources.
Pregnant woman: You mentioned that pregnant women should eat more seafood, but I was told that pregnant women should not eat seafood because it causes skin problems and allergies for the baby.
Nurse: Recent evidences did not show a link between mother’s diet and allergy in infants. In 2008, both the paediatric societies in Europe and the States concluded that dietary restrictions during pregnancy did not help in the prevention of atopic disease in infants. Instead, unnecessary dietary restriction could result in nutrient deficiencies.
Heading: Foods and drinks to avoid during pregnancy
Pregnant woman: What should I stop eating during pregnancy?
Nurse: Your diet should be light on fats and salt. Avoid foods which are very strong in favours, too salty, too oily or highly processed including pickled or deep-fried. A high intake of salt and fats increases risk of calcium loss and chance of postpartum obesity. Try using natural ingredients for seasoning, as well as adopt healthier cooking methods in daily meals. Trim off visible fats and skin from meats and poultry; try steam, poach, boil, bake, stew, grill, stir-fry, and consider to use a non-sticky pan to reduce oil use.
Pregnant woman: Can I eat sweet foods?
Nurse: Sweet foods such as sweets, soft drinks, sweetened drinks, tarts, pastries and cakes are all high in sugar and fat in general. We should limit our intake of this type of food. Try replacing your sugary snacks with some fresh fruit and vegetables, for example cucumber, celery, carrot and cherry tomatoes.
Pregnant woman: what else should I avoid?
Nurse: You should also limit drinks and foods containing caffeine. Because caffeine can increase heart rate and causes high blood pressure, restlessness and bowel problems. Too much caffeine may increase the risk of low birth weight and miscarriage.
Pregnant woman: I know I should not drink any alcohol at all. Am I right?
Nurse: You’re right. This is because alcohol can seriously affect baby’s development. Alcohol drinking in pregnancy can cause low birth weight and damage to the brain. There is no safety drinking guideline for pregnant women, so advice is not to drink alcohol at all.
Pregnant woman: My mother bought me some traditional Chinese medicine for pregnancy from the Chinese traditional medical shop. Do you think it is safe to drink?
Nurse: Drugs and herbs can affect the expectant mothers and baby. So, never take any medicine or drugs without professional advice. Always check with your doctor or registered Chinese medicine practitioner before taking any medicine.
Heading: Food and personal hygiene
Pregnant woman: Thank you for providing so much information. Any other tips for me?
Nurse: Food safety is as important as food nutrition Here’s 5 quick points for you:
- Choose safe raw materials
- Keep hands and utensils clean,
- Separate raw and cooked foods,
- Cook foods thoroughly
- Store foods at safe temperatures
For more information, you can refer to the leaflet on the ‘Five Keys to Food Safety’ published by the Centre for Food Safety (Please browse the Centre for Food Safety website: www.cfs.gov.hk).
Nurse: There are few more things that I would like to remind you. Pregnant women should take extra care to prevent listeriosis. Listeriosis increases risk of pre-term labour and miscarriage. You should avoid all unpasteurised dairy products such as soft cheese. Pasteurized cheese is considered to be safe. Avoid all uncooked seafood such as raw oysters, sushi, and sashimi. Do not eat chilled ready-to-eat and refrigerated foods including smoked salmon, cold dishes and pre-packaged ready-to-eat meat pâtés or Deli meats. To further prevent other bacterial infection, avoid all kinds of uncooked items such as eggs, dressings which made with raw eggs, mayonnaise, and eggnog. It is also very important to maintain good personal hygiene habits. Always wash your hands before preparing food and eating. If you keep a pet, you should be careful. Pets can be infected with parasites. A parasite called Toxoplasma gondii can be found in the faeces of cats when they are infected. The parasite can pass on through the food chain and infected mother and baby. Therefore, always keep your pet away from the kitchen. Do not handle their faeces. Always wear gloves when handling dirt and gardening.
Pregnant woman: Understood!
Heading: Effects of cigarette smoking on baby
Nurse: Last but not least, quit smoking during pregnancy. Smoking increases the risk of stillborn by 30% and increases preterm labour by 20%. Babies of mothers who smoke are smaller at birth and are more prone to respiratory infections. Studies showed that cancer causing substances in cigarettes can be passed on to the baby through placenta. So, women should quit smoking when they plan to have a baby; or at least stop smoking as soon as they find out they are pregnant.
Pregnant woman: I don’t smoke but my husband does. It should not cause a problem, right?
Nurse: No. Secondhand smoking affects the health of both the expectant mother and the baby. You should advise him to quit smoking for his own good and for the baby’s sake. Or, ask him to stay away from you if he smokes to minimise the effects from secondhand smoke. If you or your family want to quit smoking or need help, please call the Integrated Smoking Cessation Hotline at 1833 183 (or browse the website www.tco.gov.hk).
Heading: If you need more information
Nurse: If you have any other enquiries, please do not hesitate to ask the staff of Maternal and Child Health Centre or other medical staff.
Pregnant woman: Thank you for your clear explanation and advice!
Nurse: For other information – please contact Family Health Service of Department of Health 24-Hour Information Hotline 2112 9900 or visit the website at www.fhs.gov.hk.