MODULE 8 LESSON 1

Nutrition is extremely important before, during, and after pregnancy. And there are specific dietary requirements that should be considered at each stage.

The overarching goal is to have a healthy balanced diet, which supports the optimal health of both mother and child.

Pre-Pregnancy Nutrition

At this stage of pregnancy, your focus should be on optimising health in such a way as to minimise the risk of complications in the future. A healthy and balanced diet will go some way to support this.

But what does that mean?

Nutrients that are of particular importance include:
  • Iron: Found in meat, leafy vegetables, fortified cereals, liver, beans, nuts, and seeds.
    If you suspect a deficiency or are unsure, consult your doctor.
  • Iodine: Found in dairy, seafood, and shellfish. It is important in the healthy development of the baby's brain.
    If you suspect a deficiency or are unsure, consult your doctor.
  • Calcium: Found in dairy, nuts, and vegetables. If deficient, the body will deplete calcium from the bones in order to provide the baby with the nutrients it needs.
  • Folic Acid: Found in fortified breakfast cereals and yeast extract. Folate rich foods also include peas, beans, and orange juice.

    NICE recommendations from 2014 are that all women should supplement with 400mcg of Folic Acid before pregnancy and during the first 12 weeks of pregnancy. This reduces the risk of defects such as spina bifida. Maternal and child nutrition. (Full Text)
  • Vitamin D:
    Typically difficult to obtain from the diet, so supplementation is often recommended. Scientific Advisory Committee On Nutrition (2016) recommends 10mcg per day before, during, and after pregnancy.SACN vitamin D and health report. (Full Text)
    If you suspect a deficiency or are unsure, consult your doctor.

Weight Management

Achieving a healthy weight prior to pregnancy is an important consideration for avoiding complications during pregnancy, as well as health defects in the future.
According to the NICE 2010 guidelines, a healthy pre-pregnancy weight is within the BMI range of 18.5-24.9. A BMI above this range present an increased risk of a number of health concerns, including;
  • Impaired glucose intolerance
  • Gestational diabetes
  • Miscarriage
  • Neural tube defects
  • Heart defects

Women with a BMI above 30 would see benefit improvements in health with a 5-10% reduction in body weight, even if they were unable to reach the ideal range. Therefore, the goal should be to achieve a healthy weight through sustainable methods, prior to conception.
  • Weight management before, during and after pregnancy. NICE 2010 (Full Text)

Nutrition During Pregnancy

During pregnancy, it's important to maintain a healthy and balanced diet, which is why focusing on this pre-pregnancy helps in the longer term. During pregnancy, there are certain foods to avoid and moderate. Here are two tables detailing these recommendations, taken from the 2017 NHS guidelines.

Foods To Avoid
  • Soft blue cheeses and cheeses with a mould rind. The mould can contain listeria, which can be harmful to an unborn baby.
  • Liver and liver products (ie, fish liver oils), or any supplements containing Vitamin A Too much Vitamin A can be toxic to the baby.
  • Swordfish, Marlin, or Shark. These may contain high levels of mercury, which can be harmful to an unborn baby.
  • Pate (including vegetable pate). Pate can contain listeria, which can be harmful to an unborn baby.
  • Raw and undercooked foods, incl. meat, seafood, and eggs. These foods can cause various types of food poisoning, which pregnant women are more susceptible to. These foods should be cooked thoroughly and meat should have no pink areas.

Foods To Moderate
  • Oily fish, ie salmon, trout, fresh tuna, and mackerel. The omega 3 in the fish is beneficial. However, they may also contain small amounts of Mercury, which if eaten in large quantities could be harmful to the baby.
  • 2 portions of oily fish per week (c. 280g) Tinned Tuna is excluded from this, but no more than 4 tins per week should be eaten.
  • Caffeine. This could increase the risk of miscarriage and low birth weight. No more than 200mg per day. Equivalent to 2 mugs of instant coffee. Be aware of caffeine in tea, energy drinks, soda, and chocolate. These all count.
  • Alcohol. This could increase the risk of miscarriage and low birth weight. No more than 1-2 units (a glass of wine is 2 units), once or twice a week. Don't get drunk!

There are myths around foods you shouldn't eat while pregnant. Here's a list of foods you CAN eat that you might have thought were off-limits (taken from NHS 2020 guidelines).

  • Shellfish, including prawns (ensure these foods are well-cooked).
  • Live or bio yoghurt, Probiotic drinks or yoghurts, Fromage frais, Creme fraiche, Soured cream
  • Spicy foods
  • Mayonnaise, ice cream, salad dressing (as long as they don’t contain raw egg)
  • Honey
  • Many types of cheese include Cheddar, parmesan, feta, ricotta, mascarpone, cream cheese, mozzarella, cottage cheese, processed cheese, such as cheese spreads.
  • Peanuts
  • Herbal Teas. No more than 4 cups a day as there is limited research on their effects.

​Weight Management

While a healthy weight/BMI is recommended for the health of both mother and child, dieting while pregnant is NOT advised. Instead, opt to focus on a diet rich in nutrients. For those who are overweight, these dietary modifications may result in no weight gain. However, this is something that should not be actively sought.

Should you 'Eat For Two'?
Popular belief is that you should consume more calories because you are 'eating for two. But this is not actually the case. In fact, for the first 6 months of pregnancy, there is no requirement to increase calories. Beyond this point, the increase only needs to be c. 200 kcals, which is about the same as 2 medium bananas.

Post Pregnancy Nutrition
Once the baby is born, there is a tendency to try and lose weight immediately. And this isn't a problem if done in a controlled way while maintaining a highly nutritious and balanced diet. Gradual weight loss of c.0.5-1kg per week will not affect the ability to breastfeed and would represent a controlled return to pre-pregnancy weight.
Fad diets and juice cleanses should still be avoided like the plague!

Breastfeeding
Medical professionals encourage breastfeeding in the early stages of life. Research has shown that breastfeeding for the first 5 months after birth requires an additional 625 kcal/day. This would need to be considered if weight loss is a goal.​
Other nutritional considerations during breastfeeding include:
  • Alcohol can pass through breast milk to the baby and should ideally be avoided.
    If alcohol is consumed don't exceed 1-2 units, once or twice a week. And allow at least 2 hours before breastfeeding.
  • Caffeine can pass through breast milk to the baby and should ideally be avoided or limited.
  • Drink water throughout the day.
  • Continue to limit oily fish as per the table above. Other foods can now be consumed as the potentially harmful bacteria will not be passed on to the baby.