HEALTHY EATING DURING PREGNANCY

Pregnancy is a critical period during which good maternal nutrition is a key factor. Nutritional needs are higher when you are pregnant and meeting these needs helps protect the long-term health of both you and your baby. Maternal weight gain during pregnancy influences infant birth weight and health, and outcomes vary depending on the mother's prepregnancy nutritional status. Impaired growth and development in womb may also “program” the foetus for cardiovascular, metabolic, or endocrine disease in adult life. Some studies have also indicated increased risk of heart disease, type 2 diabetes, hypertension, and high cholesterol among men and women who were small or disproportionate at birth. Low birth weight infants who are born to undernourished mothers are at the highest risk for these health problems. Women should consume a variety of foods according to the Dietary Guidelines, with cultural food practices considered, to meet energy and nutrient needs and gain recommended amounts of weight.

Fruits and vegetables
Vegetables and fruit provide carbohydrates (sugar and starch), fibre, vitamins and minerals and are low in fat. Vitamin C, found in many fruits and vegetables, helps you absorb iron and promotes healthy gums for both you and your baby. Dark green vegetables have vitamin A, iron and folate — other important nutrients during pregnancy. You can steam or microwave your vegetables and include vegetables and fruit of a variety of colours. Add extra vegetables to your casserole and limit juice and dried fruit intake because these foods have high sugar content which can lead to undesired weight gain. Eat at least four servings of vegetables and two servings of fruit per day. Only one serving of juice or one serving of dried fruit counts towards your total number of servings for the day. One serving is equivalent to a handful of cut raw vegetables and for fruits, it is similar to 1 medium-size apple, pear, banana or orange or similar size for other fruits like pineapple.

Meat, poultry, fish, eggs and beans
The main nutrients provided by this group are protein, iron, B- vitamins, zinc, and magnesium. Protein is crucial for your baby's growth, especially during the second and third trimesters. The recommended daily intake for meat, poultry, fish and alternatives should be 4-5 servings, which is equivalent to 8-9 match box (small) sizes of fish or meat or poultry or combined proportions of these a day and about three whole eggs a week. It is advisable to limit intake of fatty portions of meats and if possible trim off visible fat before or after cooking. You can also roast, broil, grill, steam or boil these foods rather than frying. For vegetarian to meet the 4-5 servings a day for this group they require about 18-24 pieces of almonds/cashew or 3 table spoons of peanut butter or 12 - 15 flat ladles (local) of cooked beans or any combinations of these a day. It is advisable to limit fatty soups (groundnut and palm nut) to about 2 -3 times a week.

Dairy foods
This group includes milk, yogurt and cheese, and key nutrients are identified as calcium, protein, vitamin B12, vitamins A, D and E. The recommended daily intake should be at least 3 servings or more, which is equivalent to 1 cup of yoghurt or 2 cups of fat free milk (1 cup –whole milk) or 2-3 cups of soymilk (calcium fortified option if available) or any combined proportions of these a day (1 cup=250ml/average glass size). It is better to choose lower-fat varieties as the higher the fat content of milk and yoghurt, the greater the amount of saturated fat and cholesterol. You can drink the milk in your cereal bowl, enjoy yogurt for your afternoon snack and add cheese to your salad. If you have trouble digesting dairy products try calcium-fortified fruit juices or experiment with lactose-reduced or lactose-free products.

Bread and cereals
These foods provide essential carbohydrates, your body's main source of energy. Many whole-grain and enriched products also contain fibre, iron, B vitamins, various minerals and protein. Fortified cereals can help you get enough folic acid. Choose at least six servings of breads and cereals each day. They can achieve this by having about 3-4 soup ladles (local, round one) of oats, or rice water or wheat or tom brown or other similar foods for breakfast. Pregnant women should add milk (about a quarter of regular tin size) or groundnut paste (about 1 teaspoon) to their beverage. They can include 3-4 slices of bread as well as some fresh vegetables (lettuce, cucumber etc.). Pregnant women can have about one and half large orange size kenkey or banku or fufu or other similar staples for lunch or supper .You can trade sugary cereals and white bread for whole-grain cereals, brown rice, whole-wheat pasta and whole-grain bread and look for products that list whole grains, such as whole-wheat flour, first in the ingredients list.

Water
Water carries nutrients from the food you eat to your baby. It can also help prevent constipation, haemorrhoids, and excessive swelling, and urinary tract or bladder infections. Drink about 4 sachets (local) of water a day.

Alcohol and caffeine
Women who are or may become pregnant should not drink alcoholic beverages at all. A safe level of alcohol intake has not been established at any stage during pregnancy. Drinking during pregnancy increases the risk of mental retardation, learning disabilities, and major birth defects, such as those included in foetal alcohol syndrome.

In early pregnancy, caffeine might be dangerous to the developing foetus because it can readily cross the placenta and can affect foetal heart rate and breathing. A foetus does not have a sufficient metabolic system to cope with the increase in heart rate that results from this jolt of caffeine. In severe cases, the result can be a spontaneous abortion. In less severe cases, caffeine can contribute to low birth weight. Because the risk of miscarriage is highest in the first three or four months, caffeine intake should be most strictly monitored during early pregnancy. Several studies have found an increased risk of spontaneous abortion and low birth weight in pregnant women who consumed more than 150 mg/day of caffeine. Pregnant women who consume as little as 200 milligrams of caffeine per day can double their risk of miscarriage. Evidence suggests that, at levels over 500 milligrams per day, caffeine may delay conception. Pregnant women limit themselves to about 2 cups of coffee or tea per day.

Recommended weight gain during Pregnancy
Weight gain in pregnancy is also related to foetal growth. Too little gain is associated with reduced foetal growth, ie, low birth weight (less than 2.5kg) or small-for-gestational-age infants. Excessive maternal weight gain is associated with large infants, ie, macrosomia (defined as more than 4.0kg) or large-for-gestational age infants who have a higher risk of birth injury and other problems.

Obesity is usually defined in terms of body mass index (BMI), i.e. weight (kg)/height (m2). The internationally endorsed classification defines obesity in three grades; (1) BMI 25 to 29.9kg/m2 = grade 1 obesity (moderate overweight); (2) BMI 30 to 39.9kg/m2 = grade 2 obesity (severe overweight) and (3) BMI 40kg/m2 = grade 3 obesity (massive/morbid obesity). Thus, overweight is usually defined in terms of a BMI of 25 or more, and obesity in terms of a BMI of 30kg/m2 or more. A normal BMI ranges from 18 to 25kg/m2.

The pregnancy weight gain depends on the woman's prepregnancy BMI. It is advisable women in the lower BMI ranges (less than 19.8kg/m2 ) to gain 12.5 to 18.0 kg extra during pregnancy whiles those in the mid range ( 19.8 to 26kg/m2 ) can also gain extra 11.5 to 16.0kg. Women with prepregnancy BMI between 26.0 and 29.7kg/m2 could add on between 7 to 11.5kg extra weight. However those with BMI greater than 29.0kg/m2 should only gain extra 7kg weight. Besides maintaining appropriate weight after delivery, these guidelines yield positive pregnancy outcomes.

Exercise
The current recommendation is to accumulate at least 30 minutes a day of moderate physical

activity on most days of the week, preferably daily. Regular physical activity confers many health benefits, including weight management; increased physical fitness and psychological well-being; and reduced risk of chronic disease. The mothers can start from 15 minutes per session and gradually increase it by 5 minutes weekly. In addition to the exercise, mothers can also do household chores as well. Pregnant women can engage in activities that are at a low to moderate intensity level like brisk walking and riding on a stationary bicycle. Highly intensive activities that increase risk of abdominal trauma and any exercise with a high risk of falling or requiring balance, especially in late pregnancy may not be safe. Exercise is contraindicated for women with pregnancy- induced hypertension, toxaemia, preeclampsia, preterm rupture of membranes, and history of preterm labour, persistent second or third trimester bleeding, incompetent cervix, or any sign of foetal growth retardation.

Other dietary problems
During pregnancy, heartburn may occur as a result of the hormonal changes that slow the movement of food through the digestive tract. One or more of the following recommendations may ease heartburn in pregnancy: avoid lying down immediately after eating; sleep with the head slightly elevated to avoid acid reflux; consume small, frequent

meals; and avoid known irritants, such as caffeine, chocolate, or highly seasoned foods.

Infrequent or hard, dry stools may occur either as a side effect of high doses of supplemental iron or as part of the normal digestive changes during pregnancy. To alleviate symptoms, pregnant women may be advised to include high-fibre foods in their diet, increase fluid intake, and if possible, get regular physical activity.

Food cravings and aversions are very common during pregnancy. “Pica” generally refers to the compulsive intake of non-food substances over a sustained period of time. “Geophagia” specifically refers to compulsive eating of clay or dirt. Other substances that may be consumed include ice or freezer frost (pagophagia), corn starch, laundry starch, baking soda, soap, ashes, chalk, paint, or burnt matches. Pregnant women who practice pica may be, as a result, exposed to lead or other environmental toxicants. Pica has also been associated with low blood iron levels.

Pregnant women are at high-risk for food-borne illness. Among the most common causes of diarrhea during pregnancy are several food- or water-borne pathogens (bacteria, protozoa, or viruses. Listeriosis (by Listeria monocytogenes) can result in premature delivery, stillbirth or infection in the newborn. One food borne protozoan can be passed from the mother to the foetus and may result in infant death or mental retardation. Pregnant women therefore should not consume unpasteurized juices, raw sprouts, or raw (unpasteurized) milk products. They should also avoid raw or undercooked meat, poultry, eggs, fish, or shellfish.

Management of nausea and vomiting during pregnancy depends on the severity of the symptoms. Milder cases can often be treated by consuming small meals frequently, avoiding offensive odours, drinking enough fluids, and getting fresh air. Some pregnant women tolerate foods high in carbohydrate such as crackers better than high-protein or high-fat foods. However, women should learn by experience which foods ease their nausea and consume those foods to avoid an empty stomach. Hyperemesis gravidarum, or severe nausea and vomiting persisting beyond 14 weeks of gestation, is a high-risk condition usually requiring hospitalization.

The guidelines provided here is for people with optimal health. Those with special cases should seek expert advice.

The writer is a dietician email, [email protected]