Important nutrients to be included in special pregnancy diet during pandemic

The health of an expectant mother must be taken care of by ensuring nutritious and balanced pregnancy diet, especially during the pandemic in order to stay safe from the infection.

Nature has blessed womankind to be 'mothers' and continue the cycle of life. This is more than just a biological event as this involves a strong physical and emotional life-changing moment, which is impossible to describe it. Despite the Covid-19 pandemic today, life has to move on as we cannot stop the 'biological' clock of a pregnant woman. Hence, the health of an expectant mother must be taken care of by ensuring nutritious and balanced pregnancy diet, especially during the pandemic in order to stay safe from the infection.

Pregnancy may be divided into three trimesters namely first trimester (0 to 3 months), second trimester (4 to 6 months) and third trimester (7 to 9 months). No significant physical changes of the mother are seen in the first trimester but this period is of crucial development to the foetus. The major physical and hormonal changes in the mother starts gradually from the second trimester. The mother should be prepared to go through these phases of life mentally, physically and emotionally. The husband and family should be supportive, caring, understanding and helpful during this difficult journey.

The nutritional requirement of an expectant woman should be ensured. It is important to stay safe and well shielded during this pandemic so as not to complicate the pregnancy with viral infection. This calls for healthy eating. The basic principles of healthy eating must include adequate proteins, carbohydrates and healthy fats with plenty of fruits and vegetables. However, special pregnancy diet must not leave out these nutrients.

Energy – The maternal diet during pregnancy must provide sufficient energy to ensure growth and development of the foetus. Energy requirement for an average adult person is between 1900 to 2925 Kcal per day and it has been calculated that a pregnant woman needs an additional of +350 Kcal for higher basal metabolic rate, storage of fat, growth of fetus, placenta, and maternal tissue. Carbohydrate are a rich supply of energy, example whole grain rice, potato, sweet potato and bread.

Protein – The average of 55 g/day of protein is needed by a normal woman and during pregnancy an additional protein of 23g is required and this promotes the growth of maternal tissue such as enlargement of the uterus, breast and the placenta. The development of the foetus also needs additional proteins. Milk, meat, egg and cheese are complete proteins of high biological value Pulses, Cereal and Legumes, whole grains, nuts and oilseeds are good sources of additional protein.

Carbohydrate and fats - Requirement of starch, sugar and dietary fibres are the same. There is some evidence that intake of long chain fatty acid is beneficial. At least 25 to 30 per cent fat should be consumed that should come from nuts, omega fatty acid rich fishes, plant products, egg and meat.

Calcium – A normal person requires 600mg/day of calcium for the bone to remain strong and to avoid problems of osteomalacia and osteoporosis.  An increase intake up to 1200g/day is required for the formation of bone and teeth of the developing foetus. If the mother’s intake is minimum then the foetus draws it from the mother’s bone by decalcification and this is naturally harmful to the mother with weak bones and teeth. Milk, cheese, yoghurt are good sources of calcium. Dark green leafy vegetables like Indo-Malayan Taro, spinach, turnip, kale is also rich in calcium.

Iron – The requirement of iron is more in women compared to man due to loss of iron during menstruation and pregnancy.  A normal woman requires about 21mg/day and it increases up to 35mg/day when pregnant as iron is required for the haemoglobin synthesis in the red blood cells of the foetus and the mother. Iron is very much essential for the growing foetus and part of it is stored in the foetus liver for further use in the later part of its development. Consumption of vitamin C rich diet helps in the absorption of iron in the body. Liver, dried beans, dried fruit, green leafy vegetables, eggs, enriched cereals and iron fortify salt are good sources of iron.

Folic Acid – ICMR recommended 400µg/day folate during pregnancy. It is now well recognised that Folic acid (the synthetic form of vitamin folate) is of critical importance in protecting neural tube development and is given as routine supplement.  Green leafy vegetables, legumes, egg, fruits, brussels sprout, nuts, etc are rich in folic acid.

Vitamin A– Is available in two forms beta carotene and retinal. Normal requirements of beta carotene for an adult woman is 4800µg or 600µg of retinol and it increases to 6400µg or 800µg during pregnancy. The level of requirement can be calculated based on the vitamin content of liver of the newborn. Problems related to eyesight can be prevented by consuming this essential nutrient in the diet. Liver, egg yolk, butter, dark green leafy vegetables and yellow coloured vegetables and fruits are good source of vitamin A.

Vitamin D – is essential in the absorption and utilisation of calcium needed for the calcification of foetal skeleton. Much of the vitamin D is provided by maternal exposure to sun. Current vitamin D of 10 microgram is recommended for pregnant women. Vitamin D can be present in milk, milk products, nuts and other green leafy vegetables.

Vitamin C – the daily requirement of this vitamin is 40 mg of vitamin C and this compares reasonably well to that required by an average non pregnant woman.  Low intake of vitamin C can lead to maternal problems. All types of fruits can be consumed but amla citrus fruits and guava are the rich sources of vitamin C.

Other Vitamins – Sufficient supply of vitamins in the diet prevents nausea, vomiting, constipation related to pregnancy. The need for Vitamin B group – thiamine, riboflavin and niacin also increase and are needed for the release of energy in the cells. Folic acid intake must be increased to 400µg/day as it helps in promoting normal foetal growth of the neural tube and also prevents macrocytic anaemia of pregnancy.

Iodine and Zinc – Trace elements of these minerals are required during pregnancy. 100-200µg is required during pregnancy and deficiency leads to abortion, stillbirths, congenital anomalies, increased perinatal mortality, cretinism and psychomotor defects.  Zinc is required for protein synthesis and growth of the foetus as lower intake leads to low birth weight and trebles the risk of preterm delivery.

Excessive intake of vitamin A in the form of retinol. Pregnant women are advised to limit their intake of it by avoiding liver and liver products. Alcohol consumption in high amounts can be potentially damaging to the foetus and if unavoidable a consumption of 1 or 2 units per week or two is advised. High intake of caffeine during pregnancy may increase the risk of miscarriage or low birth weight. Pregnant women should pay particular attention to food hygiene and to avoid certain food to minimize the risk of food poisoning with salmonella and listeria. The pregnant mother’s diet should be planned carefully in relation to the body mass index and the trimester of her pregnancy.  Small frequent meals can be given if there are problems in eating a proper meal. Spicy, pungent, fatty foods should be avoided as much as possible. Morning sickness can be avoided by giving ginger tea, green tea, and milk (according to the individual). Toxic substances should be totally avoided. Taking high fibre rich diet and adequate hydration are essential for good health.

It is now recognised that pregnant women do not actually have to 'eat for two'. However, a rich balanced diet rich in nutrients is important both for the mother and the baby.

First Published:Oct. 9, 2020, 8:45 p.m.

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