Your pregnant client’s nutrition
A healthy, varied diet can help your clients avoid pregnancy-related problems. Nutritionist and exercise scientist Brooke Turner looks at changing nutrient needs, what to include and what to avoid during pregnancy.
THE QUICK READ
- Sound nutrition during pregnancy can assist in avoiding/reducing pregnancy-related problems such as uncontrolled hypertension and gestational diabetes, assist in healthy weight gain, promote sleep, improve energy levels, enhance mental state and overall wellbeing as well as assist in post birth recovery
- Pregnant clients have increased micronutrient and energy requirements, but they do not need to ‘eat for two’
- Protein, fats and carbohydrates play an important role throughout pregnancy with the health of your pregnant client transferring directly to their developing baby
- Pregnant women should avoid alcohol, smoking, unpasteurised dairy, raw eggs, high mercury fish, raw sprouts and unwashed fruit and vegetables to reduce the risk of illnesses such as listeria and salmonella
- Pregnancy is not the time for clients to diet, unless advised to or in consultation with their obstetrician.
Pregnancy is the one time in a woman’s life where what she eats directly impacts the health of another. During pregnancy the overall health of the mother transfers to and promotes proper development and growth of the baby. In fact, studies have shown a link between not only maternal health and the influence on the health and development of the mother’s children, but also her grandchildren.
Consuming a healthy, varied diet can help your clients avoid pregnancy-related problems, such as uncontrolled hypertension and gestational diabetes; assist in healthy weight gain; promote sleep; improve energy levels; enhance mental state and overall wellbeing; and assist in post-birth recovery.
So, how can this be achieved?
Pregnant clients can eat for two, right?
Wrong. While a pregnant woman’s daily energy requirements do increase, they do not need to ‘eat for two’, as the old saying suggests. It is more important that your client focuses on quality rather than quantity and fuels their body with what it needs to support them and their developing baby.
During pregnancy there is an increased recommended daily intake (RDI) for many nutrients, but it is important to note that one size does not fit all, and that these energy requirements vary from one expectant mother to the next due to a range of factors such as:
- activity levels
- current diet
- underlying injury/illness
- food preferences, i.e. vegetarian, vegan, celiac.
The initial stages and first trimester of pregnancy require very little change in daily energy intake. Generally, the basal metabolic rate (BMR) increases by the fourth month of pregnancy (second trimester) and can reach a 15-20% increase from its baseline towards the end of pregnancy. These increases are mainly due to the increase in oxygen demands by the growing baby and the increased cardiac output; you may notice your client’s rate of perceived exertion (RPE) is higher for any given exercise or activity compared to their pre-pregnancy levels. As women reach the second trimester, energy needs increase to approximately an additional 300 calories (1255kJ) per day, further increasing to 450 calories (1880kJ) per day by the third trimester. These increased energy requirements can be easily met by adding in a piece of fruit with a serve of Greek yoghurt and oats, a small sandwich or larger serving sizes.
The role of macronutrients during pregnancy
Macronutrients are the main nutrients that make up the food we eat, namely protein, fats and carbohydrates.
Protein positively affects the growth of foetal tissues, including the brain, and assists in the growth of the mother’s uterine tissues and breasts: the need for protein is therefore elevated during pregnancy. Protein is particularly important in the second and third trimesters, which are associated with periods of rapid growth of the baby and to assist in increasing the blood supply. Protein should account for 20-30% of daily intake. The recommended daily intake (RDI) is 1.0-1.5g/kg/day, so a pregnant client weighing, for example, 75kg, might consume between 75 and 100grams of protein each day. Good sources of protein are lean meats, dairy products, seafood, nuts and legumes.
Fats should account for 20-30% of a pregnant woman’s daily food intake. They play a vital role in proper brain growth and eye development, and are particularly important during the third trimester. Pregnant women should aim to increase their intake of unsaturated and polyunsaturated fats. With regards these varieties, encourage your clients to embrace the motto ‘fats are fun!’ Good sources include those rich in omega 3 and 6 fats, including avocado, nuts, salmon, flaxseed, oil (olive, coconut, flax), butter and eggs.
Carbs make up the remainder of the diet and can amount to 40% of daily intake. Food choices should aim to be low GI, complex and from non-refined sources. Adequate carbohydrate intake is important to help ensure a high fibre diet in your pregnant client. This is particularly pertinent because constipation can be a common concern due to the hormone progesterone which relaxes the smooth muscle of the body, including the digestive tract – which makes food pass through the intestine more slowly. Iron supplements can also increase the likelihood of constipation. Adequate hydration (2.5-3L+ per day), as well as a diet high in fibre, fruits, vegetables and minimally processed food sources, assist in both meeting daily fibre intake (~28g/day) and helping to reduce the risk and occurrence of constipation.
The role of micronutrients during pregnancy
Micronutrients are the vitamins and minerals your body needs in order to function well. The following micronutrient needs increase during pregnancy.
B vitamin intake (RDI 1.9mg/day) is increased during pregnancy with most good pre-natal supplements containing both folate and B vitamins. The increased requirement for B vitamins can easily be met if the diet includes some animal products. If your clients are vegetarian or vegan, it may be necessary to supplement with vitamin B12 (which can be checked by their doctor). Vitamin B6 can also help to keep morning sickness at bay by reducing nausea and vomiting in pregnant women. Sources include animal products such as fish, poultry, meat, eggs, or dairy, fortified breakfast cereals and enriched soy or rice milk.
Folate (RDI 600 micrograms (mcg) per day) is a B vitamin found naturally in green leafy vegetables, fruit (citrus, berries, bananas) and legumes. When this vitamin is added to food or used in dietary supplements it is known as folic acid. Women need an extra 400mcg of folic acid a day for at least one month before conception and for at least the first three months of pregnancy, which can be achieved by taking a supplement. Folic acid plays a key role in reducing the risk of neural tube defects, including spina bifida. By incorporating the likes of asparagus, broccoli, brussel sprouts, chickpeas, dried beans, lentils and spinach into their diets, your pregnant client can boost their folate intake.
Iron (RDI 27mg/day) needs increase significantly during pregnancy, particularly during the second and third trimesters when the amount of blood in the body increases to meet the needs of the placenta and the growing baby. In combination with sodium, potassium and water, iron helps increase a woman’s blood volume and prevent anaemia. Low iron levels are very common during pregnancy and even more so in subsequent pregnancies due to nutrient stores not being at optimal levels. To avoid iron deficiency, it is important to eat plenty of iron-rich foods.
Doctors should test iron levels regularly and a supplement may be required to boost levels if required. Red meat is one of the richest sources and most readily absorbed form of iron, and chicken, pork and fish contain moderate levels. Smaller amounts of iron can also be found in legumes, green leafy vegetables, whole grains, oats, and iron-fortified cereals. Vitamin C can help to increase the absorption of iron, whereas calcium and tannins found in caffeine, such as tea and coffee, can reduce absorption.
Iodine and zinc
Iodine and zinc are essential for the development of the baby’s brain and nervous system. Iodine requirements increase by just under 50% during pregnancy, and then by 80% if breastfeeding, to around 200mcg/day. Iodine can be found in dairy, seafood and fortified cereals. Generally, zinc requirements (11mg/day) can be met through diet alone. The most easily absorbed are animal sources such as red meat, fish and dairy, and to a lesser extent plant sources, such as nuts and legumes.
What NOT to eat
Your pregnant client should limit or completely avoid certain foodstuffs and behaviours, including:
- Alcohol – there is no safe limit.
- Smoking – this can affect the birth weight and growth of the baby.
- Undercooked, raw and processed meat – this may contain harmful bacteria: as a rule, meat should be cooked all the way through.
- Raw sprouts – may be contaminated with bacteria inside the seeds, so pregnant women should only eat cooked sprouts.
- Unwashed produce – fruits and vegetables may be contaminated with harmful bacteria including toxoplasma (parasite), so it’s important to thoroughly rinse all fruits and vegetables, including the skin of citrus, melon and other fruits which, although it may not be consumed, can carry bacteria that can transfer during cutting and food preparation.
- Unpasteurised food and dairy – pregnant women should not consume unpasteurised milk, cheese, soft serve ice cream or fruit juice, as these foods increase the risk of bacterial infections: they should avoid soft, semi-soft and surface ripened cheeses (e.g. brie, camembert, ricotta, feta and blue cheese) unless they are cooked above 65 ̊C and served hot, such as ricotta and spinach cannelloni, and cheese-topped pizza.
- Raw eggs – including lightly scrambled eggs, poached eggs, hollandaise sauce, homemade mayonnaise and salad dressings: uncooked eggs may carry a risk of contamination with salmonella, which can lead to sickness and an increased risk of premature birth or stillbirth.
- High mercury fish and shellfish – pregnant women are advised to limit their consumption of high mercury fish to no more than 1–2 servings per month, i.e. tuna (especially albacore tuna), shark (i.e. flake, commonly used in Aussie fish’n’chips), swordfish and king mackerel. Shellfish, undercooked or raw fish, i.e. sashimi, can be contaminated with bacteria and parasites so should be avoided altogether.
- Caffeine – pregnant women should limit their caffeine intake to 200 mg per day, which is about 2–3 cups of coffee. High caffeine intake during pregnancy can limit foetal growth and cause low birth weight.
- Foods high in saturated fat, sugar and salt – intake should be limited.
In addition to observing these dietary recommendations, pregnant clients should also ensure that, if they aren’t already, they become fastidious in their practice of food hygiene, in order to avoid listeria and salmonella.
Empower your client
Pregnancy can be both an exciting and a dauting time for women. Empower your client during this stage of her life by assisting her with the above nutritional information and working with suitably qualified allied health and fitness professionals if required.
Promote the benefits of meal preparation – even if it is as simple as pre-cutting some vegetables or fruit or hard-boiling some eggs – in helping to eat more healthily and avoid impulse snacking on less nutritious fare. Remind her that the right fats are fun, that her energy requirements will increase, and that she needs to stay hydrated. Above all, remember that pregnancy is not the time for her to be dieting (unless advised to or in consultation with her obstetrician) – but that it is never too late to start eating well.
Brooke is a nutritionist, exercise scientist, personal trainer, writer, presenter and mother of two with over ten years’ experience in the health and fitness industry. Brooke’s programs include her six-week STRIVE program and Happy, Healthy Pregnancy eGuides. Brooke is a believer in striving for a balanced approach to health and fitness and aims to inspire and empower others to see that healthy active living need not be a hindrance but a habit.