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Healthy Eating During Pregnancy November 2002 Welcome Once a pregnancy is achieved, there is much to gain from establishing a healthy pattern of eating. This case provides some useful guidelines from our consultant Dietitian. Initial Presentation Sue is thrilled to learn that she is pregnant after successful treatment with IVF. She wants advice on a healthy eating plan during pregnancy and is also wondering if there are foods she should avoid to increase the chances of her pregnancy surviving. Her only medication at present is folic acid tablets, 0.5mg daily. She is referred for dietary advice. Dietitian Comment Folic acid (0.5mg) daily is recommended beginning 1 month before pregnancy and continuing for the first trimester. Randomised controlled trials have established the benefit of this supplement for reducing the incidence of neural tube defects (1). Supplementation with oral folic acid is recommended because it is difficult to obtain the required amount through diet alone ( Table 1 ). Certain foods are a risk for listeria contamination. Listeria infection of the fetus can lead to miscarriage, still birth, premature birth or can make a newborn baby very ill. Foods to avoid include mostly chilled, ready-to-eat foods such as soft cheeses, cold meats/chicken, pat, prepared salads, raw/smoked seafood (see website for more extensive table) ( Table 2 ). Information obtained from Sue reveals she has 3 meals per day and occasionally morning tea. She has 3-4 serves of dairy product per day but only 1 piece of fruit and few vegetables. In pregnancy, it is the quality of the diet that is important, rather than significantly increasing the amount of food eaten. There is an increased need for more protein, calcium, iron, folate and vitamin C, rather than increased energy. Calcium requirements increase by 300mg per day to 1100mg daily. It is required to adequately provide for mineralisation of the fetal and maternal skeleton. The extra requirements can be met by diet as suggested by the Australian Guide to Healthy Eating (2). Only 2 serves from the dairy group would be required as vegetables also provide some calcium. If only relying on the dairy group for calcium 3-4 serves would be needed. Iron requirements double with an extra 10-20mg of iron per day needed to provide for maternal and fetal haemoporesis ( Table 3 ). Red meat is the best source for iron. Green vegetables and wholegrain cereals are also high in iron and best eaten with foods rich in vitamin C as this improves the iron absorption (see Table 2 ). Folate is also important in the latter stage of pregnancy with requirements doubling from 200mcg to 400mcg per day. Therefore besides the importance of having the extra 500mcg per day early in pregnancy, high folate foods such as wholegrain breakfast cereals and vegemite should also be eaten in late pregnancy. Vitamin and mineral supplements are not required, as long as the diet is healthy. A multivitamin could be recommended when nutrition is poor. During the session Sue also reveals she drinks lots of coffee and has a glass of wine each night with dinner. Alcohol is not recommended during pregnancy, as it may be harmful to the developing baby, particularly in the early stages of pregnancy and conception. Binge alcohol drinking is a particular risk and may result in major fetal abnormalities (3). The amount of caffeine recommended during pregnancy is no more than 2-3 cups tea/coffee or cola drinks per day (4). Caffeine crosses the placenta and the developing baby cannot metabolise large amounts. Herbal teas are also not recommended due to the uncertainty of the origin of some and therefore what they contain. Sue is pleased to discover that generally her eating pattern is good and that modifications in her diet can help her with morning sickness, heartburn and constipation, if these develop. She will seek further advice once she commences breast feeding and is determined to extend her healthy eating plan to her partner and her evolving family. Click here for more web-only information on this topic. References 1. Lumley, J et al (2002). Periconceptional suppplementation with Folate and multivitamins for preventing neural tube defect.Cochrane Database of Systematic Reviews 3. 2. Australian Guide to Healthy Eating booklet available from the Commonwealth Department Health and Family Services or at www.health.gov.au/pubhlth/strateg/food/guide 3. Australian Alcohol Guidelines published by NHMRC 4. Eskenazi, Brenda. Caffeine During Pregnancy: Grounds For Concern? JAMA 270, 2973-2974.  PRINT THIS PAGE
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