2.0 Antenatal nutrition - Home | Queensland Health HEALTHY START IN LIFE ANTENATAL NUTRITION 1 2.0 Antenatal nutrition 2.1 Nutrition during pregnancy (1,2,3,4,5) Nutritious foods and

1A HEALTHY START IN LIFE ANTENATALNUTRITION

2.0 Antenatal nutrition2.1 Nutrition during pregnancy (1,2,3,4,5)Nutritiousfoodsandanactivelifestylecanhelpachieveoptimalhealththroughoutlife.Goodnutritionisimportantatallstagesthroughoutlifeandparticularlyduringpregnancy.Thehealthandnutritionalstatusofmothersandchildrenareintimatelylinked(1).

Beginningpregnancywithahealthydietisgivingthebabythebestpossiblenutritionaladvantage.Awidevarieddietisvitalinsupportingthegrowthanddevelopmentofthefoetusandthemaintenanceofthewomansownhealth.Nutritionalrequirementsformostnutrientsincreaseduringpregnancy,particularlyfolate,iron,zincandvitaminC(2).Thereisonlyasmallriseinenergyrequirements,whichcanbeachievedbyeatingforexampleanextra23slicesofbreadperday(3).

Table 5 Foodrecommendationsduringpregnancy

Food group Number of serves 1 serveBread, cereal , rice, pasta, noodles

4 6

2slicesbread1mediumbreadroll1cupcookedrice,pastaornoodles1cupbreakfastcerealflakesorporridgecupmuesli

Fruit

4

1piecemediumsizedfruit2piecessmallerfruit8strawberries20grapesorcherriescupjuice1cupdiced/cannedfruit1Tbspsultanas

Vegetables, legumes

5 6

1mediumpotato/yammediumsweetpotato1cuplettuceorsaladvegetablescookedvegetables

Meat, fish, poultry, eggs, nuts and legumes

1

65100gcookedmeat/chicken80120gcookedfish2smalleggs1/2 cupcookeddriedbeans,lentils,chickpeas,splitpeasorcannedbeans1/3cuppeanuts/almonds

Dairy

2

1cupmilk40g(2slices)cheese200gyoghurt1cupcustard

Extra foods0 2

1Tbspmargarineoroil1cansoftdrinksmallchocolatebar4plainsweetbiscuits

Adaptedfromthe Australian Guide to Healthy Eating

2 A HEALTHY START IN LIFE ANTENATALNUTRITION

2.2 Sample meal planThe following examples illustrate how the Australian Guide to Healthy Eating can be incorporated into a daily meal plan to meet minimum nutritional requirements.

Breakfast

1cupbreakfastcerealflakes/1cupporridge

Milk(250ml)

1cupstrawberries/1freshorange/grapefruit

Morning tea

2ricecakes/1slicetoastwith1slicecheeseandtomato

Lunch

Salmon/eggortuna/andsaladbreadroll

1piecefreshfruit

Afternoon tea

1scone

cupfruitjuice

Dinner

1smallsteak(100g)withmixedvegetables(total1cups)

1smallpotato

1cupfruitsaladwith2Tbspyoghurt

Supper

2slicesraisintoast,scrapemargarine

Parenthandoutsavailableat

qheps.health.qld.gov.au/ahwac/content/home_nemo.htm

3A HEALTHY START IN LIFE ANTENATALNUTRITION

Folate during pregnancyFolateisaBgroupvitaminneededforhealthygrowthanddevelopment.Itsrequirementsareincreasedduringpregnancyfornormalgrowthoftheunbornbaby.Adequatefolateintakehelpstopreventneuraltubedefectsinthebaby,suchasspinabifida(2).

Thevitaminisknownasfolatewhenitisfoundnaturallyinfoodandasfolicacidwhenitisaddedtofoodorusedindietarysupplements(4).

Therecommendedintakeofdietaryfolateforpregnantwomenis600g/daythroughoutpregnancy.However,toreducethelikelihoodofneuraltubedefectsinthebaby,itisrecommendedthatwomenconsumeanadditional400g/dayfolicacidthroughasupplementorintheformoffortifiedfoodsforatleast1monthbeforeand3monthsafterconceptioninadditiontoconsumingfoodfolatefromavarieddiet(2).

Itisdifficulttogetenoughfolatefromnaturalsourcesalonetoreducetheriskofneuraltubedefectsinpregnancy.Folicacidsupplementsareavailableoverthecounter.Womenwhohaveafamilyhistoryofneuraltubedefectslikespinabifidarequiremedicaladvicebeforebecomingpregnant(4)astheymayneedevenhigheramountsoffolicacid.

Goodsourcesoffolateincludeleafyvegetables,wholegrains,fortifiedcereals,peas,nuts,avocadosandyeastextracts(egMarmite, Promite, Vegemite etc).

Forfurtherinformationandparenthandouts:

www.foodstandards.gov.au/foodmatters/pregnancyandfood.cfm

Checkdiet contains rich sources of folate before and during pregnancy

advise women to take folate supplements for 1 month before conception and during the first trimester of pregnancy

if dietary intake is poor, consider continuing folate supplement after the first trimester

folic acid intakes should not exceed 800 1000 g/day.

4 A HEALTHY START IN LIFE ANTENATALNUTRITION

Iron during pregnancyIronisacomponentofhaemoglobin,thecomponentofbloodwhichcarriesoxygenaroundthebody.Thepeakironrequirementinpregnancyoccursthroughoutthesecondandthirdtrimesters.Thisistosupporttheexpansionofthematernalredbloodcellmass,thegrowingfoetusandtheplacenta.Alackofironmayresultinanaemia.Womenwhosedietpriortopregnancywaslowiniron,mayhavelowironstores.Thisincreasestheirriskofdevelopingirondeficiencyanaemiaduringpregnancy.Dietaryironisusedbythegrowingbabyfirst,leavingthemothersstoresdepletedifherintakeisinadequate.Lowironlevelsinearlypregnancyhavebeenlinkedtoprematurebirthandlowbirthweight.

TheRDIforironinpregnancyis27mg/day(5).Amixeddietofanimalandplantfoodscanhelpyouachieveyourironintake.AbsorptionofironisbetterfromanimalfoodscomparedtoplantsourcesandtherecommendeddietaryintakesarebasedonamixedWesterndiet.

Therearetwotypesofironinfood:ironfromanimalfoods(calledhaemiron)andironfromplantfoods(callednon-haemiron).

Haemironistakenupbythebodyabout10timesbetterthannon-haemiron.Meatsarethebestsourceofiron.Theredderthemeat,thehigheritisiniron.Thismeansbeefandlambarehigherinironthanpork,chickenorfish.Colouredfleshfish,suchastunaandmulletarehigherinironthanreeffish,suchasbarramundi.

Non-haemironisfoundinsomeplantfoodssuchas:

wholegrainandironfortifiedbreadsandcerealsfoods,eg.breakfastcerealwithaddediron

legumes,eg.kidneybeans,bakedbeans

greenleafyvegetables,eg.spinachandbroccoli

nutsanddriedfruit.

Rememberthatironfromthesefoodsisnottakenupbythebodyaswellasironfromanimalfoods.Youwillneedtoeatmoreofthesefoodsiftheyareyouronlyironsource.

AddingaglassoffruitjuiceorotherfoodsrichinvitaminC(suchastomato,broccoliorcapsicum)toamealwillincreasetheamountofironthebodyabsorbs.Incontrast,tea,coffeeandunprocessedbrancaninhibitironabsorption.

Indicators of iron deficiency

Ironstatusisdeterminedbymeasuringbloodlevelsofhaemoglobin,serumferritinandserumtransferrin.Serumferritinisthebestindicatorofironstores.Lowserumferritinlevelsindicatedepletedironstores.Haemoglobinisnotasensitiveindicatorofironstatus,withlevelsdecreasingoftenonlywhenferritinstoresareseverelydepleted.Inaddition,haemoglobinlevelsdecreaseduringthethirdtrimesterofpregnancyduetohaemodilutioneffects.Ferritinlevelsremainunchangedduringthistime.Serumtransferrintransportsironintheblood.Transferrinvaluesincreasewithirondeficiencyanddecreasewithironoverload.Ironintakeshouldbeincreasedwhenserumferritinlevelsarelow.Ideallythedietshouldbeexaminedforadequateironintake.Ifthedietappearstoprovideadequateirondespitelowferritinlevels,supplementsmaybeconsidered.

5A HEALTHY START IN LIFE ANTENATALNUTRITION

Checkif serum ferritin levels are low, iron intake needs to be increased

iron supplements may cause constipation. Constipation may be minimised by consuming adequate intakes of dietary fibre and fluid. Foods from the meat/meat alternatives group provide the best sources of iron. Vegetarians need to consume vitamin C rich foods with meals to increase iron vabsorption and eat a good variety of non-haem iron sources.

IodineTheRDIforiodineinpregnancyis220ug/day(5).Iodinedeficiencyinpregnancycanaffectgrowthanddevelopmentintheunbornchild,increasethechanceofmiscarriageandhaveseriousimplicationsforintellectualdevelopment.Iodinecanbefoundindairyproductsiemilkandyoghurt,breadbakedwithiodisedsaltandsaltwaterfish.Itisveryimportantformotherstoconsumesufficientiodinefromthetimeofconception,justasitisforthemorewell-knownnutrientsofironandfolate(5).

Multivitamin supplementsApartfromtherecommendedfolatesupplement,itisbesttoobtainnutrientsfromahealthydiet.MultivitaminsnotdesignedforpregnancyarenotrecommendedastherearedangersassociatedwithexcessivedosesofnutrientssuchasVitaminsA,DandB6(2).

Alternative and herbal remediesMostherbalandhomeopathicremedieshavenotbeentestedtodeterminetheirsafetyduringpregnancy.Manyherbalpreparationshaveadrug-likeeffectandshouldbeusedwiththesamecautionaswithotherdrugsduringpregnancy.Herbalpreparationsshouldbeavoidedduringthefirsttrimester.TheNationalPrescribingService(NPS)Medicineslinecanprovideinformationregardingalternativetreatmentsinpregnancy,phone1300888763.

Patienthandoutsavailableat

qheps.health.qld.gov.au/ahwac/content/home_nemo.htm

6 A HEALTHY START IN LIFE ANTENATALNUTRITION

2.3 Special considerations during pregnancyListeriaListeriaarebacteriacarriedinsomefoodsthatcancauseaninfectioncalledlisteriosis.Thebacteriacommonlyinhabitsoil,water,plantsandsewerage.Theinfectionmaycausefewornosymptomsinhealthypeople,includingpregnantwomen.However,theriskoftransmissionfromtheinfectedpregnantwomantoherunbornchildishigher.Infectionofthefoetuscanleadtomiscarriage,stillbirth,prematurebirthorsevereillnessinnewbornbabies(2).

Thebestwaystoavoidlisteriainfectionsincludehygienicpreparation,storingandhandlingoffood.Foodsshouldbeeatenfresh,orthoroughlycooked,orwellwashedifeatenraw(fruitandvegetables).Leftoverscanbeeateniftheyhavebeenrefrigeratedimmediatelyandstoredforlessthan24hours.

Thefoodsmostlikelytocarrythebacteria,increasetheriskofinfectionandthereforeshouldbeavoided,include:

softandsemisoftcheeses,eg.brie,camembert,ricotta,blue,fetta

softserveicecream

unpasteuriseddairyproducts

pate

chilledseafood

salads-fruit/vegetable,eg.prepared,prepackaged,smorgasbord/saladbars

coldmeats,includingchicken,eg.deli,sandwichbars,andpackagedready-to-eat.

Healthy tips

always wash hands before preparing or serving food and after han