Nutrition

Good nutrition can help to ensure a healthy pregnancy. Pregnant women who eat a diet low in milk, whole grains, vegetables, and fruits, or who do not gain enough weight during pregnancy, are at risk of having a premature birth and a low birth weight baby. Excessive weight gain is linked to high birth weight, prolonged labour and birth, birth trauma, and caesarean section.

Healthy eating can help to reduce your risk of developing chronic conditions that can affect pregnancy, such as high blood pressure, diabetes, and obesity. A nutritious diet can also ensure that you receive the right nutrients to support a healthy pregnancy.

The US National Research Council and Health Canada recommend that pregnant women increase their daily intake by 300 kcal (kilocalories). If a woman is carrying twins, she should increase her intake by an additional 300 kcal. Kilocalories are often referred to as "calories" on food product labels. Calories are important to maintain energy. If a pregnant woman does not take in enough calories, her reserves, which are needed for the healthy development of the unborn baby, will start being used up for energy.

General requirements for healthy eating

Consuming a healthy diet involves choosing a variety of items from the four major food groups. For women of childbearing age, this includes:

• Vegetables and fruits (seven to eight servings per day): Choose ample amounts of dark green and orange vegetables, and orange fruits.
• Grain products (six to seven servings per day): Choose whole grain and enriched products.
• Milk products and alternatives (two servings per day): Choose lower-fat milk products.
• Meat and meat alternatives (two servings per day): Choose lean meat, poultry, fish, dried peas, beans, and lentils.

To maintain energy, Canada's Food Guide recommends that pregnant and breastfeeding women should add an extra two to three servings of food per day. This could mean a snack of fruit and yogurt, or a slice of toast and an extra glass of milk.

Servings are not very big. For instance, a serving is about ½ cup of vegetables, 1 slice of bread, or ¾ cup of yogurt. Consult Canada's Food Guide for more information.

Three nutrients are especially important during pregnancy, and if you are thinking of becoming pregnant: calcium, iron, and folic acid.

Calcium

Your developing baby needs calcium to grow strong bones and teeth, a healthy heart, nerves, and muscles. To increase calcium intake, choose more servings from the milk products food group. Try using milk in puddings, soups, pancakes, and casseroles. If you are lactose intolerant, try lactose-reduced milk. For some women, calcium supplements may be appropriate.

Iron

Both you and your baby will need iron during pregnancy. If you do not take in enough iron, you could become anemic, which could cause complications during pregnancy and birth. The need for iron increases throughout pregnancy and peaks in the third trimester. To increase the amount of iron in the diet, choose more servings of meat, meat alternatives, and whole and enriched grains. In some women, a low-dose iron supplement may be needed.

Folic acid

The first trimester of pregnancy is the most common time for the unborn baby to develop congenital abnormalities, which are also referred to as birth defects. Cells that are growing rapidly need a vitamin called folic acid to develop properly. Therefore, adequate levels of this vitamin can protect against birth defects. Folic acid is especially important in protecting against neural tube defects, which are abnormalities that occur in early pregnancy, if a structure called the neural tube fails to close properly. Neural tube defects can lead to serious problems with the brain and spinal cord, including a disease called spina bifida and a problem with the structure of the brain called anencephaly.

The recommended folic acid intake for women with no health risks or with health risks such as epilepsy, diabetes, or obesity is 0.4 to 1.0 mg per day with a daily multivitamin. Folic acid should taken from two to three months before conception, throughout pregnancy, and for the first four to six weeks after birth or as long as breastfeeding continues.

A woman who has previously conceived a baby with a birth defect such as anencephaly, myelomeningocele, cleft lip or palate, structural heart disease, limb defect, a defect of the urinary tract, or hydrocephalus should take 5.0 mg of folic acid daily from three months before conception until 10 to 12 weeks after conception. After that time, she needs to continue taking folic acid 0.4 to 1.0 mg per day throughout the rest of pregnancy and for the first four to six weeks after birth or as long as breastfeeding continues.

Folic acid can be found in dark green vegetables, legumes, and whole grain products, but most women need a supplement to meet the daily requirements in pregnancy.

Canada's Food Guide recommends that all women who are pregnant or breastfeeding, as well as all women who could become pregnant, should take a multivitamin containing folic acid every day. Speak to your health care provider about finding the right multivitamin for you.

Other important nutrients

Other important nutrients that need to be increased in pregnancy include:

• protein: for growth and repair of the unborn baby, placenta, uterus, and breasts, and increased blood volume during pregnancy. Protein is found in meat, eggs, dairy products, and certain plant sources such as beans and nuts.
• iodine: to meet the increased needs of the unborn baby. Iodized salt is the most common source of iodine.
• potassium, vitamin C, and vitamin B12: because their concentrations in the mother’s blood usually decrease significantly during pregnancy. The richest sources of potassium are fruits and vegetables. Vegetables and fruits, such as citrus fruits and tomatoes, are high in vitamin C. The best sources of vitamin B12 are meat and dairy products; women who do not eat meat or meat products may need to include vitamin B12-fortified foods in their diet.
• vitamin D: Daily multivitamins should also contain 200 to 400 IU of vitamin D per day, and some studies are starting to show that a higher dose of vitamin D is beneficial throughout pregnancy and breastfeeding.

Nutrition when you have discomfort during pregnancy

Nausea and vomiting

Nausea and vomiting affect 50% to 80% of pregnant women. Nausea and vomiting in pregnancy are thought to be linked to the increased hormone levels in the body. If you have nausea or vomiting in pregnancy, there are a few dietary changes you can make to ease the symptoms:

• Eat small meals every two to three hours.
• Avoid hunger and do not skip meals.
• Try eating a piece of bread or a cracker before getting up in the morning.
• Have a snack before bedtime or during the night.
• Avoid high-fat and fried foods.
• Try carbohydrate-rich foods such as fruit, fruit juice, breads, and cereals.
• Avoid strong food smells and cooking odours.
• Avoid highly seasoned foods.

Women with severe vomiting, called hyperemesis gravidarum, are at risk for dehydration, weight loss, and problems with their metabolism, which may need to be treated with medication and intravenous fluid replacement.

Heartburn

Heartburn is a problem in pregnancy if it causes the woman to stop eating. About 30% to 50% of pregnant women experience heartburn. Heartburn is caused by the enlarged uterus pressing up against the stomach, forcing stomach contents up into the esophagus. To guard against heartburn, try these tips:

• Eat small amounts of lower-fat foods frequently.
• Eat slowly and chew food well.
• Avoid spicy foods that seem to make heartburn worse.
• Avoid lying down for one or two hours after eating.
• Avoid bending and stooping after eating.
• Do not take antacids without first talking to your doctor.

Constipation

Constipation is another concern during pregnancy, and it affects 11% to 38% of pregnant women. Constipation is linked to changing hormone levels and pressure from the enlarged uterus on the colon. A diet that is low in fibre and fluids and decreased physical activity can also contribute to constipation. Try the following tips:

• Increase fibre intake by eating whole grain breads, vegetables, and fruits.
• Drink eight to 12 cups of fluid per day, including water, milk, or juice.
• Stay active by walking or swimming regularly.
• Avoid laxatives unless directed by a physician.