Proper nutritional habits during pregnancy

PROPER NUTRITIONAL BEHAVIOR DURING PREGNANCY

Nutrition refers to an area that especially studies physiological and pathological aspect of nutrients in the body. Physiologic aspects of nutrients deal with composition of nutrients such as macro nutrients (proteins, lipids and carbohydrates) and micronutrients (vitamins and minerals), and also deals with metabolism of those nutrients to be used by the body.

Pathologic aspects of nutrient deals with nutritional problems or malnutrition due to insufficiency or over nutrients within the body. Some examples of insufficient nutrients intake are including; stunting, kwashiorkor (protein deficiency), marasmus (protein-energy deficiency), anemia (iron deficiency), rickets (vitamin D calcium deficiency), spine bifida (neural-tube defect) caused by lack folate during pregnancy.

Furthermore, nutrition can be defined as “Food Utilization by the Body for ensuring a normal growth and a normal functioning of different organs’’.

In this paper we are going to focus on the nutrition package (good nutrition behavior) of a women during pregnancy for purpose of enhancing and maintaining life of women as well as her baby.

A child’s birth weight is an important determinant of infant and child health and mortality. A birth weight of less than 2.5 kilograms is considered as low. In Rwanda, nationally 38% of children less than 5 years are stunted and 2% of children under age 5 are wasted, and less than 1 percent are severely wasted.(RDHS 2014-2015)

The wasting prevalence is highest among children less than age 8 months (5 percent) and begins to decline only after age 8 months. Wasting is about four times as common among children born to malnourished mothers (BMI below 18.5 kg/m2) as among children whose mothers have a normal BMI (18.5-24.9 kg/m2). These malnutrition problems are mainly caused by poverty, lack of knowledge about good nutrition behaviors, lack of food supplements during pre-conception, pregnancy and during lactation, lack knowledge about hygiene and sanitation.         

                                

          OBJECTIVES 

1. Identify energy and nutrients requirements to support health of pregnant woman.

2. Recommend food choices and supplements of pregnant women for purpose of enhancing better life of mothers and their children before and after delivery.

3. Explain how nutrition influences women, their children and contributes to their health to avoid malnutrition diseases. 

NUTRITION CARE, PRACTICES AND NUTRITION BEHAVIOR OF A WOMAN DURING PREGNANCY.

Pregnancy starts when a male’s sperm fertilizes a female’s egg, the fertilized egg implants in the lining of uterus, a full-term pregnancy, also called the period of gestation, lasts 38 to 42 weeks, it is divided into three trimesters, with each trimester lasting about 13 to 14 weeks.

A well balanced, nourishing diet as well as supplements throughout pregnancy provides the nutrients needed to support fetal growth and development without depriving the mother of nutrients she needs to maintain her own health.

Proper nutrition during the first trimester of pregnancy

The fetus requires abundant nutrients from the mother’s body to support its dramatic growth during this period, the placenta is now a mature organ that can provide these nutrients.

Because of the formation of body limbs, eyes and ears, brain, and organs occurs during the first trimester, nutrient deficiencies during this time can lead to irreversible structural or functional damage. The embryo is most vulnerable to teratogens during first trimester.

Alcohol, illegal drugs, over-the-counter medications, megadose of supplements such as vitamin A, certain herbs, microbes and cigarette smoking, can interfere with embryonic development and cause birth defects, fetal malformation or miscarriage.

             

Nutritional behaviors during the second trimester

During the second trimester (approximately weeks 14 to 27 of pregnancy) the fetus continues to grow and mature, the fetus can suck its thumb, its ears begin to hear, and its eyes can open and close and react to light, the placenta is now fully functional.  Some babies born prematurely in the last weeks of the second trimester survive with intensive neonatal care.

The second trimester characterized by continued growth and maturation. Nutrition is important throughout pregnancy to support fetal development without depleting the mother’s reserves. During the second and third trimester, an average of about 0.453 kg a week is considered healthful for normal-weight of the women. During the last two trimesters of pregnancy, energy needs increase by about 350 to 450 kcal/day. By the second trimester, hemoglobin level indicative of iron deficiency anemia < 10.5 g/dl in the second trimester. 

                                

During the third trimester of pregnancy  

The third trimester is a time of remarkable growth for the fetus. During three short months, the fetus gains nearly half its body length and three quarters of its body weight, Brain growth (which continues to be rapid for the first 2 years of life) is also quite remarkable, and the lungs become fully mature. Because of this  intense growth and maturation of the fetus during the third trimester, it continues to be critical that the mother should eat an adequate and well balanced diet. 

 

WEIGHT GAIN DURING PREGNANCY

Adequate weight gain for a mother is one of the best predictors of pregnancy outcome. Weight gain during pregnancy is an indicator of plasma volume expansion and positive calorie balance; Recommendations for weight gain vary according to a woman’s weight before she became pregnant.(Fouzia, Hayet and Abdenacer, 2017)

Pre pregnancy Weight Status	Recommended Total Weight Gain (kg
Underweight (BMI< 18.5kg/m2)	12.7-18.2
Normal (BMI 19-24.9 kg/m2 )	11.4-15.9
Overweight (BMI 2529.9 kg/m2 )	6.8-11.4
Obese (BMI>30 kg/m2)	6.8

A woman of normal weight should gain no more than 1.36 to 2.26kgs during the first trimester, the second and third trimester, an average of about 0.453 kg a week is considered healthful for normal-weight women. For overweight women 0.27 kg /week is appropriate, and obese women should gain 0.22 kg/week.

Dieting during pregnancy can harm the health of both mother and fetus by depriving them of critical nutrients. Instead, the woman should merely attempt to slow the rate of weight gain; On the other hand, if a woman has not gained sufficient weight in the early months of her pregnancy, she should gradually increase her energy and nutrient intake.

NUTRIENTS NEEDED DURING PREGNANCY

 

The requirements of all nutrients are nearly increased during pregnancy to accommodate the growth and development of the fetus without depriving the mother of the nutrients she needs to maintain her own health, energy requirements increase during pregnancy, mainly due to increased maternal body mass and fetal growth.

During the first trimester, a woman should consume approximately the same number of calories daily as during her non-pregnant days, during the last two trimesters of pregnancy, energy needs increase by about 350 to 450 kcal/day, it’s better to select nutrient-dense foods instead of eating more.

Carbohydrates; basic foods such as vegetables, fruits, and whole-grain products containing fibers, cereals and a variety of other nutrients are good choices for high-carbohydrate foods, the pregnant women are advised to aim for a carbohydrates intake of at least 175 g per day. fiber rich foods are very important to avoid constipation.

Proteins; protein requirements increase due to protein tissue accretion, rapid growth of the baby, development of placenta, growth of maternal tissues and amniotic fluid.

Protein needs increase to about 1.1 grams per day/ per kg body weight over the entire 9-month period. Main sources of proteins are including; milk and milk products, meats, fish, small fish, poultry, eggs, and soy and products, beans, peas, lentils nuts, and seeds.

Fats; Because new tissues and cells are being built during pregnancy, adequate consumption of dietary fat is even more important than in the non-pregnant state, during the third trimester, the fetus stores most of its own body fat, which is a critical source of fuel in the newborn period. Besides fetal growth and development, fat serves as a source of fat-soluble vitamins. without adequate fat stores, newborns cannot effectively regulate their body temperature.

Recommendations for the types of lipids during pregnancy are generally the same as for non-pregnant adults (20%-30%) of total calories, saturated fat should be limited and trans fat should be avoided. Poly- and monounsaturated fats like omega-3 and omega-6 should be chosen whenever. Main fats foods sources are; avocados, olive, peanuts, sunflower, soybeans, almonds, sesame, etc.

Micronutrients; the need for micronutrients increases during pregnancy because of the expansion of the mother’s blood supply and growth of the uterus, placenta, breasts, body fat and the fetus. Main micronutrients needed during pregnancy are including; Folate (synthetic form: folic acid), Vitamin B12, Iron, Zinc, Vitamin D and Vitamin C.

This table below summarize the amount of micronutrient needed by the pregnant women.

      

	Micronutrient	Amount	Main sources	Functions	Problems related deficiency
	Folate	600mg/day	Spinach, avocado, fortified foods	Cell division, brain formation and neural tube.	Neural tube defects such as spine bifida.
	Vitamin B12	2.6µg/day	Meats, milk, eggs.	Cell differentiation	Macrocytic anemia
	Vitamin A	770µg/day	liver, milk, and eggs, fruit and vegetables	Vision and the growth and differentiation of cells	Night blindness, impaired immune function, and growth failure
	Vitamin C	85 mg/day	Fruits and vegetables	Antioxidants, prevent the damage of cells and tissues, Iron absorption	risk of premature birth
	Vitamin D	5μg/day	Fish, milk, supplement food,	Regulate blood calcium levels, which in turn maintains bone health	Impaired fetal growth, fetal bone defects.
	Iron	27g/day	Cassava leaves, beans, fortified food, spinach	Red blood cell formation, and transport of oxygen.	Low birth weight, preterm birth, death of newborn.
	Zinc	11 mg/day	Meats, seafood, grains, enriched cereals	DNA, RNA, and protein synthesis, proper growth of fetus	Fetal malformations, premature birth, low birth size, extended labor

             Important things to be considered  

1. The women who are vegan need to be more vigilant than usual about their intake of nutrients that are mainly from only animal products. Those nutrients include; vitamin D (unless regularly exposed to sunlight throughout the pregnancy), vitamin B6, vitamin B12, calcium, iron, and zinc. So that, supplements containing these nutrients are usually necessary.

2. Pregnant women should take at least 2 to 3 liters of water per day.

3. Moderate and simple regular physical exercise is very important to pregnant women because Facilitates labor, reduce psychological stress, enhance mood, help keep blood pressure down. 

                

                        Summary 

All in all, a good nutrition during pregnancy is a cornerstone of baby’s life and very important to the mothers on short and long-term effects to their later health.

we have to remember these, insufficient nutrients intake during pregnancy can leads to child malnutrition diseases after delivery those diseases including; stunting, kwashiorkor (protein deficiency), marasmus (protein-energy deficiency), anemia (iron deficiency), rickets (vitamin D calcium deficiency), spine bifida (neural-tube defect) caused by lack folate of pregnant women and so others.

Avoiding those malnutrition diseases is to keep and maintain mother’s health by giving them quality and recommended quantity of balanced diet and proper supplements as well.

                         Bibliography

1.      Survey, H. (2014) Rwanda. 

2.   Fouzia, T., Hayet, O. and Abdenacer, A. (2017) ‘Early Weight Gain during Pregnancy : Which Women are the Most Affected ?’, (January 2016). doi: 10.5455/ijmsph.2017.0208623012017.

3.      Goudoever, V. and Waard, D. (2019) ‘Nutrition During Pregnancy , Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health : The Early Nutrition Project Recommendations’, (January). doi: 10.1159/000496471.