What to eat and what not to eat during pregnancy

It’s a no-brainer that consuming the right diet is very important during pregnancy.

What a woman eats and drinks during pregnancy is her baby's main source of nourishment. Adequate nutrition during pregnancy also enables the mother to accumulate stores of nutrients inside her body that are necessary to breastfeed successfully after birth.

Pregnant women must follow a healthy, balanced diet to meet their nutrition needs. They can do this by:

i) Eating a variety of vegetables, fruit and whole grains (i.e., oats, whole wheat, barley, etc.).

ii) Consuming beans, peas, lentils, nuts and seeds often.

iii) Opting for lean meats (i.e., chicken, turkey) more often than red meats (i.e., beef and mutton).

iv) Consuming 2 cups of low-fat milk or yogurt per day.

v) Reducing their intake of sugary drinks, deep fried foods, salty snack foods and baked goods like patties, cakes and pastries.

In general, the dietary recommendations for pregnant women are similar to the daily diet recommendations for other adults, but with a few notable exceptions. These include:

1) Adding folic acid to your diet

Take a daily supplement of folic acid, or a daily multivitamin containing 400 mcg (0.4 mg) of folic acid, until the 12th week of pregnancy.

This helps to reduce the risk of neural tube defects (NTDs) in the unborn child. There is an emphasis on supplementation because the extra folate required during pregnancy, especially during the first 12 weeks of pregnancy, is difficult for women to obtain through the diet alone.

After the 12th week of pregnancy, women are encouraged to consume plenty of folate-rich food sources such as green leafy vegetables, oranges, yeast extract, pulses and folic-acid fortified bread and breakfast cereals.

Women who have a family history of neural tube defects and who may become pregnant may be advised by their doctor to take a larger supplement of 5000 mcg (5 mg) per day, until the 12th week of pregnancy.

2) Taking Vitamin D supplements

Taking a daily supplement of vitamin D (10 mcg), or a daily multivitamin containing 10 mcg of vitamin D throughout pregnancy. Women in Pakistan are especially vulnerable to vitamin D deficiency due to their diet and lack of sun exposure.

A lack of vitamin D during pregnancy can adversely affect fetal bone development and can also limit the accumulation of infant vitamin D stores during the early months of life.

3) Eating iron-rich foods

Consuming plenty of iron‐rich foods such as leafy green vegetables like spinach and broccoli, iron-fortified breakfast cereals, red meat, nuts and seeds, legumes, shellfish and dried fruit. Many women of childbearing age in Pakistan have low iron stores, and are therefore at risk of developing anaemia when they are pregnant.

Anaemia during pregnancy can increase the risk of having a low-birth weight baby and the baby developing iron-deficiency anaemia during the first few months of life.

Pregnant women are also encouraged to consume foods or drinks containing vitamin C (i.e., 150 ml glass of pasteurized, no-sugar added orange juice, citrus fruits, bell peppers or berries) at the same time as their iron‐rich meal, as this helps the body absorb more iron from the diet.

4) Controlling retinol consumption

Pregnant women should reduce consumption of vitamin A in the form of retinol by avoiding animal liver and liver products and cod liver oil supplements. This is because excessive intakes of retinol are toxic to the developing fetus and may increase the chances of birth defects.

Other dietary sources of vitamin A and beta‐carotene (e.g. dairy products, eggs, carrots and leafy vegetables) can be included as part of a healthy, balanced diet during pregnancy.

5) Limiting caffeine intake

Caffeine intake should be no more than 300 mg per day (around four cups of coffee). This is because many scientific studies have shown an association between high maternal caffeine intakes during pregnancy and an increased risk of low birth weight babies and spontaneous abortion.

Caffeine is present in many foods and beverages, including cocoa, colas, energy drinks and chocolate, as well as tea and coffee. Caffeine is also found in a number of prescription and over‐the‐counter medicines, i.e., headache pills, cold and flu remedies, diuretics and stimulants.

6) Avoiding certain types of fish

Fish like shark, swordfish and marlin should be avoided altogether and limiting intake of tuna. These large fish may have possible mercury contamination, which can harm the developing fetus. It is recommended to consume no more than two portions of fresh tuna per week or four medium‐sized tins of tuna per week.

7) Fatty acids from certain fish are good

Consuming fish up to twice per week and making one of those servings oily fish (i.e., salmon, trout, tuna, mackerel, herring) is a good idea. Oily fish is a valuable source of omega-3 long-chain fatty acids.

These types of fatty acids are required for the development of the central nervous system, the brain and the retina of the fetus. However, official guidelines limit consumption of fish to twice per week due to the risk of exposure to certain pollutants, such as dioxins and PCBs, which have been found in oil‐rich fish.

8) Increasing dietary fiber intake

It is quite common for women to suffer from constipation during pregnancy due to natural changes in gastrointestinal function and a decline in physical activity. Therefore, it is advised to alleviate constipation by gradually increasing dietary fiber intake in the form of wholegrain cereals, beans and legumes, or using a dietary bulking agent such as psyllium husk. As women gradually increase their fiber intake, they must also increase their water intake at the same time.

9) Paying very close attention to food hygiene and food safety.

Pregnant women have a compromised immune system, making it harder to fight off infections. Thus, they must avoid certain foods to minimise the risk of food poisoning from harmful food-borne bacteria such as Listeria and Salmonella.

Listeria can pass through the placenta and infect the baby and severe cases of food poisoning may cause miscarriage or premature birth. Thus, pregnant women are advised to:

i) Avoid eating raw eggs or partially-cooked eggs, and foods containing raw eggs (i.e., home‐made mayonnaise, cake and cookie batter). Eggs should be cooked until the white and yolk are solid.

ii) Avoid unpasteurised milk and unpasteurised milk products.

iii) Wash fruit and vegetables very thoroughly, especially if they are to be eaten raw to remove harmful bacteria from the surface.

iv) Avoid ready‐prepared and grab-and-go meals in restaurants and supermarkets, which will not be re‐heated. This includes purchased salads, deli meat sandwiches (roast beef, turkey breast, hunter beef), quiches and cold meat pies, especially if they contain poultry.

v) Avoid raw or undercooked meat, such as steak tartar. Always order your steak well-done.

vi) Avoid raw seafood, such as sushi and sashimi.

vii) Avoid refrigerated smoked salmon. It is safe to consume seafood in cans (e.g., canned tuna and salmon).

viii) Avoid mould-ripened cheeses such as Brie, Camembert and blue‐veined cheeses.

ix) Avoid unpasteurised and pasteurised semi-soft cheeses such as Havarti and Monterey Jack. Hard cheeses such as cheddar and other cheeses made from pasteurised milk pose no risk, including cottage cheese, mozzarella, cheddar, Parmesan, Romano and processed cream cheese spreads.

x) Avoid fresh fruit and vegetable juices. It is advised to consume only pasteurised fruit juices.

Other tips to avoid food poisoning include:

i) Washing hands before handling food.

ii) Checking food packaging for the expiry and best-before dates before consumption.

iii) Washing all fruit and vegetables very well before eating them raw or using them in foods.

iv) Washing hands, surfaces and utensils after preparing raw meat.

v) Avoiding cross-contamination by using separate cutting boards and utensils for raw meat and for vegetables.

vi) Thoroughly cooking meat so there is no trace of pink.

vii) Heating meals on the stove or microwave until piping hot all the way through.

viii) Keeping leftovers covered in the fridge and using them within two days.

The mother’s diet must not only provide sufficient energy and nutrients to meet her own nutritional needs, but also those of the fetus for optimal growth and development. Therefore, it is essential that she pay close attention to her diet to ensure that her baby is born healthy.

This article is part of a series about pregnancy and nutrition. Check out the first and second instalment.