Nutrition during pregnancy

As we saw in the previous presentation, nutritional guidelines prior to pregnancy should be aimed at ensuring the optimal nutritional status of the woman for the beginning of pregnancy, and we also learned that these guidelines should be followed throughout the woman's fertile life, to prevent any nutritional deficiency from endangering the initial stage of an unplanned pregnancy.

Pregnancy is a process of physiological adaptation whose main function is to provide the fetus with the nutrients necessary for its growth and proper development; therefore, the nutritional needs of women increase during this period and are modified throughout the different stages of its development.

Why should we pay special attention to the initial stage of pregnancy?

The first trimester of pregnancy is an extremely vulnerable period from the nutritional point of view for the pregnant woman, because often before she realizes that she is pregnant, the organs and systems of the baby begin to form inside her, processes that demand sufficient nutrients - especially vitamins, minerals and water.

Deficiencies of vitamins and minerals in the mother's body during this stage can cause irreparable damage to the child. For example: Folic acid deficiencies could increase the risk of malformations in the fetus' spine and brain, which would permanently affect the individual's quality of life.

Moreover, during the first trimester of pregnancy the child is much more susceptible to the effects of substances such as alcohol, drugs and certain medications.

Physiological changes in pregnant women that modify their nutritional needs

• A series of hormonal changes occur that direct nutrients to the placenta for transfer to the fetus to promote its growth and development.
• There is an increase in the size of certain organs: uterus, breasts, vagina, heart, etcetera.
• Blood volume increases, which modifies the composition of the blood, with a consequent decrease in hemoglobin concentration.
• Blood cholesterol increases, as well as other lipid fractions.
• Renal function is modified, increasing the formation of urine to facilitate the purification of waste products; this causes, among other disorders, a greater loss of water and electrolytes.
• The mammary tissue is prepared for milk production, experiencing a considerable increase in size.
• There are frequent variations in appetite and digestive and biliary functions.
• The growth of the uterus as gestation progresses puts pressure on the lower portion of the colon and rectum, which may cause constipation.

Weight gain during gestation

Weight gain during pregnancy should be monitored periodically by a specialist, since excessive or insufficient weight gain can cause health problems in the mother and baby.

In general, it is estimated that a healthy pregnant woman gains around 11 kilograms of weight during the entire pregnancy; although this figure is variable, since gains may be greater for thin women than for those of normal weight, and less for overweight, obese and short women.

What disorders could be caused by overweight pregnant women?

• Newborns may be too large, increasing the chances of cesarean births and the use of forceps in deliveries.

• It increases the risk of gestational diabetes mellitus.
• It favors the appearance of arterial hypertension and preeclampsia in the mother.

What disorders could be caused by low birth weight in the pregnant woman?

• Intrauterine growth retardation and low birth weight.

• Increased risk of malnutrition in the baby.

• Spontaneous miscarriage.

• Premature delivery.

• Congenital malformations.

Diet-related disorders during pregnancy.

Nausea and vomiting: Nausea and vomiting are the most common disorder affecting pregnant women. It is estimated that between 50 and 80% of pregnant women suffer from it from the 5th week and up to 16 weeks; and after that time only 20% of women continue to have it.

Some pregnant women may have nausea and vomiting that evolve rapidly, this disorder known as hyperemesis gravidarum, causes dehydration, weight loss, metabolic and electrolyte imbalance, so it can become serious and often requires hospitalization.

Recommendations to reduce nausea and vomiting:

• Start meals with foods of the farinaceous group (made with flour), for example: bread, cookies or rusks.

• Eat moderately and plan light snacks every two or three hours.

• Prioritize the ingestion of water, milk and natural juices slightly cold or at room temperature.

• After vomiting, wait a while and eat again.

Heartburn, heartburn and gastroesophageal reflux: Gastric acidity or burning sensation is likely to occur because during pregnancy there is less resistance of the esophageal sphincter, which allows the passage of stomach contents into the esophagus, or because the enlarged uterus presses on the stomach and forces it to expel its contents into the esophagus.

Recommendations to avoid heartburn and gastroesophageal reflux:

• Eat moderately and plan light snacks every two to three hours.

• Avoid lying down immediately after meals and adopt positions in bed that do not compress the stomach.

• Reduce consumption of acidic foods such as lemon and vinegar.

• Do not drink carbonated beverages, infusions, coffee or tea.

Constipation: Constipation as we have already mentioned can be caused by the growth of the uterus; although it can also be related to the consumption of iron supplements; with a diet poor in fiber and liquids; and with rest or reduced physical activity.

Recommendations to reduce constipation:

• Drink two to three liters of fluids daily - preferably water - at room temperature.

• Increase the consumption of vegetables, fruits, whole grains and legumes - lentils, chickpeas, beans, etc. -.

• Daily moderate physical activities such as walking, swimming, etc.

Important: Laxatives or fiber supplements should not be used without prior consultation with your doctor.

Anemia: The most common causes of anemia during pregnancy are iron deficiencies - which account for about 90% - and folate (vitamin B9) deficiencies. Risk factors are inadequate iron intakes, teenage pregnancies and repeated pregnancies.

Recommendations to reduce the risk of anemia during pregnancy:

• Increase the consumption of foods rich in iron and vitamin B12 -vegetables, red meat, etcetera-.

• Consume green leafy vegetables and fresh fruits.

• Take ferrous sulfate and folate supplements as directed by the physician.

Gestational diabetes mellitus: This is a form of pregnancy-induced diabetes mellitus whose specific cause has not been determined; however, it is believed to be related to the hormonal processes inherent to pregnancy. The main risk factors are: pregnancy over 35 years of age; being overweight or obese and the use of corticosteroid hormones.

Recommendations to reduce the risk of gestational diabetes mellitus and control its effects:

• Arrive at pregnancy at a healthy weight.

• Gain weight during pregnancy progressively.

• Do moderate physical exercise.

• Eat several meals throughout the day.

• Reduce the intake of carbohydrates of rapid absorption - sweets, cookies, white bread, white rice, etc.