September 17, 2020
“Congratulations .. You’re pregnant,! You need to eat for two now!”
“Doctor, she isn’t eating as much as she should. She should eat ghee and almonds. After all, we want a brilliant child!”.
“I know I’ve loose motions, doctor. But I can’t help having the roadside panipuri and chat! It is just too tasty!”
“My mother isn’t allowing me to walk because I’m pregnant. I’m getting really bored at home.
“I was so lean before my pregnancy. And now I just can’t seem to get rid of my excess weight!
Pregnancy cravings, a stupendous weight gain, ‘eating for two’, myths and misconceptions about what one should eat while pregnant- are all common questions women have during pregnancy. It is important to understand basic nutrition in pregnancy, so as to be better equipped to deal with the do’s and don’ts.
There’s no magic number to answer this question, because the ideal weight gain is different for each pregnant mother. It depends on a lot of factors such as your age, your pre-pregnancy body weight (BMI), your activity level, any other comorbid conditions like diabetes, high blood pressure that you may be having, and your overall nutritional state. Remember always, that ‘if I gain more weight, my baby will be healthier’, is a myth!
When you are around 1 &1/2 months pregnant, your baby is around the size of a pea. At 5 months, your baby weighs around 300 grams, at 7 months, it weighs around 1.2- 1.5 kilos, and at term, the average Indian baby weighs between 2.5- 3.5 kilos. The placenta weighs around 500 grams, the water around the baby another kilo. Some weight gain can be attributed to fluid retention, blood volume expansion and so on. That means, if you put on 15 kilos in pregnancy, you are just going to lose a third of it once you deliver! The rest of it is your fat gain, and that’s why women struggle to ‘get back in shape’ after delivery.
As is commonly taught in medical schools, the fetus is an ‘ideal parasite’. The baby growing within you always takes what it needs. What does that mean? If you have a deficiency of certain nutrients, there is still a chance that your baby would be healthy, but at the cost of your health.
It also means that even if a woman may not gain a lot of weight while pregnant, her baby may still have an average healthy birth weight as long as she’s eating right.
Doctors often recommend the ideal weight gain to each woman based on all the factors mentioned above. On an average, a young woman with a normal BMI and no other risk factors can gain around 10- 12 kilos throughout the course of pregnancy. An underweight woman can gain around 15 kilos, an overweight woman around 7- 10 kilos, and an obese woman only around 3- 5 kilos! These figures may vary based on other risk factors. Also, it is important to understand that most of the weight gain needs to occur in the later months of pregnancy. In the first trimester, several times there’s just a borderline weight gain, sometimes none, and sometimes even weight loss due to nausea and vomiting. But even in the later months, it is recommended that one should not gain more than 1.5- 2 kilos a month!
Another thing we need to understand is that ‘weight gain’ does not necessarily mean being ‘nutritionally sufficient’. One needs to gain weight by eating right- the diet needs to have proteins, fats, carbohydrates, vitamins, minerals and micronutrients in the right proportion for an optimally healthy pregnancy. A ‘balanced diet’ is the key to this.
If one looks at the traditional meal pattern of any region, it is ‘whole’ and contains all the essential ingredients in the right proportion. For instance, a traditional Indian meal contains carbohydrates (chapatis or rice), proteins (dals or sprouts), vitamins, minerals and fibre (vegetables, salads or fruits), fat (oil/ ghee), probiotics (yoghurt or buttermilk), and calcium, essential oils, Omega 3 fatty acids (chutneys of seeds like sesame or flaxseeds). Likewise the whole meals of all regions in India are balanced and healthy.
Often, for our ‘convenience’ or ease, we happen to skip a few of these ingredients, thus overdosing on one component and entirely missing out on another. This may lead to certain preventable issues in pregnancy such as anaemia, gestational diabetes or fetal growth restriction.
A balanced diet with an ideal proportion of each component is what is needed for an uneventful pregnano quote an easy to understand way of ‘balance’, for each bowel of rice/ roti you have, ensure you have a bowl each of salad, vegetables, dal and buttermilk.
A healthy home cooked balanced meal is ideal for a pregnant woman.
Having said that, ensure that you include lots of fresh fruits, vegetables, sprouts, pulses, legumes, whole grains, yoghurt and buttermilk in your diet. Ensure that you wash fruits and vegetables well in warm water before you consume them raw. A lot of them may be layered with pesticides or a coat of wax to make them shiny.
You should have adequate fluids- depending on the season and your activity, atleast 3- 4 litres in a day-more in summers.
Consumption of alcohol, aerated beverages, canned foods, foods containing preservatives, artificial colours, chemicals, synthetic substances should preferably be avoided.
Restrict the intake of tea and coffee to not more than two cups a day.
Even if you eat out, ensure you eat foods that are freshly and hygienically prepared- go for something like idlis or dosas which you know cannot be stored for long, instead of salads or cold sandwiches. Avoid roadside foods, or eating at places, the hygiene standards of which are questionable. Oily or spicy food may cause acid reflux, hence is best avoided.
Homemade soups and salads are healthy and ensure you consume vegetables and fluids in the right proportion.
Cravings can be satiated by hygienically preparing pani puris or chat at home- when you can be certain of the water used, and the cleanliness of the hands that dip into it!!
The reason for avoiding roadside food is not because it will harm the baby, but because if you fall ill after eating it, there are restrictions on the medications that can be safe in pregnancy, and you would have to suffer.
It is important to eat regional and seasonal- for the optimal nutrient proportion, and to go easy on your digestive system.
A pregnant woman, especially in the first trimester, can have the tendency to lose her appetite. You may feel full even after eating just a third of what you were accustomed to before pregnancy. In such a scenario, family members can especially get paranoid and fussy, urging you to eat against your wishes!
I always suggest that you take it easy. Eat in the quantity you feel comfortable consuming, but ensure you have small frequent meals- eat something every 2- 3 hours instead of three large main meals. The pregnancy hormones can affect your appetite in a huge way, and if you vomit all that you eat, it won’t serve the purpose!
Eat foods you are comfortable with, especially those with simple carbohydrates. You may have an aversion to strong smells and tastes, masalas and oils. Bland foods like crackers, fruits like apples, banana, dry toast may be ideal foods that will not cause you to throw up, yet give you the energy you need.
In the first trimester, the baby is very small, hence your dietary pattern will not adversely affect its growth. However, an insufficient intake and food perversions may cause nutritional deficiencies in your body, which is why you need to eat right, and also ensure you stay well hydrated.
Not all women may have aversions in pregnancy, this solely depends on how well your body adapts to the hormonal changes. If you are able to tolerate most foods, you can go for a healthy balanced diet as mentioned earlier.
I recommend that you have an early dinner in pregnancy. Progesterone causes the sphincter muscles at the bottom of your food pipe to relax, which can lead to reflux if you lie down soon after your meal. If you feel hungry again at bedtime, you may have a fruit or a power bite.
Most of your nausea, vomiting and aversions reduce and gradually disappear after you cross into the second trimester.
The answer is a big NO!
In the first trimester, one requires the same calories per day as a non- pregnant woman. In the second trimester, an additional 340 calories a day and in the third trimester, an additional 450 calories a day are required.
Moreover, most pregnant women tend to restrict their activities compared to the pre- pregnancy stage.
Ghee, laddoos, sweets, fried foods and a lot of other such high calorie foodstuff, especially when you are already eating enough through your balanced meals, tends to accumulate as fat in your body- the same fat that is so difficult to get rid of post-delivery!
Dry fruits such as walnuts are an excellent source of Omega 3 fatty acids, as are flaxseeds. Almonds provide essential amino acids, black raisins and dates are rich sources of iron, so they can definitely be had in moderation. Restrict the intake to nor more than 4- 5 each of walnuts, almonds, and 15- 20 black raisins per day.
Many women develop an aversion to milk, which is unfortunately obsessively force- fed by elders in the family! Remember, humans are the only mammals who source milk from other animals! That obviously means it is replaceable. Milk is definitely a good source of calcium, but not the only one! Soy, tofu, green leafy vegetables, figs, whole cereals like ragi, sprouts, sesame, walnuts, almonds, broccoli are some of the non- dairy calcium- rich foods commonly available in the Indian household.
I recommend the intake of yoghurt or buttermilk since they are probiotics, rather than whole milk. They are better tolerated by pregnant women as well.
In the second trimester, in our country, most practitioners start the woman on oral iron and calcium supplements, to be continued till delivery. This usually takes care of the body’s increased requirements owing to pregnancy.
What happens inside the uterus stays with your baby for life!
In 1990, the British epidemiologist David Barker, proposed a hypothesis based on a series of studies that babies with intrauterine growth restriction and low birth weight are more likely to develop obesity, hypertension, hyperlipidemia and complications including heart disease and stroke earlier in life than their healthy counterparts.
Another recent field of interest is ‘nutritional epigenetics’, which covers food affecting patterns of gene regulation. A lot of lifestyle based diseases such as diabetes, hypertension, obesity as well as certain cancers can be linked to epigenetics, that is, the way in which your DNA and RNA replicates. A sedentary lifestyle, obesity, smoking, alcohol consumption, a diet rich in saturated fats have been proven through several studies to negatively impact gene expression through free radicals and certain toxic substances, whereas a nutritionally sufficient diet rich in fresh fruits and vegetables, ample physical activity has shown to have a protective effect.
In simple terms, this means, what you eat now is going to affect your health, as well as your baby’s future health in a more direct way than you had imagined!
Every mother loves her babies a lot, and protects them with her life and needless to say, it is hence important to keep yourself fit by eating right before and during pregnancy to give your baby the gift of good health!
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