Prenatal Nutrition: Changing Needs for New Life

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  • May 11, 2015
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Prenatal Nutrition: Changing Needs for New Life

Pregnancy is a pivotal point for the body in any woman’s life. At no other time does it go through such in-depth physiological changes than when creating a new life form. Every cell formed of the unborn child depends on the mother’s body for nourishment. So, of course, the nutritional needs of the mother are altered during all stages of gestation. The sad truth is most women have a hard enough time meeting nutritional standards for themselves, let alone for two! According to some studies, “74% of [American] women are falling short on nutrients from their diets.”1 The prevalence of the Standard American Diet (referred to as S.A.D. for a reason), high in processed foods, and devoid of nutrients, has done more than increase heart problems and diabetes, it has also passed along nutrient deficiencies to children.

Many people are aware that during gestation the mother’s health is irrevocably linked to development of her unborn child, but they don’t know that with the emerging study of epigenetics, more and more evidence shows that health decisions can actually alter her baby’s DNA and impact future generations. “For example, babies who are malnourished during fetal life but then experience accelerated growth in infancy or childhood may be at increased risk for cardiovascular disease and type 2 diabetes later in life, partly due to differences in epigenetic patterns.”2

Some studies from malnourished German women circa WWII traced developmental disorders to their grandchildren3. There are reasons that indigenous cultures began to prep their women nutritionally for conception! In Fiji, islanders hiked down to the sea to acquire a species of lobster crab that “tribal custom demonstrated [to be] particular efficient for producing a highly perfect infant.”4 Another example is of the Massai and how they “allowed couples to marry only after spending several months consuming milk from the wet season when the grass was especially lush and the milk much denser in nutrients.”5

Now in our modern age, instead of raw milk and lobster crabs, we have packaged prenatal vitamins, which women are recommended to begin taking if they are planning on getting pregnant, not only during the pregnancy itself. The micronutrients needed for a healthy pregnancy are utilized immediately at conception but, like all nutrients, a few weeks lead time should be factored in to enjoy their benefits, and many women do not know they are pregnant for a few weeks after conception.

Prenatal Vitamins 

The most important nutrients to be aware of in prenatal vitamins are folate and iron. Folate is used for cell division and, therefore, assists in the development of tissues and of the central nervous system of the fetus. An RDA of 600 mcg per day has been set for pregnancy, and women who may become pregnant are advised a minimum of 400 mcg per day6 just in case. Natural sources high in folate include romaine lettuce, spinach, asparagus, calf’s liver, collard greens, broccoli, cauliflower, beets, and lentils.

Iron

Iron deficiencies are common, and 12% of women enter pregnancy with impaired iron status.7 The RDA for iron, essential for conception and early pregnancy to aid the fetus and placenta development, increases from 18 to 27 mg per day.8 Iron can be especially hard for vegans and vegetarians to acquire. While iron is available in many plant-based foods, it is more bioavailable in animal products.9 Some plants high in iron are spinach, turmeric, and swiss chard.

Calcium 

Calcium should also be mentioned as a vital micronutrient for fetal development. “Extra calcium is needed for the fetus to grow, but maternal physiology accommodates this need without increasing intake.”10 So, technically, the calcium needs stay the same, about 1,000mg per day, but with pregnancy comes additional reasons to maintain the minimum. Most prenatal vitamins will contain calcium for this reason. Milk may be the most publicized calcium source, but spinach, collard greens, and kale are also excellent sources.

Additional Calories Needed 

After conception, the body’s first priority is the new baby and to create a healthy home for it to grow. The body’s changing needs require additional fuel to keep both mother and baby healthy. Pre-conception, micronutrient recommendations increase but no additional calories are universally recommended. However, during gestation an additional 60,00011 to 80,00012 calories are needed to fully support the changing physiological needs of the mother and aid in full development from zygote to baby.

Recommended weight gain varies by individual woman based on their Body Mass Index, or BMI. Underweight women are advised to gain more weight than overweight women. In general, the combined weight of the fully developed baby (7-8lbs), additional fluid (6-7lbs), maternal adipose stores (7-8lbs), maternal fluids including blood and amniotic fluid (6-7lbs), mammary tissue (1-2lbs) and placenta (1.5-2lbs) is 25-30 pounds total.13 Additional weight gain should be measured in conjunction with overall BMI.

The additional caloric intake is most vital during the Fetal period of the second and third trimester. During the Embryonic period of the first trimester, while additional nutrients are recommended, the additional calories needed are minimal. Women are still advised to consume 45-65% of calories from carbohydrates, 10-35% from protein, and 20-35% from fat. Of these, women should try to intake healthful and nutrient rich sources, avoid processed foods, and choose whole food sources whenever possible.

Carbohydrates 

Of the calories derived from carbohydrates, the RDA is an average of an additional 45g, for a total of around 175g per day14. Women should be especially aware of excess sugar intake, as insulin resistance during pregnancy is common and happens naturally as a way to make glucose more available to the fetus15. Gestational Diabetes is a real risk for all pregnant women; regardless of health, 18% develop it16, although risk increases significantly with obese women or those with a history of diabetes. Gestational Diabetes is a “temporary form of diabetes typically develop[ed] the 24th week of pregnancy, disappearing within 6 weeks of delivery.”17 What this means for the growing baby is that excess glucose is passed along, resulting in fat accumulation in the fetus. In addition to being born larger, children whose mothers experience Gestational Diabetes may also be at increased risk for developing type 2 diabetes.18 Healthy sources of carbohydrates include sprouted wheat, brown rice, sweet potatoes, and fresh fruits and vegetables.

Antioxidants 

Two important antioxidant vitamins to be aware of properly ingesting along with carbohydrates are vitamin C and vitamin E, and are vital during all stages of pregnancy. Studies show deficiencies of both may cause pregnancy-associated hypertension or preeclampsia, and that supplementation (a recommended 1,000mg and 400mg per day, respectively) was associated with up to a 61% reduction rate.19 Vitamin C RDA intake recommendations increase from 65mg to 85mg per day.20 Vitamin C also helps with iron absorption, another essential nutrient during gestation. The RDA for Vitamin E stays the same at 15mg per day.  Most brightly colored fruits and vegetables are great sources of vitamin C, including citrus fruits, bell peppers, papaya, parsley, and kale. For natural sources of Vitamin E, look to Swiss chard, sunflower seeds, and almonds.

Protein 

Protein is another increased macronutrient during gestation. While the RDA recommendations are still 10-35% caloric intake from protein, and a minimum of 60g per day21; micronutrients directly associated with gene cell production, including folate, iron, vitamin B6, vitamin B12, and zinc, are found in high and bioavailable volumes in protein sources. Again, choosing nutrient dense protein is vital during pregnancy as not all protein sources are created identically. Organic and grass-fed meats will yield higher nutrient concentrations and be free of any harmful hormones or fat-soluble chemicals that may harm the developing fetus. Vegetarians and vegans can look to organic eggs, tempeh, beans and lentils for protein, and may want to consider discussing micronutrient supplements with their doctors.

We have already discussed the many benefits of folate, and of iron’s essentialness for conception and early pregnancy to aid the fetus and placenta development, but as the body moves into the second and third trimesters, iron also is needed for hemoglobin. The pregnant body produces an estimated 1250ml of blood, and iron is directly related to red blood cell production: “Red cell mass increases by…a rise of about 250 ml in women who take no supplemental iron, and between 400 and 450 ml when iron supplements are taken.”22

B Vitamins

The B vitamins also assist with blood synthesis and cell development. Vitamins B6 and B12 are critical for genetic expression23 and studies have linked vitamin B12 deficiencies to birth defects24. For an added bonus, vitamin B6 may help reduce nausea, vomiting, and depression during pregnancy25. Some B vitamins are very difficult for vegetarians and vegans to acquire in large usable amounts. I have read conflicting information on whether vitamin B12 found in plants (such as spirulina and nutritional yeast) is able to be properly synthesized by the body. Non-vegetarians can find vitamin B12 in all animal proteins; including eggs, chicken, pork, and beef. Vitamin B6 is readily available in plant sources such as spinach and bell peppers.

Zinc

Zinc is another micronutrient which helps regulate genetic activity. The RDA for zinc for pregnant women is 11mg per day.26 Some high natural sources of zinc are calf’s liver, crimini mushrooms, and spinach.

Fat

The last macronutrient to discuss is fat. Like carbohydrates and protein, the RDA for overall fat increases proportionately with the increased overall energy needs. Fat intake should be no higher than 10-35% of overall intake – and some recommend no more than 30%27. Within this recommended amount, the most vital are the essential fatty acids: linolenic acid and linoleic acid. Linolenic (also referred to as omega-3) especially aids in fetal development, as it is converted to eicosapentaenoic acid (EPA) and in turn docosahexaenoic acid (DHA). “DHA is particularly important to brain development and formation of the retina.”28. A minimum of 13g per day of linoleic acid and 1.4g per day for linolenic is recommended. Good natural sources of linolenic acid are found in seafood (although pregnant women should be careful of mercury intake), most notably wild salmon, scallops, and sardines. Some healthful plant sources are flaxseeds and walnuts.

Lactation 

After birth, the body’s nutritional needs again change to prepare to feed the baby in a new way: through lactation. For lactation many of the same nutrients needed during conception and pregnancy are still vital, but there is some change. The most drastic increases during lactation are vitamin C, vitamin A, and iodine. Macronutrient needs stay similar to pregnancy, with a slight increase in carbohydrates. Folate and iron needs drop. Zinc and B vitamins intakes stay relatively stable29. The RDA for vitamin A for lactating women increases from 2,500 IU to 4,333 IU per day. Vitamin A is found readily available in carrots, spinach, calf’s liver, and sweet potatoes. Vitamin C RDA increases to 115mg per day, and iodine to 290mcg per day.

Eat Real Food 

Obviously changing needs come with a changing body, and from a holistic perspective, rather than counting mg’s, IU’s, and mcg’s, women should focus on consuming a wide variety of nutrient dense food, and consult their doctor or holistic health care provider about supplementing to round out their individual dietary needs. Choosing fresh and brightly colored organic fruits and vegetables ensures readily available vitamins and minerals. Grass-fed organic eggs, meat, and dairy will most likely contain more minerals and B vitamins than processed meats, and the protein will be higher quality. Remember the Massai who fed their women special milk before conception?  “Maasai milk is higher in fat and cholesterol and lower in sugar than commercial American milk. The highest quality Maasai milk used for preconception diets, however, is even richer: compared to commercial American milk, it has over twice the cholesterol, nearly three times the fat, and over five times the quantity of phospholipids.”30

Every woman is different and should listen to her body. There is no one road for pregnancy nutrition! In my doula training I heard a story about a woman who wanted to only drink raw milk during her pregnancy. Her doctor advised against it and she went against her natural instinct. She ended up having many teeth fall out during later stages of pregnancy; her body was so starved for calcium that it resulted in this. Is this story true or a natural birth urban legend? Either way, it is a good tale highlighting the importance of respecting biochemical individuality. There is a reason that women have such strange cravings during pregnancy. The bottom line is to focus on nutrient denseness, listen to your body, and make your own decisions about supplementing.


Kyra Bramble  a published writer, private chef, teacher, yogi, traveler, dancer and doula. She is deeply passionate about birth education and empowering women to see birth as a sacred journey. She sees many parallels between the commercialization of birth and food, and is committed to bringing love and awareness to both subjects. She lives on Maui. Please visit her food website, More Pleaze.

*Photo by Cristian Bortes

 

 


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