Maternal Nutrition During Pregnancy

Nutrition and pregnancy:

Refers to the nutrient intake, and dietary planning that is undertaken before,
during and after pregnancy.

Introduction:
Pregnancy is an important time in a woman’s life. The fetus develops in 40
weeks from 2 cells into an independent infant with functioning nervous
system, lungs, a heart, stomach and kidneys. There is a general rise in
metabolism, increased glomerular filtration rate, the blood volume increases
by 50%, red cell mass by 20% and water overload i.e. oedema.

IN IRAQ:
The Iraqi Ministry of Health is running a number of programs which help to
enhance nutrition directly or indirectly.
1-Wheat fortification program (WFP).
2-Ferrofolic supplementation program.
3-Target nutrition program (TNP).
4-Vitamin A deficiency (VAD) program.
5-Salt iodization program (SIP).
6-Micronutient national assessment and response (MNAR)

BENEFICIAL PRE PREGNANCY NUTRIENTS:

As with most diets, there are chances of over-supplementing, however, as

general advice, both national and medical recommendations are that mothers
take according to Recommended Daily Allowance (RDA).

Women who have an increased risk of experiencing poor nutrition

during pregnancy:
1- Vegan and vegetarian women, as many micronutrients are largely
sourced from animal derived foods.
2- Members of ethnic minorities, immigrants , refugees and aboriginal
women, who are predisposed to poor nutrition due to socioeconomic and
demographic factors such as poverty and food insecurity.
 3- Women of low socioeconomic status who generally have poorer
nutrition and health and are more likely to give birth to a low birth weight
infant.
4- Women with medical conditions including diabetes and infections
which create additional nutritional demands on the body.
5- Short birth intervals do not give a woman’s body the chance to
recuperate and build up nutritional stores between pregnancies.
6- Multiple pregnancies (twins, triplets, etc.) which place greater
nutritional demand on the pregnant woman’s body.
7- Women exposed to stress, as this can increase nutrient losses and
change eating patterns.
8- Maternal smoking, alcohol or illicit drugs as these can increase nutrient
losses and change eating patterns.
9- Adolescent women as their bodies are still growing and require nutrients
to sustain their growth. As such, the growing fetus competes with the
growing adolescent body for nutrients.
10- Women with hyperemesis gravidarum, a condition which occurs in
1-2% of pregnancies and typically occurs beyond 16 weeks gestation.

BENEFICIAL PRE PREGNANCY NUTRIENTS:

Magnesium and zinc supplementation is needed for the binding of
hormones at their receptor sites.

Folic acid supplementation or foods containing it for the regular growth of

the ovarian follicle.
Regular vitamin D supplementation decreases the chances of
deficiencies in adolescence. More importantly, it is known to reduce the
likelihood of rickets with pelvic malformations which make normal delivery
impossible.

Regular vitamin B12 supplementation, again is known to reduce the

chances of infertility and ill health.

Omega – 3 fatty acids:

Omega-3 fatty acids increase blood flow to reproductive organs and may
help regulate reproductive hormones. Consumption is also known to help
prevent premature delivery and low birth weight. The best dietary source of
omega-3 fatty acids is oily fish. Some other omega-3 fatty acids not found in
fish can be found in foods such as walnuts, pumpkin seeds, and enriched
eggs.
Alcohol:
Excessive amounts of alcohol have been proven to cause fetal alcohol
syndrome. The World Health Organization recommends that alcohol should
be avoided entirely during pregnancy, given the relatively unknown effects
of even small amounts of alcohol during pregnancy.

Food Hygiene: Pregnant women are advised to pay particular attention to

food hygiene and to avoid certain foods during pregnancy in order to
minimize the risk of food poisoning from potentially harmful pathogens
such as listeria, toxoplasmosis, and salmonella. Pregnant women are
therefore advised to avoid foods in which high levels of the bacteria have
been found, such as in soft cheeses

Recommendations:

Energy consumption:
During pregnancy energy consumption needs to be increased by up to 200-
300 kcal per day , this is especially true in the last trimester.
Protein:
A pregnant woman needs an extra 15 g per day to a maximum of 65
grammes per day RDA=50g/day .

Vitamin A:

Dietary vitamin A is obtained in two forms which contain the preformed

vitamin (retinol), that can be found in some animal products such as liver
and fish liver oils, and as a vitamin A precursor in the form of (carotenes),
which can be found in many fruits and vegetables
Vitamin A needed in pregnancy=600microgram
Vitamin C:
A pregnant woman needs an extra 150 microgram per day .

Folic acid:
Deficiencies in folic acid may cause neural tube defects; women who had 4
mg of folic acid in their systems due to supplementing 3 months before
childbirth significantly reduced the risk of NTD within the fetus. This is now
advocated by recommending 400 µg per day of folic acid

Hydration during pregnancy:

During pregnancy, weight increases by 12 kg. Most of this added weight
(6 to 9 L) is water because the plasma volume increases, 85% of the placenta
is water and the fetus itself is 70-90% water. This means that hydration
should also be considered an important aspect of nutrition throughout
pregnancy. To ensure healthy hydration during pregnancy, it is
recommended that an increase of 300 mL per day compared to the normal
intake for non-pregnant women, taking the total adequate water intake (from
food and fluids) to 2,300 mL, or approximately 1,850 mL/ day from fluids
alone

During lactation, water intake needs increase to compensate for the loss of
water through milk production. Milk is made of 88% water, and the
European Food Safety Authority therefore recommends that breastfeeding
women increase their water intake by about 700 mL/day, giving an adequate
volume of 2,700 mL/day (from food and drink), or approximately 2,200
mL/day from fluids

Iron:
A pregnant woman needs an extra 3 mg per day

STRATEGY FOR PREVENTION OF ANEMIA DURING

PREGNANCY:
1-All pregnant women should be given a standard dose of iron/folate .
2-Dietary advice should be given about the consumption of adequate
quantities of iron-rich food ,food rich in vitamin C enhance absorption of
iron while tea and coffee inhibit absorption.
3-All pregnant women should be clinically examined for anemia as a part of
ANC check-up.
4-Pregnant women reside in holoendemic malaria areas should be given
antimalarial prophylaxis according to country policies.
5-Blood flow following delivery should be minimized by practicing the
active management of the third stage of labour.
6-During the pre-pregnancy and inter pregnancy period ,any contact between
health system and the women (eg. infant immunization, family
planning)should be used for identifying and treating anemia.
Also lactating mothers should also be given prophylactic or therapeutic
iron/folate.
7-Hookworm infections contribute to iron deficiency anemia, hookworm
control should be included in strategies designed to improve the health
,development and nutritional status of the girls and women.