By Rachel Cunningham
Vitamin D a very important vitamin to incorporate for the overall benefit of mother and child.
Historically, there has been this idea that you can eat whatever you want during pregnancy. It’s difficult because I see women who are feeling lethargic and who then assume that the solution is that they should be eating more, whereas scientifically speaking that probably isn’t the case
CORU registered dietitian, Bláithín O’Neill says the greatest myth surrounding pregnancy nutrition is the notion of ‘eating for two’, which is often considered to be fact.
Ms O’Neill, who specialises in treating the dietary requirements of those who are hoping to conceive, who are pregnant and who are breastfeeding, broke down for the Dublin Gazette how the calorie intake should differ during pregnancy.
“During the first trimester there are no extra calorie requirements, there may be minimal additional calories needed in the second trimester and then in the third, you’re adding on an estimated further 300 calories a day, which is actually quite small.
“Historically, there has been this idea that you can eat whatever you want during pregnancy. It’s difficult because I see women who are feeling lethargic and who then assume that the solution is that they should be eating more, whereas scientifically speaking that probably isn’t the case. At the same time, if someone is tired and feels like they need a bit more food then we would never recommend that they restrict themselves.
“Some women report food cravings and some don’t. There is nothing wrong with them, provided you keep your diet balanced overall. Sometimes there is a misconception that pregnant women have to do something dramatically different from a regular healthy diet, which for the most part is untrue other than including some extra nutrients. Once you’re eating plenty of fruit and vegetables, good carbohydrates and are keeping sugar to a minimum then that’s generally all you need to do.”
She outlined the key nutrients that lay the foundation for a healthy pregnancy: “Folic acid is one of the main supplements that we recommend to prevent spina bifida in babies. Another one that I would commonly recommend is vitamin D, mainly for the mother and baby’s bone health. During pregnancy, the baby is growing bones very quickly and we need calcium and vitamin D for that.
“If the mother does not have sufficient calcium or vitamin D in their diet, it breaks down the calcium and vitamin D from their bones, which is why it’s vital for the mother to be getting enough in what she’s eating to ensure that she won’t be left with deficiencies after pregnancy. There has been a lot of research surrounding vitamin D and it has been linked with other benefits, such as brain development and helping the immune system. It’s a very important vitamin to incorporate for the overall benefit of mother and child.
“Omega-3 fatty acids also provide beneficial nutrients and the best source is from oily fish, if you can consume it between two to three times a week. However, many of the women I speak to either don’t like to eat it or are following a vegetarian or vegan diet. It’s an important supplement to include if you can’t get it from your diet because it assists with eye and brain development for the child and good vegan-friendly options are easily available.
“I always refer women towards a good prenatal multivitamin, there are many on the market and they usually include vitamin D and folic acid all in one, as well as things like calcium, iron, zinc and magnesium, which are great for pregnancy health as well. You should be able to find these in your pharmacy or health food store and these days there are great choices for vegetarians and vegans. It’s good to switch if you were taking a general multivitamin, as it may not be appropriate for pregnancy. The prenatal option will include everything you need for that stage of your life, which is a reassurance during pregnancy.”
She highlighted that there should not be a need to take other supplements unless the person in question has a deficiency: “Other than the first three I have listed, your folic acid, vitamin D and omega-3, you should not typically need to take anything extra. Some women are commonly diagnosed with low iron and their GP may start them on an iron supplement. However, unless you have been told to do this, you don’t need to do so.
“In terms of avoiding anything in your diet, my first advice would be to consider general food safety and food hygiene practices to protect against illness and to avoid things like listeria and food poisoning. Make sure you’re storing your food correctly in the fridge, make sure you’re washing your hands and disinfecting the chopping boards when you’re preparing food.
“Following that, I would encourage patients not to eat unpasteurised foods, such as milk or dairy, which you probably wouldn’t find in a supermarket but you should pay closer attention to if you’re shopping in a farmer’s market. Really fresh soft cheese, raw or undercooked meat, poultry or fish, things like smoked salmon, sushi, pâté or maybe even parma ham, wouldn’t be advised during pregnancy.”
For those who are struggling with the thought of parting with their beloved coffee or tea, Ms O’Neill advised to be sparing with caffeine: “When it comes to coffee, I would always say to keep it to one a day. We would advise between 200-400 micrograms per day, which would be roughly one cup. Tea has less caffeine but it is still present in each cup, so if you’re a big tea drinker make sure to keep an eye on how your daily intake measures up. You could probably have between two to three cups of tea a day and after that, you’re better off switching to the decaffeinated equivalent. There is some evidence to suggest that it can affect the growth of the baby, which is generally why we would advise being cautious.”
A particularly contentious point in terms of pregnancy safety is whether the consumption of alcohol at a low level can be deemed safe. Ms O’Neill commented: “A question I get asked a lot is whether a certain amount of alcohol is okay. I previously worked in a hospital where I witnessed firsthand children suffering from the detrimental effects of foetal alcohol poisoning from mother’s drinking during pregnancy. Unfortunately, we can’t say whether a certain amount of alcohol is safe because we can’t ethically ask mothers to drink a certain level of alcohol during pregnancy to test the effects.
“Keeping it to a minimum is always what we advise, we certainly are aware of the negative effects of too much alcohol and we simply don’t know what the impact of moderate drinking could have on a pregnancy. I’d imagine a small amount, meaning a very occasional glass, would be fine but we certainly would not be encouraging it because we don’t have the research to stand over that recommendation.”
While gestational diabetes can be a concern, Ms O’Neill gave reassurances that it need not be a great worry, once it is well-monitored: “Regular blood tests are done throughout the pregnancy to identify higher fasting blood glucose levels. If you are given the diagnosis, you will be referred to the right people, you’ll chat to a dietitian and a diabetes nurse and will be given all of the information you need. It is very manageable, we’ll make sure that you are eating the most nutritious food and the doctor will test your blood sugars more frequently to ensure that everything is moving forward safely. Gentle exercise is always beneficial, as that will improve your insulin sensitivity. Sometimes the doctor may have to put a patient on metformin, or insulin, but usually this is not even necessary.
“Something to bear in mind is that gestational diabetes can raise the risk of developing type two diabetes post-pregnancy, which is why I would always advise anyone in this position to check in with a dietitian after giving birth to make sure that their diet is the best it can be to keep them healthy for years to come.”
“The most important thing is for women to take care of themselves during this time and to look after their mental health too. We recommend not being too hard on yourself, particularly towards the end of the pregnancy, where constipation will more commonly occur even when you’re eating a perfectly balanced diet. It’s an exciting time but can also be uncomfortable, drinking plenty of water and eating plenty of fibre will keep you a bit more regular at this stage, especially combined with light movement, like a gentle walk”, she concluded.