Getting the right nutrition during pregnancy

Getting the right nutrition is essential during pregnancy as it can have an important influence on the lifelong health of the developing baby1. National dietary intake data shows some women of reproductive age to have low intakes of several key nutrients1,2. Certain nutrients are either hard to get from commonly consumed foods (e.g. vitamin D and iodine) or are required in higher amounts during pregnancy (e.g. folic acid).

Introduction

Nutrition in pregnancy has an important influence on lifelong health1, and so a healthy, balanced diet is essential during pregnancy.

While dietary recommendations for pregnant women are similar to those for other adults, there are some important exceptions3 and specific recommendations regarding supplementation during this crucial time. This article explains what these are to help you make informed recommendations.

What should pregnant women be aiming for?

As with the general population, dietary advice for pregnant women should focus on consuming foods from the five main food groups as illustrated in the recently updated Eatwell guide. The main food groups are described below.

Starchy carbohydrates

This group includes potatoes, bread, rice and pasta. Wholegrain varieties, which provide more fibre, should be encouraged. These should be eaten at each meal.

Fruit and vegetables

Pregnant women should eat at least five portions per day of fruit and vegetables4. Folic acid is important during pregnancy and foods that are rich in folic acid include green leafy vegetables, peas, oranges and bananas.

Proteins

This group includes beans, pulses, fish, meat, eggs and other proteins. Although pregnant women require a little more protein in their diet, average daily protein intakes amongst women in the UK is already above the reference nutrient intake (RNI)2. For this reason, most women do not need to consume additional protein during pregnancy.

Milk and dairy foods

Although calcium needs are increased in pregnancy, the body adapts to ensure more calcium is absorbed, so higher intakes are not required3. Milk and dairy products are important sources of iodine for pregnant women.

Fats and oils

Whilst some fat is essential during pregnancy, fats and oils should be used in small amounts, encouraging women to choose unsaturated fats where possible.

Omega-3

Although there is no additional requirement of DHA (omega-3) for pregnant women, these fats are particularly important during pregnancy as they play a key role in the development of the baby’s brain and eyes5. Eating two portions of fish per week of which one portion (140g) should be oily fish such as anchovies, mackerel, salmon, sardines and trout will help provide adequate omega-36. Red meat, eggs, linseed or flaxseeds, soybean oil, rapeseed oil, tofu and walnuts are good alternative non-fish sources. Whilst it is not a government recommendation, some women may choose to take a DHA supplement during pregnancy.

Food and drink high in fat or sugar

Since these foods are high in calories and generally low in other nutrients, they should be consumed in small amounts during pregnancy.

As pregnancy is a vulnerable time for the developing foetus pregnant women need to avoid eating certain foods and take extra care with aspects of food preparation/hygiene. NHS Choices provides up to date information on foods to avoid in pregnancy7.

Key nutrients

Current data show that some women of reproductive age have poor dietary intakes of certain key nutrients2, and a high proportion are not taking supplements while pregnant1. Even though a healthy, balanced diet and supplementation meets nutritional requirements in pregnancy, data form the National Diet & Nutrition Survey (NDNS) shows that some key nutrients are often low in women’s diets2.

Current data shows that women of reproductive age have poor dietary intakes of some key nutrients8.

Even though a healthy, balanced diet and supplementation meets nutritional requirements in pregnancy, data from the NDNS shows that some key nutrients are missing from women’s health.

The recommended amounts of five key nutrients during pregnancy and their specific role and key food sources are shown in table 1.

 Daily dietary recommendation during pregnancyRole and sources
Vitamin D*10µg[9]Contributes towards the maintenance of normal bones through normal calcium and phosphorous absorption[10] Taking 10µg vitamin D during breastfeeding is also recommended. There are relatively few dietary sources of vitamin D but oily fish is a good source and eating it once a week can be a useful contribution to intake.
Folic acid400µg[11]Helps prevent neural tube defects[11]. Women should take this from before pregnancy until 12 weeks of pregnancy.Green leafy vegetables – such as broccoli and cabbage – green bean, chickpeas and brown rice are rich in folic acid.
Iron*14.8mg[3]Contributes to the normal functioning of the immune system and to normal blood formation[12,13]. Iron-rich foods include lean red meat, poultry and fish; and dark green leafy vegetables, spinach, beans and lentils.
Iodine*140µg[3]Contributes to the woman’s normal cognitive function during pregnancy[14]. Rich sources include sea fish and shellfish, but milk and dairy products are also major contributors.
Omega -3 (DHA)*450mg[6]Contributes to the growing infant’s brain and visual development during pregnancy[15].In the UK, 450mg/day of omega-3 fatty acids equates to two portions of fish per week, one of which should be an oil rich fish[6].

* no increment

Supplementing the diet during pregnancy

The UK government recommends that all pregnant women should take a supplement of folic acid one month before and until 12 weeks of pregnancy and a vitamin D supplement throughout pregnancy (see table 1). However, some specifically formulated food products are also available to help pregnant women achieve optimal nutrient intakes. This can completely replace the need for additional supplementation as some products contain the five key nutrients outlined above (folic acid, iron, omega-3, vitamin D and iodine). Healthcare professionals should seek opportunities to discuss the government vitamin supplementation recommendations with pregnant women.

Summary

Getting the right nutrition is essential during pregnancy as it can have an important influence on the lifelong health of the developing baby1. Despite this, some women of reproductive age can have low intakes of several key nutrients. Whilst a healthy balanced diet should always be encouraged as the best way to improve nutritional intakes, certain key nutrients are either hard to get from commonly consumed foods or required in larger amounts during pregnancy such as folic acid, iron, omega-3, vitamin D and iodine. Vitamin supplements should be recommended according to government guidelines whilst specially formulated food products are also available to help pregnant women achieve recommended levels of these key nutrients.

  1. Scientific Advisory Committee on Nutrition. The influence of maternal, fetal and child nutrition on the development of chronic disease in later life. London; 2011.
  2. Bates B LA, Prentice A, Bates C, Page P, Nicholson S and Swan G. National Diet and Nutrition Survey Results from Years 1, 2, 3 and 4 (combined) of the Rolling Programme (2008/2009 – 2011/2012). 2014.
  3. Department of Health. Dietary reference values for food energy and nutrients for the United Kingdom (Report on Health and Social Subjects, No. 41). London; 1991 .
  4. NHS Choices. [NHS Choices. Pregnancy and baby]. Available from: http://www.nhs.uk/conditions/pregnancy-and-baby/pages/healthy-pregnancy-diet.aspx#Fruit.
  5. Koletzko B, Cetin I, Brenna JT. Dietary fat intakes for pregnant and lactating women. BrJNutr. 2007;98(5):873-7.
  6. Scientific Advisory Committee on Nutrition. Advice on fish consumption: Benefits and risks. London; 2004.
  7. NHS Choices. Pregnancy and baby [Foods to avoid in pregnancy]. Available from: http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/foods-to-avoid-pregnant.aspx.
  8. National Diet and Nutrition Survey: Headline results from years 1,2 and 3  (combined) of the Rolling Programme (2008/2009-2010/2011). Available: https://www.gov.uk/government/publications/national-diet-and-nutrition-survey-headline-results-from-years-1-and-2-combined-of-the-rolling-prgramme-2008-9-2009-10 [Accessed: October 2014]
  9. Public Health England. PHE publishes new advice on vitamin D [press release]. 2016.
  10. EFSA Panel on Dietetic Products,Nutrition and Allergies. Scientific Opinion on health claims already evaluated pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal. 2011;9(6):2203.
  11. Scientific Advisory Committee on Nutrition. Folate and Disease Prevention. London; 2006.
  12. EFSA Panel on Dietetic Products, Nutrition and Allergies. Scientific Opinion on the substantiation of health claims related to iron pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal. 2010;8(10):1740.
  13. EFSA Panel on Dietetic Products, Nutrition and Allergies. Scientific Opinion on the substantiation of health claims related to iron pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal. 2009;7(10):1215.
  14. EFSA Panel on Dietetic Products, Nutrition and Allergies. Scientific Opinion on the substantiation of health claims related to iodine pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal. 2010;8(10):1800.
  15. EFSA Panel on Dietetic Products, Nutrition and Allergies. Scientific Opinion on the substantiation of health claims related to docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal. 2011;9(4):2078.

 

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