Some food for thought: Healthy Pregnancy

Janette Marshall recommends ways of eating healthily during pregnancy

Eating a healthy diet before and during pregnancy is a positive contribution that women can make to provide their baby with vitamins and minerals essential for healthy growth and development. It also provides lots of energy and helps keep weight gain in check.

Healthy diet in pregnancy

A good diet in pregnancy is much the same as at any other time, based on enjoying a wide variety of foods. To get the right balance of foods, eat:

t A higher proportion of fruit, vegetables, bread, other cereals and potatoes. Fruit and vegetables help to provide the vitamins you need as well as fibre which helps digestion and prevents constipation. Starchy foods like bread, potatoes, rice and pasta are an important part of any diet and should, with vegetables, form the main part of any meal. We should aim to eat at least five portions of fruit and vegetables every day.

t Moderate amounts of meat, fish, alternatives and milk and dairy products, choosing low fat alternatives where possible. Lean meat, fish, eggs, cheese, beans and lentils are all good sources of protein. Dairy products like milk, cheese and yoghurt are important as they contain calcium. Reduced fat varieties contain just as much calcium as full fat dairy foods.

t Sparing use of foods containing fat, looking out for low fat alternatives. A little fat is essential in everyone's diet, but fat is very high in calories and increases our risk of heart disease. Try and reduce the amount of saturated fat you eat by using poly and monounsaturated oils and spreads.

t Foods containing sugar, but not too often. Try and cut down on sugar and sugary foods. They contain calories without any of the other nutrients that the body needs. They also add to the risk of tooth decay.

t Drink plenty of fluid every day (eight glasses) Replace some or all cups of tea, coffee, cola and fizzy/soft drinks with water, unsweetened fruit juice (diluted, if liked), or milk to avoid too much caffeine and tannin which is a stimulant to the baby as well as you. If you do drink tea, make sure it's at least half an hour after a meal as the tannin it contains reduces iron absorption from the foods we eat. Limit the tea and coffee you drink and try and give decaffeinated varieties a try.

t It's a fallacy that you need to "eat for two". Improving the nutritional quality of your diet is more important than quantity. Only an additional 200 calories a day is needed during the last three months of pregnancy (and 450 or so afterwards when breastfeeding). Before then, women don't need more calories than they normally eat.

Healthy Snacks

2 slices wholemeal bread/toast or bagel/roll with low fat cheese

jacket potato with 25g/1oz cheese

slice of cheese on wholemeal toast fruit bun/muffin low fat spread and preserve/-Marmite

2 medium bananas

3-4 fishfingers prawn/canned salmon and salad sandwich (no spread/mayonnaise), bowl porridge with few raisins

potato scone/farl with lean grilled bacon generous 25g/1oz unsalted nuts

NUTRIENTS

Some nutrients are particularly important before and during pregnancy.

Iron

If you do not get enough iron you will feel tired and may become anaemic. Eating foods rich in iron will help prevent the need for supplements which can cause constipation. Blood tests for iron status should be taken early in pregnancy, usually at the first ante natal appointment. Reserves are also needed by the baby during her first year.

Good sources include lean red meat, fortified breakfast cereals, wholemeal bread, green leafy vegetables.

Vitamin C

Iron from non-animal sources is not easily absorbed so vegetarians should eat vitamin-C rich foods, or drinks, with vegetable sources of iron to enhance absorption. Good sources: citrus fruit/juice, other vegetables and fruit, potatoes.

Calcium

Essential for the development of the baby's bones and teeth.

Good sources are low fat milk, yogurt, fromage frais, cheese, canned fish with edible bones (pilchards, salmon, sardines). Vegetarians should choose calcium-fortified soya products.

Vitamin D

Needed for calcium use. Supplements may be needed if the diet does not include oily fish, eggs and margarine, or if the skin is very dark and not exposed to natural daylight because of clothing or lifestyle.

Essential fats

Although fats and fatty foods should be eaten sparingly, small amounts of some polyunsaturated fats are essential for the baby's brain, eyes and other developments. Fish, especialy oily fish (mackerel, herring, salmon) contain these long chain fatty acids. Eat fish a couple of times a week, but don't worry if you are vegetarian or cannot eat fish. Similar fatty acids in green leafy vegetables and vegetable oils (also found in margarine/spread) can be turned into beneficial long chain versions by your body. Beware of fish oil in supplements which may contain too much vitamin A.

SAFE EATING

If you are pregnant, do not eat liver or liver products - they contain lots of vitamin A which can harm your baby.You will not go short of vitamin A because the body can turn beta-carotene found in orange and green fruit and vegetables into vitamin A if it is needed. Also avoid liver pate. Pate, ripened soft cheeses such as camembert, brie and blue- veined varieties should be avoided as listeria monocytogenes which can cause listeriosis may be found in these foods. This is a rare illness producing flu-like symptoms in pregnant women, but severely affecting a developing baby. Listeria can also occur in cook-chill meals, but reheating them thoroughly to piping hot will destroy it. Ready-to-eat salads may contain listeria, so avoid or wash carefully.

Raw eggs or foods made with uncooked or undercooked egg (eg ice-cream, freshly-made mayonnaise, some dips, cold souffles and mousses, other desserts) should be avoided as they may contain salmonella which would result in food poisoning that could cause sickness and diarrhoea in the mother, even though it rarely causes damage to unborn babies. Like eggs, poultry and meat should also be cooked thoroughly to destroy salmonella bacteria. Take care to wash hands after handling raw poultry and meat. Store raw meat separately from cooked and use different utensils for preparation.

Raw or undercooked meat should not be eaten as the parasite that causes the rare disease toxoplasmosis that affects unborn babies and may cause miscarriage could be present. The parasite is also found in unpasteurised goat's and sheep's milk, so avoid these and cheese made from them. It is also in soil and cat faeces: always wash vegetables and salads thoroughly, in addition, wash hands after contact with kittens and cats and wear gloves for gardening.

Alcohol is best avoided when trying to conceive and during early pregnancy. If you do drink, limit to one or two units once or twice a week and avoid getting drunk.

FOLIC ACID

Women who are planning to become pregnant are advised to take folic acid tablets while trying to conceive and until the end of the twelfth week of pregnancy to reduce the risk of spina bifida, similar neural tube defects, and possibly other birth defects that occur early in pregnancy. However, up to half of pregnancies are not planned, so the next best thing is to start as soon as you suspect you might be.

Daily folic acid tablets of 400 micrograms (mcg) or 0.4 milligrams (mg), which cost between 2p-and-4p-a day (depending on brand), are the recommended dose.

In addition to supplements, many breads and some breakfast cereals are fortified with folic acid, and foods rich in folates (the name given to Folic acid where it occurs naturally in food) should also be eaten regularly. Folic acid is a B vitamin excreted naturally by the body so there is no danger of overdosing.

Foods rich in folates include

Cooked black eye beans, brussels sprouts, beef and yeast extracts, cooked kidney, kale, spinach, spring greens, broccoli and green beans.

Cooked soya beans, cauliflower, cooked chick peas, potatoes, iceberg lettuce, oranges, peas, orange juice, parsnips, baked beans, wholemeal broad, cabbage, yogurt, white bread, eggs, brown rice, wholegrain pasta. Liver is a rich source of folates but it should not be eaten if you are planning a baby or pregnant because it contains high levels of vitamin A.

Information and advice on folic acid is available from the Health Information Service freephone line on 0800 66 55 44.

VEGETARIAN DIET

Pregnant women must ensure they're getting sufficient iron and should make sure their diets contain dried fruit (especially apricots) and nuts, spinach fortified breakfast cereals, wholemeal bread and beans. Eating foods containing vitamin C (such as citrus fruits, broccoli and other vegetables) with every meal will increase the absorption of iron from vegetable sources.

The B12 vitamin is also vital. It is found naturally only in foods of animal source including fish, eggs, milk and cheese. Some foods from vegetable sources are fortified with B12, such as breakfast cereals, some soya milks, textured vegetable protein and yeast extracts.

Vegetarians who take milk and other dairy products should not have a problem getting all the calcium they need. For those who don't, calcium is also found in bread, green leafy vegeatbles, nuts, fortified soya milks and beans. However vegans (who eat no animal food) need to plan their diet very carefully.

VITAMIN & MINERAL SUPPLEMENTS

Other than folic acid, these are not necessary for most people during pregnancy. In fact, too much vitamin A can be toxic and harm your baby. The best way to ensure you're getting all the vitamins you need is by eating a varied healthy diet.

However, if you're on a restricted diet for any reason, or suffer from prolonged, severe nausea and sickness, you may require extra vitamins, but you should always check with your doctor first. If a vitamin and mineral supplement is taken, choose one that provides no more than 100 per cent RDA (recommended daily allowance) to avoid any toxic effect. The largest nutrient needs occur at the beginning and end of pregnancy, so limited use during those times may be the safest option.