"Nutrition is the foundation of life, throughout pregnancy and beyond."

Introduction

Healthy mom refers to the health of woman during pregnancy,childbirth and postnatal period. Each stage should be a positive experience,ensuring women and their babies reach their full potential for health and well –being.

The importance of nutrition in achieving a healthy pregnancy. There are specific roles of key nutrients that are especially important during pregnancy. The various factors that influence a pregnant woman’s ability to obtain these key nutrients. The implications of both overeating and undereating during pregnancy.Undernutrition is the prevalent type of malnutrition in tropical developing countries.

An undernourished mother inevitably gives birth to an undernourished baby perprtuating an intergenerational cycle of undernutrition. It is globally acknowledged that focusing on first 1000 days of child’s life- beginning from conception to 2 yrs. Of age.

Nutritional requirement in pregnancy :

• Pre-conception : Benefits of good pre-conception health include improved pregnancy & outcomes. Folic acid is mainly required in this phase.
• Pregnancy : Optimal fetal growth and prepare mother for delivery. Iron, folic acid, vitB6 &B12 and especially DHA in last trimester.
• Lactation : Lay the foundation of healthy life of the infant. Postnatal mother required mainly iron and calcium. Infant required all macro and micro nutrients including DHA.

Changes during pregnancy:

1. Plasma volume increase over the course of preganancy by about 50%. Dilutional anaemia is caused rise by rise in plasma volume.

2. The needs for most nutrients are increased during pregnancy to meet the high demands of both the growing fetus and mother.

3. Nausea and vomiting in early phase of pregnancy.

4. Food aversions and cravings may impact the food intake and preferences.

Recommended dietary allowances for Indian Women

Dietary quality and timing :

1st Trimester

• Both the amount of a nutrient and it’s timing of intake are extremely important to fetal development.
• The 1st Trimester is a time of rapid cell devision ,organ development and preparation for the demands of rapid fetal growth that occur later in pregnancy.
• Critical nutrients during this phase include protein, folic acid, vitB12 and Zinc.

2nd and 3rd Trimester

• Energy intake is especially important since 90% of fetal growth occurs during last half of gestation.
• Critical nutrients during this phase include protein,iron, calcium,magnesium,B vitamins, Omega 3 fatty acid DHA.

Water

• Water plays crucial during pregnancy.
• Not only does it carry vital nutrients from the foods you eat to your baby,but it also helps prevent you from getting constipation, excessive swelling, urinary tract & bladder infections.
• Pregnant women should drink at least (5-6)lt. of water especially in 3rd Trimester when dehydration can result in early labour.

Energy Needs:

• There is great variability among pregnant women with regard to energy costs during pregnancy related to differences in body size and lifestyles.
• Appropiate weight gain and appetite are better indicators of energy sufficiency that the amount of kilocalories consumed.
• Only (30-40)% of women actually gain weight within the recommended ranges during pregnancy.
• Many women gain much more weight than is necessary during pregnancy.
• Many women gain much more weight than is necessary during pregnancy, which is related to postpartum weight retention.

Eating strategies:

Strategies that are recommended to deal with some of these issues include:

• Small frequent meals and snacks.
• Adequate fiber intake.
• Adequate fluid intake.
• Avoiding an empty stomach.
• Choosing foods that are well tolerated.

That may result in excessive wt. Gain during pregnancy:

• Food cravings (dairy and sweet foods).
• Psychological influences on eating behavior.
• Reduced attempts to control food intake.
• Pregnancy legitimizes eating more.
• Reductions in physical activity.

Life in balance:

The risk of overweight due to excessive pregnancy weight gain needs to be balanced against the risk of poor fetal growth associated with inadequate weight gain.

Diet needs to be nutrient dense to supply sufficient nutrients to the developing fetus, since fetal demends may double some micronutrient requirements.

Beyond Pregnancy:

• Energy and nutrient needs continue to be elevated post-partum, particularly in woman who choose to breastfeed or who have had a LUCS.
• The energy required for daily milk production in close to 560kcal.
• Protein,Zinc, VitC promotes wound healing.
• The inherit demands of a newborn are a challenge to the new mother and her family.

Summary

Critical nutrients are required in the right amounts at the right time to achieve a healthy pregnancy. The majority of women do not gain weight within the recommended ranges during pregnancy.Various factors influencr eating patterns during pregnancy, resulting in either inadequate or excessive intake of energy and certain nutrients. Studies show that pregnant women eat too many refined carbohydrate and fat and too little iron and fibres. Meals and or snacks should be healthy, tasty, convenient and economical. Balanced diet with necessary nutrients is a key to healthy pregnancy.

References :

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2. ClerkM.OgdenJ.The impact of pregnancy on eating behavior and aspects of weight concern,IntJobes Relat Metab Disorder1999;23(1):18-24.

3. Position of the Americal Diabetic Association:Nutrition and lifestyle for a healthy pregnancy outcome.J Am Diet Assoc2002;102(10):1479- 1490.

4. BaranoskiS, AyelloEA. Wound care essentials practice and principles,pp157-160,Lippincott Williams and Wilkins PA;2004.

5. Buttle NF,Wong WW,Energy Requirements during pregnancy based on total energy and expenditure and Energy deposition,Am J Clin Nutr2004;79:1078-1087.