While it’s now widely accepted that a pregnant woman is not ‘eating for two’ the one she is eating for still needs a lot of nutrition and energy to successfully enter the world. Kicking off our new series on healthy eating in partnership with the Nutrition Society of Sri Lanka, we speak this month with [...]

The Sundaytimes Sri Lanka

Baby and you both need the right food


While it’s now widely accepted that a pregnant woman is not ‘eating for two’ the one she is eating for still needs a lot of nutrition and energy to successfully enter the world. Kicking off our new series on healthy eating in partnership with the Nutrition Society of Sri Lanka, we speak this month with Clinical Nutritionist Dr. Angela de Silva, President of the Nutrition Society of Sri Lanka about the essentials of the pregnant woman’s diet.

Here Dr. De Silva talks about what to include in your diet (and more importantly, what to leave out) and goes on to share tips on how her diet can help a woman through the physical challenges of pregnancy.

In the early months of her pregnancy, a woman at the mercy of morning sickness could be forgiven for not having much interest in her diet. While the hormonal changes during pregnancy are important for maintaining the flow of nutrients to the foetus, some of these same hormones are associated with nausea in early pregnancy that make it difficult for women to eat an adequate amount of food. Dr. de Silva recommends pregnant women replace large meals with smaller, more frequent meals.

Intense food cravings for chocolate, citrus fruits, pickles, and other salted foods are common, as is an equal and opposite revulsion to other drinks and foods like coffee, tea, fried or fatty foods, highly spiced dishes, meat, and eggs. Avoiding highly spiced food, high fat foods and strong odours will help you keep your meal down. “Taking a small carbohydrate snack prior to getting out of bed in the morning, such as a one or two dry biscuits, and keeping well hydrated is also known to be helpful against nausea/vomiting,” she suggests.

Women should gain a reasonable amount of weight during their pregnancy and maternal weight gain does influence infant birth weight and health. Dr. de Silva emphasises though that a pregnant woman really does not have to eat for two, since excessive weight gain is as detrimental as inadequate weight gain. A mother’s nutritional status is key because pregnancy creates extra demands for nutrients including carbohydrates, fats, protein, iron, calcium, iodine and many vitamins. It is best that a woman be in optimum nutritional health prior to conception because the nine months of her pregnancy may not be enough time for her to catch up on any deficiencies.
In a foetus, the organs begin forming in the very early stages, (often before pregnancy is even detected) and deficiencies in nutrition can affect the development of the baby. “If a female’s BMI is below 18.5 at the start of pregnancy, her weight is considered to be inadequate and, her energy intake is most likely low. Therefore, she should increase her energy intake by eating extra at mealtimes and adding on two to three healthy snacks,” says Dr. de Silva.

Pregnancy doesn’t demand a huge shift in your diet, but a general rule of thumb is that a woman should have a healthy and varied diet that incorporates adequate quantities of foods from each of the five food groups, namely starchy foods, fruits and vegetables, animal foods, milk and milk products and small quantities of fats and oils.

As a woman progresses through subsequent trimesters and her foetus grows, her body begins to prepare for delivery and breastfeeding. During her second and third trimesters, her energy needs to climb to approximately an additional 350 kcal/day. This additional energy goes towards not just the growth of the foetus but growth of placenta and other maternal tissues, deposition of fat which is needed by the mother to sustain the energy needs of pregnancy and lactation.

Despite her growing needs, a pregnant woman need not take a food supplement, it being best to rely on natural foods, says Dr. de Silva. However an iron, folic acid and calcium containing multi-vitamin tablet is essential but many women tend to forget its importance during the lactation period. Government clinics provide multi-vitamin supplements of iron, folic acid, vitamin C and calcium tablets to all pregnant women. Women should take these supplements not only during pregnancy but also in the first six months of lactation.
Returning to food supplements, the exception is if the mother has a low energy intake, then an energy rich supplement is recommended. “Recognizing that a fair number of women have a lower than normal BMI, in Sri Lanka the government health programme delivers thriposha, an energy and micronutrient rich food supplement to all pregnant women.

This can be taken as a snack,” she says. The idea is to use such supplements as they were intended – not as a substitute but as an addition to the normal diet. Unfortunately, in poorer households, thriposha is sometimes used as a replacement rather than a supplement, and often shared with the entire family.

Pregnancy brings with it a range of challenges. Pregnant women often complain of heartburn. Dr. de Silva explains that this is caused by the slow movement of the food through the digestive tract. “Avoid lying down immediately after eating,” she advises, “sleep with the head slightly elevated to avoid acid reflux; consume small, frequent meals; and avoid known irritants, such as caffeine, chocolate, or highly seasoned foods.”

A healthy diet will help you combat other problems too. For instance, constipation can be averted by ensuring your diet is rich in fruits and vegetables, with enough fluids and regular physical activity. “A pregnant woman must be aware of this and try and balance her intake of such foods as to achieve a healthy diet,” says Dr. de Silva. The recommendation for fibre is approximately 25 g a day – therefore, excessive intake can also lead to constipation and interfere with and cause decreased absorption of other nutrients from the gut.

It helps also to pay attention to fluid intake. Taking at least 6-8 glasses of water or other beverages could prevent constipation. Throughout this period, emphasis should also be placed on doing a moderate amount of physical activity but resting for at least two hours each day.

After birth, a woman needs to remain aware of her diet. Though she may be concerned about getting back in shape, she needs to keep eating healthy. “Postpartum women need to take an adequate diet to replenish nutritional stores, prevent problems in subsequent pregnancies, and reduce risk of chronic diseases later in life,” says Dr. de Silva, explaining that if the mother’s weight gain was adequate and not excessive during pregnancy, she should not restrict her food intake, during the period of breastfeeding, in fact she has to take in extra calories.

This being said, it’s comforting to know that most often, the additional weight typically is lost naturally as lactation is a process which requires a lot of energy. Some cultural norms involve lactating mothers (in the early stages of lactation) are restricted from taking protein containing foods, says Dr. de Silva, emphasising that such practices are best avoided. Similarly religious practices such as fasting should be avoided during both pregnancy and lactation.

Generally for a healthy woman, dietary restrictions are not advisable. “Having said that, doing pelvic floor exercises and abdominal exercises to strengthen abdominal muscles is a good idea. One should have some sort of daily physical activity- going for a walk, etc. in order to be completely healthy during the lactation period,” concludes Dr. de Silva.

Struggling with morning sickness?

Here are some foods that you may be able to keep down.

  • Bananas are well tolerated and nutrient dense. Any other fruits of preference are recommended.
  • Milk is a healthy source of proteins, calories, calcium and essential fats; if milk cannot be tolerated, try some yoghurt or curd.
  • Rice or wheat flour products, sago or any other cereal including oats, are a good source of calories.
  • Usually chilled foods are better tolerated, so cold juices for instance can help to keep up an adequate fluid intake.

Diet ‘dont’s’ during pregnancy

  • Coffee and aerated drinks containing caffeine: In high doses caffeine can cross the placenta and increase foetal heart rate. Decaffeinated coffee is safer. Also, drinks such as fizzy drinks only provide calories without any other nutrients and should be avoided.
  • Herbal substances: some of these may have various chemical substances and contaminants which may adversely affect the developing foetus.
  • Excessive intake of any food item: high fat consumption as well as excessive consumption of carbohydrates or very high protein diets should be avoided. Foods high in nitrite, nitrates, or nitrosamines, such as cured meats should be taken in limited amounts. While we’re uncertain of its long term effects, it is best to limit intake of processed meats and foods with a very high salt or Mono Sodium Glutamate (MSG) content.
  • Artificial sweeteners: some have been accepted to be safe during pregnancy. However, such products should be taken with caution and only in small quantities if at all.
  • Consumption of alcohol has been associated with birth defects in babies.

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