Getting the Right Nutrition During Pregnancy

For both a mother and her unborn child, a healthy lifestyle is important for well-being and good health. There is no need for a specific regime, rather a balanced diet is the key factor in the healthy development of an unborn child. On the whole, calorie requirements during pregnancy are overestimated and the importance of taking folic acid and iodine supplements, even if you eat a varied and healthy diet, are underestimated. Advice to avoid certain foods should be taken seriously, due to the risk of developing toxoplasmosis or listeriosis. Alcohol should be completely avoided, and coffee consumption should be limited to 3 cups per day.

More is Less

The energy requirements of a pregnant woman increase much less than most people think. There is no increased energy requirement in the first trimester. In the second trimester it increases by 250 kcal/day and in the third trimester by 500 kcal/day. The extra energy is used for the development of tissues, for the placenta and the foetus as well as increased lung and heart activity. With this energy intake, an average weight woman should put on around 12 kg during pregnancy.¹ 250 kcal is gone in a flash: one slice of wholemeal bread with cheese, or a portion of natural yoghurt with a handful of berries and four tablespoons of oat flakes contain 250 kcal. To get an extra 500 kcal, going back for seconds at lunchtime is often sufficient.

Compared to energy requirements, the need for certain vitamins and some minerals increases dramatically. Despite the small increase in energy requirements, in order to make sure that mother and child get enough nutrients, the following rules generally apply: Choose wholemeal products in place of white flour products to increase your consumption of B vitamins. An extra slice a day compared to before pregnancy is a good idea. Low fat milk products are no less rich in micronutrients than full fat milk products. Fat and energy intake is reduced, while you are able to eat more and increase your micronutrient intake. It is also advisable to eat an extra portion in order to meet the increased need for protein. In addition, one portion of fruit or vegetables should be eaten every day to fully or partially meet your requirements for vitamin C and folic acid.

Folic Acid and Iodine – Start Taking It Before You Get Pregnant

Even when eating a healthy balanced diet, it is still highly recommended that all pregnant women take folic acid and iodine supplements, since the amount obtained from diet alone is not sufficient. Women who are trying to get pregnant should begin taking 400 µg folic acid/day in the form of a supplement before they get pregnant. Folic acid is important for cell division and the development process. According to the Nationale Verzehrstudie II (German National Nutritional Study II), the German population only manages to consume 86% of the reference value for folic acid. So, if the reference value is increased by 50% - as is recommended by specialists during pregnancy - it is to be expected that most women will fall short of this level. Starting to take folic acid early reduces the risk of nervous system abnormalities and neural tube defects, but also other deformities, such as congenital heart problems and cleft lip/palate.² Plant-based foods, such as leafy greens, cabbage, pulses and tomatoes, as well as oranges and wholemeal bread are rich in folic acid and contribute to the recommended daily intake of folic acid, but are not sufficient on their own.

As well as folic acid, it is also important to consume plenty of iodine before getting pregnant. Women trying to become pregnant should ensure they use iodised salt at home and make sure it is used in catered meals. Even your bakery should make your bread with iodised salt to help you reach your target intake of 200 µg of iodine a day. Iodised salt contains 15 to 25 mg of iodine per kg of salt. You can achieve half the recommended daily intake of iodine by consuming 5 g of iodised salt and foodstuffs produced using it.³

The reference value for iodine intake increases from 200 μg to 230 μg per day during pregnancy. On average, around 120 μg of iodine per day will be consumed through diet and iodised table salt. This still leaves a shortfall, which should be met with a 100 to 150 μg iodine supplement. Studies have shown that even a slight iodine deficiency during pregnancy can have adverse effects on brain development. According to the World Health Organisation (WHO), iodine deficiency is the most common cause of avoidable early childhood brain damage.⁴ 

Freshwater fish contains high levels of iodine, but most people eat freshwater fish only rarely. The recommendation is to eat freshwater fish twice a week, to use iodised table salt and regularly consume milk, milk products and baked goods made with iodised salt.

Iron – 100% Increase in Reference Value

Even though the reference value for iron increases by 100% to 30 mg/day, there is generally no need to take supplements, since during pregnancy the intestinal iron absorption rate increases and menstrual blood loss stops. Pregnant women are encouraged to keep an eye on their iron intake and take iron supplements if necessary. Easily absorbed sources of iron include haem iron. Meat should be on the menu three times a week and fish twice a week. Even iron intake from grains and iron rich vegetables can be improved by consuming more vitamin C, for example in the form of oranges. Pregnant women should pay particular attention to this, especially if they eat very little meat.

Avoiding Foodborne Infections

Toxoplasmosis and listeriosis are foodborne infections. They can be transmitted to the unborn baby during pregnancy and can lead to serious illness and even the death of the child. Complications develop in around 50 out of over 600,000 pregnancies and births in Germany each year due to foodborne infections, according to official statistics from the Robert Koch Institute (RKI). 

Even though the risk may seem small, pregnant women are strongly encouraged to completely avoid raw animal products. This includes: raw or undercooked meat, cured meats and hams (e.g. Salami and prosciutto), raw fish and seafood, raw milk, raw eggs and meals and products made from these items that have not been heated sufficiently. It is also advisable to avoid soft cheese, even if it is made from pasteurised milk, as well as smoked fish. Furthermore, it is important to wash fruit, vegetables and salad thoroughly before eating, to ensure they are freshly prepared and consumed shortly afterwards. Pre-prepared salads are not recommended for pregnant women. Aside from this they should make sure that vegetables covered in soil, such as carrots or potatoes are stored separately from other foodstuffs and washed thoroughly before eating.⁵

Alcohol – a No Go!

As soon as a woman knows that she is pregnant, she must stop drinking alcohol completely. The amount of alcohol that presents a risk to each individual is unknown. Therefore, in order to protect the baby from birth defects, developmental defects etc, no alcohol should be consumed.⁶ But expectant mothers who drank alcohol before they became aware they were pregnant need not feel guilty, since it is true that the risk of harming the baby by drinking small amounts of alcohol is very low.

Coffee - in Moderation!

Drinking up to 3 cups of coffee a day poses no risk to a pregnant woman, but caffeinated energy drinks should be avoided completely. Drinking more than 3 cups a day can have a negative effect on birth weight and whether the pregnancy reaches full term.⁷