SingaporeMotherhood | Parenting

June 2014

Nutrition during Pregnancy – A Personal Guide

Your nutritional health before and during pregnancy can affect your baby’s future health. Dr Abdul Aziz Bin Mohd Ali Sujak from Aziz Clinic For Women Pte Ltd tells us why this is so, and how to enhance maternal nutrition for baby’s best development. Congratulations! Now that you are pregnant, you will be wondering how your baby will develop. There are many factors that will affect the outcome and well-being of your baby.

These, to name a few, include — (a) genetic and chromosomal influence, which we can do very little to alter, and (b) a big group called multifactorial influence which include the environmental conditions, infections, chemicals/drugs, radiation and nutrition. Of these, nutrition is the one that the pregnant mother can “take charge” of the most and therefore, influence the development of her baby.

The period of influence is the “window of opportunity” for the mother to give her baby the best that she can. This can be enhanced by pre-pregnancy nutritional enhancement so that the mother will be at her best before she gets pregnant.

During pregnancy, the developing embryo, and later foetus, will require adequate nutrients. “First trimester nutrition” — sometimes called early life nutrition, is perhaps the most influential period but perhaps the most overlooked.

Pre-Pregnancy Nutrition

Folic acid and iron are the two most important supplements prior to pregnancy that may influence the future development of the embryo and the foetus. However, many nutrients and supplements are important for the general health of the mother.

Most food supplements which are labelled as “multivitamins” should be adequate for pre-pregnancy general health. Additional folic acid and iron is recommended to build up storage for the body. In early pregnancy, when morning sickness strikes, these stores will be mobilised for the mother and the embryo.

First Trimester — Early Trimester, Early Life Nutrition

This is the continuity of pre-pregnancy nutrition. The aim is to ensure optimal development of the embryo to a foetus. The most common “visible” effect of poor early trimester nutrition is spina bifida, a birth defect in which the spinal column does not develop completely, due to a lack of folic acid.

This has been well researched and documented and most parents are aware of it. However, there is growing evidence to show that early life nutrition also influences susceptibility to obesity, diabetes and other non-communicable diseases in later life. Obese and diabetic mothers are at higher risk of miscarriages and foetal abnormalities due to complex interaction of poor nutrition and metabolic disorders.

Second and Third Trimesters — Mid and Late Trimester Nutrition

This is the period of growth and maturation of the foetus. The developmental period of the embryo is over. However, the genetic and chromosomal potential of the foetus can be influenced by infection, radiation, drugs and nutrition through epigenetic mechanisms.

Simply put, these factors can alter the expression of the genetic material of the chromosomes through protein “switches” to turn on or turn off a particular genetic expression. These protein “switches” are influenced by the factors mentioned, which include nutrition. The evidence for Developmental Origins of Health and Diseases (DOHaD) (which describes how early life environment induces changes in development that have long term impact on later health and disease risk) is overwhelming. Nutrition and other factors in the womb influence the outcome of health and diseases for the baby. Therefore, it is very important that the mother takes care of her health and nutrition during pregnancy.

DOHaD Example

A malnourished or undernourished mother would not provide adequate or optimal nutrition to the foetus. Foetal organs and tissues would not develop optimally and may adapt by re-channelling food, nutrition and oxygen to important organs like the brain. The other organs and tissue would have reduced functional and adaptive capacities.

Later on, in childhood and adulthood, having a slightly unhealthy lifestyle will make a person less adaptive and he or she might end up being obese, hypertensive, or diabetic, and suffer from other metabolic diseases.

A well-nourished foetus, baby and child will be more adaptive and perhaps will not be severely affected even by a moderately unhealthy lifestyle. (Do note, of course, that a healthy lifestyle is always recommended for everyone.)

Baby massage

On the other hand, an obese and over-nourished mother will have an over-nourished foetus/baby. This baby will secrete more insulin, leading to fat deposition. The baby in turn becomes obese and this is likely to continue into adulthood, thus leading to adult obesity, diabetes and other metabolic disorders.

Other Effects of Foetal Nutrition

Poor brain and nerve nutrition would lead to impaired cognitive and visual functions, as well as educational performance. Body composition, internal organs and muscle would influence immunity, work capacity and sports.

Window of Opportunity

Pre-pregnancy and pregnancy is the period when you chart your baby’s future, in more ways than you would ever know. Nutrition is very important and in turn influences other life fundamentals – educational, spiritual, emotional, and physical.

The most opportune period is from conception up to the first 1,000 days of life.

a) Pre-conception – maternal nutrition and healthy preparation for pregnancy.
b) Antenatal nutrition – good maternal supplementation and “mama’s milk”.
c) Post-natal nutrition – breast feeding and quality formula supplementation.
d) Maintenance of maternal health and nutrition

Eating Right and Supplementations

Eat right during pregnancy, in the right quality and quantity. On top of that, exercise, keep healthy and get adequate rest. There are many vitamins to supplement pregnancy. Follow your doctor’s advice.

A well balanced amount of nutrients may also be found in maternal milk supplements such as Similac Mum, a Healthier Choice maternal milk for pregnant and breastfeeding mothers.

The “food pyramid” offers a general guide on the ratio of “go”, “grow” and “glow” food types. A recommended eating guide is as follows:

a) 3 regular meals – breakfast, lunch and dinner
b) 2 snacks – one in the afternoon and a light supper after dinner
c) Eat more fibre-rich food
d) Take in essential micronutrients – folate, iron, calcium, vitamin D, DHA
e) Food should be well cooked; avoid raw food e.g. sashimi, ‘rojak’
f) Drink 10–12 cups of fluid every day; reduce caffeine intake to one serving per day
g) Reduce intake of food high in sugar, salt and fat
h) Strictly no smoking or alcohol consumption

Nutrient Highlights

a) Folate and iron – Helps to prevent neural tube defects and anaemia, respectively
b) DHA – Supports brain/cognitive and visual development; reduces premature labour
c) Iodine – Needed for thyroid hormones, body and nerve metabolism
d) Zinc – Supports growth and immune function, trace element in some proteins and enzymes
e) Calcium – Supports bone and dental development
f) Vitamin A – Needed for immunity and visual development, excess leads to anencephaly

Weight Management

  • Light exercises are recommended. Weight gain during first trimester is 0-3 kg and subsequently is 1-2 kg per month.
  • Get adequate sleep as your body dictates, but the average is about 6–8 hours a day.

Other Considerations

I would not recommend any of such supplements unless they have been certified safe for pregnancy/lactation by the Health Sciences Authority or similar bodies. There must an accurate list of ingredients in these supplements. It is best to avoid them or consult your doctor before taking any.

Chicken’s Essence/Bird’s Nest
These are some of the approved food supplements, but please consume them in moderation.

In conclusion, the mother-to-be’s nutrition greatly influences the nutrition of the baby and its subsequent health and future development. Maternal nutrition when taken lightly may result in unhealthy outcomes of the baby and in his/her adulthood. Thus, mothers must pay more attention to their nutrition and health to ensure the future of the health of their children.

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Nutrition during Pregnancy – A Personal Guide