Pregnancy can be an exciting time, and it's certainly a time of great change and high demands on an expectant mother's body. Following a healthy diet that's rich in nutrients can help mother – and baby – stay healthy throughout pregnancy, birth, and breastfeeding.

Nutritional needs in pregnancy

Human bodies are very good at nourishing the foetus during pregnancy, and will even do so to the detriment of the mother's health.[i]

The old adage that you're eating for two when you're pregnant isn't quite right, but it's certainly true that an expectant mother's nutritional needs change alongside the demands of a growing foetus, placenta, and a pregnant body.[ii]

What to eat in pregnancy

The nutritional demands of pregnancy can be met with a well-planned healthy diet, and a range of supplements are available to boost any nutrients in the diet.

The usual rules for healthy eating apply in pregnancy, and it's important to make sure you get enough:

• Carbohydrates: Plenty of starchy foods mean that you'll get enough fibre for a healthy bowel and healthy heart, with plenty of slow-release sugars for energy, alongside some vitamins and minerals. Some breads and cereals are fortified with some vitamins and minerals too, which are all good for helping meet those extra nutritional needs in pregnancy. Choosing wholegrain versions like wholewheat pasta and brown rice helps you get enough fibre, which is especially important as pregnancy can have an impact on the gut. High fibre diets can also help prevent problems with haemorrhoids (piles) which are quite common later in pregnancy.
• Protein: Beans, pulses, nuts, fish, lean meats, dairy products and eggs can all be good sources of protein, essential for the growing foetus and all the other nutritional needs of pregnancy. Make sure that food is cooked well, especially meat, fish, and eggs, and avoid liver and uncooked pates. Protein foods are also often good sources of other vitamins and minerals.
• Dairy: Dairy products can be a great source of calcium and other nutrients. If you go for dairy alternatives, make sure you choose ones that are fortified so you're not missing out on the nutrients that are naturally present in dairy. If you're concerned about meeting your calcium requirements, there are supplements available, but do check with your midwife before consuming.
• Fat: A certain amount of fat in the diet is important, but not all fats are equal. Sticking to healthy vegetable oils is heart-healthy and can give a boost of vitamins that aren't present in some spreads and oils. Omega 3 fatty acids, which are found in oily fish and in some nuts and seeds, are essential fats and are good for the cardiovascular system, as well as important carriers for vitamins.
• Fruit and vegetables: Colourful, tasty, fresh fruit and vegetables are a great source of vitamins, slow-acting carbohydrates, and fibre. The range and amount of vitamins found in a good variety of fruit and vegetables is really incredible. Tinned, frozen, and dried fruit and veg are all easy to add to the diet too.
• Multivitamins designed to support a healthy pregnancy: There is a wide range of vitamin and mineral supplements designed for health in pregnancy. Not all supplements are of equal quality, however, and you have any doubt or questions about supplements in pregnancy, a pharmacist or midwife can help. Supplements must be taken according to the instructions, and it's important to never take more than the recommended dose.

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What not to eat in pregnancy

Some foods are not recommended in pregnancy, either because they contain toxins which can affect the foetus, or because they carry a high risk of causing illness.[iii]

• Unpasteurised dairy products: Some soft cheeses, mould-ripened cheese and unpasteurised milk can contain bacteria that can be very dangerous in pregnancy, so should be avoided.
• Liver: liver is high in vitamin A, which can be toxic to a growing foetus.
• Uncooked or under-cooked meat, fish, and shellfish: These can contain bacteria which can cause illnesses with a high risk of serious untoward outcomes in pregnancy.
• Shark, marlin, and swordfish: Some fish are often found to be high in toxic heavy metals which can pass to the growing foetus, so these fish should be avoided. While oily fish is a great source of protein and nutrients, you should limit it to once or twice a week as these kinds of fish can contain relatively high amounts of heavy metals and other pollutants.
• Alcohol: Alcohol passes across the placenta into the foetal bloodstream very easily, so, in effect, if you are drinking alcohol, so is your baby. There is no safe amount of alcohol to have when you're pregnant; you should completely avoid alcohol.
• Junk food: As always, a little what we fancy is fine, but lots of high fat and sugar, low nutrient foods just fill you up with empty calories, reducing your chances of getting all the nutrients you need from a health balanced diet.

Special diets in pregnancy

• Fasting during pregnancy, for example, Muslim women during Ramadan: Islamic law is clear that fasting isn't required during pregnancy if there's any concern about impact on the health of the mother and the baby. However, many pregnant women do still choose to fast during Ramadan, and for most people this can be done safely and sensibly.[iv] An adequate regular intake of calories, nutrients, and fluids is crucial. For Muslim women living in countries with highly varying daylight hours on a year where Ramadan falls in summer, this may need to be taken into account.
• Vegetarian and vegan diets: Vegans and vegetarians can have a complete and healthy diet, but it's important to plan for the extra nutritional requirements in pregnancy. Being aware of those nutrients that are harder to get from strict plant-based diets is essential, and the diet is likely to require supplements including vitamins B12 and D, iodine, zinc, and calcium.[v]
• Diabetes: People with type one diabetes or gestational diabetes may need to be extra cautious in pregnancy, and are likely to need to make some adjustments to their eating habits and insulin regime. Diabetics should have specialist input to help them through pregnancy, and will need to keep an extra close eye on their blood sugar.[vi]

Following a healthy balanced diet is particularly important in pregnancy – and most diets followed for health, religious, or ethical reasons can be adapted to adequately meet needs in pregnancy.

Restrictive diets designed for weight loss, especially those very low in calories, carbohydrates, and other essential nutrients are not a good idea in pregnancy, and if you're planning to follow a very restrictive diet in pregnancy, this must be discussed with a specialist first.

Morning sickness

Morning sickness is common, especially in the first trimester of pregnancy. If you're still able to get enough food and fluids over the course of the day to stay well, it's normal and should pass.

If you're concerned, it's okay to ask your midwife or doctor for advice.

If morning sickness becomes unmanageable and you're unable to keep down enough food or water to stay healthy, this may be a condition called hyperemesis gravidarum, which needs medical attention.

Weight gain and weight loss in pregnancy

People who are very overweight or obese when they become pregnant may be advised that their pregnancy and childbirth may be safer if they do try to lose a little weight.

It's a good idea to follow a healthy balanced diet, and to continue to exercise, or take up gentle exercise within your own limits.

However, attempting any significant weight loss beyond following a healthy diet and lifestyle should usually only be done with input from healthcare professionals who specialise in nutritional needs in pregnancy, whether that's a midwife, obstetrician, or dietitian.

The priority is to make sure that you get enough calories and nutrients to keep yourself and your baby healthy, while reducing some of the risks associated with obesity in pregnancy.[vii]

Cravings

We've all heard of those strange cravings that people sometimes get in pregnancy – usually stories of unpleasant-sounding combinations that can only make sense in pregnancy!

It does happen, but it's more common to have cravings for normal foods. It isn't always clear why some people crave certain things in pregnancy, or why there should be such a wide variety in the things pregnant women crave.

There are some theories that it's the body's way of telling us that we need more of a certain nutrient, but cravings aren't usually consistent with being low in a certain nutrient.[viii]

Healthy diet, healthy pregnancy

Pregnancy can be an incredibly exciting time, but it can also be a time of great change and cause anxiety.

There are many aspects of pregnancy which aren't within our control but making healthy lifestyle choices is one thing we can do to improve our experience with pregnancy, childbirth, and a new baby.

If you have any concerns about your pregnancy, get in touch with your midwife or one of the other healthcare professionals supporting you through this journey.

This article was first published in Homage.