It won’t come as news to mothers-to-be that they are not eating for two, as the old saying goes, but the number of extra calories needed may come as a surprise. And it’s much fewer than you might think.
Pregnant women need about 300 extra calories a day in the second trimester and 500 more in the last trimester and while breastfeeding, according to this month’s updated guidelines on nutrition during pregnancy. The emphasis should be on quality — nutrient-rich foods such as vegetables, fruit, wholegrains lean protein and dairy rather than quantity, the guidelines say.
While women are not eating for two, there is another doubling-up effect that has very positive long-term health implications,says Louise O’Mahony, senior dietician at Cork University Maternity Hospital.
Pregnancy is the only time in life when health professionals get to see ‘two patients in one’, she says, so it’s a great moment to put in place long-term health behaviours.
Women are willing to do anything to boost their health and, by implication, that of their baby: “I never see patients more motivated than in pregnancy,” says the dietician.
Good nutrition is linked with more favourable pregnancy outcomes. If we can optimise maternal nutrition it gives baby the best start in life and it helps to decrease the risk of heart disease, obesity and diabetes, not just for the mother but for the baby in the longer term.
Yet, for all that, the message on the importance of taking folic acid before and during pregnancy has still not hit home.
“Women are not hearing that message,” say Louise O’Mahony, Linda Culliney and Ingrid Brockie, who make up the team of maternity dieticians at the hospital where 8,000 babies are born every year.
On average, women start to take folic acid at week five but the neural tube which goes on to form the entire nervous system has already started to develop between days 21 to 28.
That is when folic acid is needed to prevent neural tube defects, such as spina bifida, which accounts for more than half of all neural tube defects in Ireland.
“All women planning a pregnancy or at all likely to become pregnant should betaking their folic acid (400 micrograms)and continuing throughout pregnancy and lactation,” says Louise.
Supplements are extremely cheap and available over the counter but some women — those at risk of neural tube defects, with pre-existing diabetes or with obesity — will need a prescription for higher doses.
The new guidelines also outline the importance of getting enough Vitamin D, the so-called sunshine vitamin which,unsurprisingly, is hard to get in Ireland.
Also, at Ireland’s latitude, the vitamin is generated on the skin from March to October only, so it makes sense to check levels and take a supplement if necessary.
Pregnant women are also advised to limit their intake of caffeine to 200mg a day. That translates to two to four cups of tea, two cups of instant coffee or one cup of filtered coffee. They should also be aware that there is caffeine in cola drinks and chocolate, says O’Mahony.
As for alcohol, it’s best to cut it out completely, say the experts, and while breastfeeding, to have just one or two units a day and to try to leave two to three hours before breastfeeding.
It’s also really important to continue to exercise. Some women just stop but the experts recommend that women get at least 30 minutes of aerobic exercise, such as pregnancy pilates, at least five times a week.
The HSE and RCPI Clinical Practice Guideline for Nutrition in Pregnancy 2019 were launched on November 4 to help healthcare professionals give women the best advice at a time when they often receive conflicting messages. They aim to dispel confusion, says Louise. She advises pregnant women to always seek advice if they are worried and if they do go online, to consult reputable websites.