Good nutrition during pregnancy is vital for the health of women and developing babies, but foods consumed during pregnancy also influence the baby’s future health, according to nutritionists and dieticians. 

“It’s another good reason to be mindful of food choices during pregnancy," said Nutrition Australia’s Senior Public Health Nutritionist, Kasey Bateup.

It’s important that pregnant women eat a varied diet that includes the five food groups each day, advised Ms Bateup:

1. Vegetables and legumes
2. Fruit
3. Whole grains
4. Lean meats, poultry, fish, eggs, tofu, nuts and seeds
5. Milk, yoghurt and cheese or dairy alternatives such as soy products. 

However, be aware of kilojoule intake because the age-old adage that pregnant women need to eat for two is a myth.

“Kilojoule requirements for women of a healthy weight before pregnancy only increase modestly to around 1,400 kilojoules (350 calories) in the second trimester and up to 2,000 kilojoules (500 calories) in the third trimester,” said Ms Bateup.

The role of supplements during pregnancy

While it’s best to meet nutrient requirements from foods, there is a role for supplements during pregnancy, said Ms Bateup, as long as they are pregnancy-specific and safe during pregnancy.

“Folic acid, which is added to most pregnancy supplements, should ideally be taken for three months leading up to conception to help reduce the risk of neural tube defects.

“Make sure pregnant woman seek advice from a doctor regarding vitamin supplements and other medications during pregnancy, said Ms Bateup.

Dietician and Nutritionist Stefanie Valakas has a particular interest in fertility, pregnancy and paediatric nutrition, and encourages women to take a prenatal supplement, probiotic and adequate omega-3 fatty acid post-conception and during pregnancy.

“Omega-3 fatty acid status before and during pregnancy has been shown to reduce the risk of early labour by 10-fold.

“It’s important to take a prenatal supplement that contains folate and iodine as well as Vitamin B3,” said Ms Valakas. 

Foods to avoid during pregnancy

Pregnant women often feel overwhelmed by the long list of foods they should avoid during their pregnancy, said Ms Bateup, so reminding them that it's only for a short period is helpful.
 
Nutrition Australia advises that pregnant women avoid foods that may be contaminated with listerias, such as soft and semi-soft cheeses, soft service ice-cream, and unpasteurized dairy.

“It’s best to err on the side of caution, especially if it’s uncertain how the food has been prepared or what ingredients have been used. It always pays to have a snack in a handbag for this reason,” said Ms Bateup. 

The microbiome and probiotics in pregnancy

It’s vital to build up a healthy gut microbiome in pre-conception and during pregnancy and lactation, said Ms Valakas. 

“This (building the healthy gut microbiome) is important because the gut of the growing baby is sterile until exposed to the mother's microbiota through vaginal delivery or breastfeeding. 

“Exposing baby to a diverse range of bugs is important. Research has shown that for infants with a family history of eczema, taking a probiotic of Lactobacillus rhamanosus GG during pregnancy and during the post-partum period resulted in a reduction of the incidence of eczema in infants.

“Probiotics should be included before, during and after pregnancy to optimise the benefits passed onto the baby via delivery and breastfeeding," said Ms Valakas.

Midwives and their role in nutrition education 

A midwife is often the first healthcare professional a pregnant woman meets during her antenatal care, which makes them well placed to support healthy eating, said Ms Bateup.

“Encouraging (pregnant woman to consume) nutritious foods from the five food groups and limiting highly processed foods which have little nutritional value is a great place to start.

“While it's appropriate for midwives and other members of the antenatal care team to encourage pregnant women to eat well, it's not appropriate to promote dieting or weight loss during this time.

“This includes recommending restrictive diets, taking detailed food diaries and counting kilojoules.

“If a pregnant woman develops gestational diabetes, or is losing weight during the second and third trimesters, it’s important that they are seen by an Accredited Practicing Dietitian to make sure they are meeting their energy and nutrient requirements,” advised Ms Bateup. 

Diet diaries & healthy eating tips

Clinical Midwife and Naturopath Meghan Arthurson said healthy eating and supplements during pregnancy improves stress and energy levels and helps women prepare both physically and emotionally for birth.

“I often use diet diaries as a tool to educate women about the importance of eating a varied diet and as an opportunity to discuss practical ways in which families can incorporate healthy eating habits,” said Ms Arthurson. 

Ms Arthurson suggests the following healthy eating tips during pregnancy:

• Consume plenty of fruit and vegetables to provide all the nutrients and minerals the pregnant body needs (calcium, magnesium, zinc, B-vitamins, folate, iodine, Vitamins C/E/A/D).
• Include whole grains and healthy sources of protein in the diet to maintain blood sugar and energy levels.
• Identify iron-rich foods to prevent anaemia.
• Discuss safe ways to consume fish and seafood in pregnancy and while breastfeeding to ensure an adequate intake of EPA/DHA which is vital for baby's developing brain.
• Avoid foods that might cause listeriosis, salmonellosis and toxoplasmosis.

Healthy snacks during pregnancy

• The following healthy, easily digested protein-rich snacks are perfect during pregnancy, advised Ms Arthurson.
• Organic full-fat yoghurt (such as Jalna) with nuts/seeds, berries and bananas
• A handful of nuts (almonds & walnuts) & seeds (flaxseed, sesame, sunflower)
• Organic rice or wheat crackers with avocado
• Hard-boiled egg
• Baked beans on a piece of sourdough or wholegrain toast
• Spirulina smoothie & banana, berries with nuts and seeds
• Nut butter on toast or cut up apple or celery sticks
• Hummus or bean dip & crackers or cut up apple or celery sticks
• Steamed veg & nut/seed mix or goat's or cottage cheese
• Scrambled eggs on toast

Nutrition in the preconception and postnatal period

Ideally, it’s beneficial to provide healthy eating education in the preconception period to address deficiencies, explained Ms Arthurson, and ongoing support postnatally.

“Often, I discuss healthy eating in the postnatal period, just before the woman leaves the hospital or at a home visit and mention how to prepare for the next baby as a part of discussing contraception and normal postnatal hormonal physiology.

“Discussing the links between healthy eating and prevention of pregnancy complications such as anaemia, high BMI and adverse birth outcomes, hypothyroidism, gestational diabetes, baby's immune system health and bone and brain development are good motivators to make changes," said Ms Arthurson.  

Tips on managing morning sickness

Morning sickness can hinder good intentions when it comes to eating well, so being prepared is essential to maintaining proper nutrition.

Writing a list of snacks or meals that are appealing during a bout of morning sickness and putting it on the fridge is one way to avoid nutritional deficiency, explained Ms Arthurson.

“So, when a woman is feeling too nauseous or too tired to eat or cook her partner can pick something off the list.

“Having healthy snacks on hand, beside the bed or in a handbag, desk or car, can help to manage morning sickness by maintaining blood sugar levels and preventing sudden cravings for sugary foods," said Ms Arthurson.

While midwives play an essential role in educating pregnant women on nutrition during pregnancy, an accredited practising dietitian is a critical part of any pregnant woman's health care team, said Ms Valakas.

“Nutrition during the first thousand days of life is critical in reducing the risk of chronic disease in children.”