Preparing for pregnancy. Part 1: balanced nutrition.

Pregnancy involves instincts that were embedded in our genes thousands of years ago. These instincts tell the consciousness what to do to keep and carry the baby. Balanced nutrition is one of the important components of this preparation. Presently, the whole hectic world with its delights and drawbacks slows down and recedes so that the expectant mother can listen to herself and the life emerging inside.

Schedule and balanced nutrition

Morning. Sleep lasting at best 5–6 hours, a quick breakfast and watching the news on the way to work, where you need to make decisions, take responsibility and contact with people. Household chores, gym, self-care – this is the image of a modern woman. How does pregnancy fit into this structure?

Why pre-gravid consultations are important

Gestation and further development of the child will be happier if parents can prepare for conception in advance. The health of both mother and child depends on it. To prepare for conception, we recommend preconception counseling for all women of reproductive age during scheduled and unscheduled visits to an obstetrician-gynecologist. Consultations allow you to learn how to maintain reproductive health in general, to prevent abortion. Examination and correction of detected diseases reduce the risk of complications of pregnancy, childbirth and postpartum period.

Unplanned pregnancies are dangerous because a woman could be intoxicated with chronic diseases, hypovitaminosis, bad habits – all this doctor can correct during preliminary consultations. According to the Public Health Agency of Canada, half of pregnancies are unplanned, and women’s health is often undermined by various factors:

73% of women drink alcohol;
23% of women aged 20 to 34 smokes;
16% of women aged 20 to 29 smoke cannabis;
58% of women do not take folic acid before pregnancy;
10% of women have low serum ferritin concentrations;
16% of women aged 25 to 34 are obese, 22% are overweight.

Regarding the point about weight: just in the last 10 years, obesity rates have doubled!

What is the threat of this?

For the mother: early abortions and miscarriages, the threat of abortion, the development of preeclampsia and gestational diabetes, anemia and thromboembolic disorders. For the child: congenital malformations, frequent neural tube defects, defects of the cardiovascular and maxillofacial systems, chromosomal abnormalities.

Prenatal preparation helps to adjust the lifestyle to reduce all risks and make the pregnancy experience as positive as possible for the woman. This article is about nutrition correction before and during pregnancy.

Planning a balanced nutrition: the diet

Pregnancy changes your needs for nutrients – establishing good nutritional habits in advance can help optimize the health of the mother and fetus. Overall, evidence supports the benefits of a healthy diet that includes sufficient calcium, vitamin D, folic acid and iron in the period before conception.

How to plan your nutrition:

Vegetables, fruits, large leafy greens, whole grain products (rye bread, bran, bread);
Unsaturated fats: olive and sesame oil, nuts, avocado;
Fish and seafood. Avoid fish with high mercury content: tuna, wild sea bass, tile fish, etc. Eat 2–3 servings of other types of fish per week;
Meat or meat by-products, especially red lean meat (beef) and liver. Better to reduce the consumption of chicken or replace it with turkey.

What to limit in the diet:

Dairy. You can eat sour-milk products, but better to exclude milk from the diet. Or choose lactose-free products;
Salt. You should consume no more than 5 g per day (slightly less than a teaspoon), which is equal to 2 g of sodium. Increased sodium content in the body can lead to the development of hypertension or worsen its course;
Caffeine. According to AJGP research, consumption of more than 300 mg of caffeine per day, that is 2 standard servings of coffee, increases the risk of fetal loss by 31%;
Sugar. WHO strictly recommends limiting the share of sugar to 10% of the total energy balance of the diet, optimally – to 5%. With an average caloric intake of 2000 kcal, 5% is 25 g of sugar or 6 teaspoons. As a gynecologist-endocrinologist, I recommend removing sugar from the diet totally and replace it with seasonal fruits for lunch or breakfast;
Processed food. Especially if it’s high in calories, trans fats, food additives and flavor enhancers, emulsifiers, refined sugars, hydrogenated fats and modified starches. According to research by the National Institute of Health, these products increase your chances of cardiovascular disease and mortality;
Alcohol. It can affect the fetus at any stage of pregnancy and provoke fetal alcohol syndrome, which includes growth deformities, facial abnormalities, central nervous system disorders, behavioral disorders and intellectual disabilities. Also, alcohol consumption in early pregnancy increases the risk of spontaneous abortion (ACOG, 2019 guidelines).

Although, diets that strictly limit one or more food groups (except for medical diets prescribed by a doctor) should be avoided before and during pregnancy.

Body mass index and balanced nutrition

Body mass index (BMI) is an important indicator of changes in eating habits and physical activity. It allows assessing the degree of correspondence between the weight of a person and his/her height, and thus indirectly judge whether the weight is insufficient, normal or excessive.

Before attempting to become pregnant, try to achieve a BMI in the normal range, since high or low BMI is associated with infertility and complications during pregnancy.

Women who are overweight and obese before conception should be counseled about the increased risk of adverse maternal and perinatal outcomes, especially neural tube defects, macrosomia, premature birth, stillbirth, gestational diabetes, hypertension and thromboembolic disorders.

Underweight and weight loss

It is crucial that during pregnancy it is not recommended to lose weight, regardless of what it was initially. Counseling will allow you to determine individual tactics for weight loss by 5-10% within 6 months during pregnancy planning.

Being underweight increases the risk of premature birth. It also increases the risk of low birth weight, or that the baby weight is insufficient for gestational age. This may indicate intrauterine fetal growth retardation or birth defects such as gastroschisis. In the case of underweight, it is worth undergoing an examination and, if necessary, therapy for eating disorders, namely anorexia and bulimia.

Eating well and quitting bad habits before conception is important not only for women, but also for men (more about the role of men in conception here). Men are also encouraged to change their eating habits to reduce the risks for the woman during pregnancy and the life of the child.

About vitamins that are important in preparing for pregnancy, I tell in this article.

To obtain basic knowledge and to get acquainted with general recommendations for couples preparing for conception, you can also use my lectures within the course – WeMakeFamily. Preparing for pregnancy. 

I’m eager to file all of these courses in English, just send me a request to dr.silinaeducation@gmail.com.

💕  to everyone

With love, your Natalia Silina,
doctor of gynecologist-endocrinologist,
UNICEF and UNFPA expert on sexuality education

Sources:

1. World Health Organization. Meeting to develop a global consensus on preconception care to reduce maternal and childhood mortality and morbidity: 2012 Feb 6–7 meeting report. Geneva (CH): WHO; 2013
2. Edwina Dorney, Kirsten I Black. Preconception care. Australian Journal of General Practice, July 2018
3. Family-Centred Maternity and Newborn Care: National Guidelines Chapter 2: Preconception care. Public Health Agency of Canada, December 2017
4. American College of Obstetricians and Gynecologists. Prepregnancy Counseling. Fertility and Sterility, January 2019
5. Professor Judith Stephenson, FFPH, Dr Nicola Heslehurst, PhD. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet, May 2018
6. Zohra S Lassi, Ayesha M Imam. Preconception care: caffeine, smoking, alcohol, drugs and other environmental chemical. Reproductive Health, September 2014