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A Balanced Diet Is Crucial for a Normal Pregnancy

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Pregnancy is a critical period of growth, development and physiological changes in both a mother and child. Nutritional considerations are crucial during this period. Nutrient intake and body fat before conception influence the mother’s health during pregnancy and the growth and development of the fetus and is something to be taken seriously (Brown, 2017, pg. 56). Increased BMI is often correlated with adverse health outcomes for both the woman and the fetus. An obese mother is at a greater risk for gestational diabetes and preeclampsia, while the fetus is at risk for stillbirth and congenital anomalies (Leddy et al, 2008). Not only does maternal obesity have implications for fetal development, that child is also at an increased risk for childhood obesity and diabetes. Risk of pregnancy complications appears to go up with increasing BMI, and weight loss prior to conception has been shown to have favorable outcomes.

However, BMI is not always an accurate representation of health. While excess body fat can lead to fertility problems, not all individuals with a higher BMI are at risk for health problems. One can still have a healthy pregnancy is they are considered metabolically healthy (Brown, 2017, pg.73). Metabolic syndrome is a cluster of abnormal metabolic indicators often seen in individuals classified as obese. These include large waist circumference, elevated blood triglycerides, blood pressure, and fasting blood glucose, and low HDL cholesterol levels. Research indicates that utero exposure to metabolic syndrome may contribute to the offspring developing the syndrome later in life (Ryckman et al, 2013). While a woman may be overweight, if she has no evidence of metabolic syndrome she may not need to lose weight. Instead, she should focus on nutrition and proceed with caution.

When a woman becomes pregnant, nutrition becomes very important to ensure a healthy baby. Often women do not focus on this until after they are pregnant but doing so before conception can provide favorable outcomes. There are several nutrients to be mindful of when looking to become pregnant. Folic acid is one of uttermost importance. This B vitamin is vital for making red blood cells, as well as for the synthesis of DNA and RNA, aiding in cell division and growth and enhancing brain health (Brown, et al, 2018, pg. 112-113). The absence of folic acid increases the possibility of a child being born with a neural tube defect, Spina bifida being one of the most common. The US Public Health Services currently advises for women to take 400 micrograms of this nutrient before getting pregnant to avoid this complication (American Pregnancy Association, 2019). Folic acid can be obtained naturally through green leafy vegetables, whole grains, nuts and legumes. However given its importance, additional supplementation is often recommended.

Iron is another nutrient of concern. Poor iron status prior to pregnancy is not uncommon, and is associated with reduced fertility (Brown et al, 2018 pg. 58). Iron’s major role in the body is to transport oxygen throughout the body via hemoglobin in the blood (Brown, et al, 2018, pg 24). During a normal pregnancy blood volume increases in the mother by 20% (Brown, et al, 2018, pg. 94). This leads to an increase need for iron to oxygenate the body, as well as to build iron stores in the developing fetus. Low iron prior to pregnancy increases the risk that iron-deficiency anemia will occur during pregnancy and that the baby will be born with low iron stores. It also increases the incidence of pre-term delivery, which is associated with a number of problems (Oregon State University, 2019). If iron levels are within normal range, focus should be put on consuming healthy iron rich foods, such as spinach, beans, lentils, and broccoli.

Once a woman becomes pregnant, there are other nutrient considerations to be made. Certain micronutrient needs increase substantially during pregnancy, such as folic acid, iron, iodine and zinc (Oregon State University, 2019). Others are slightly increased or even unchanged, but under consumed by pregnant woman. Each plays a vital role in the developing fetus. Vitamin A plays an important role in cell differentiation, while vitamin D supports fetal growth through the addition of calcium to bone. Vitamin D deficiency is pregnant women is associated with babies being born smaller than average, hypocalcemia, and poorly calcified bones. Calcium is needed for fetal skeletal mineralization, and iodide for fetal brain development (Brown, et al, pg.115).

Nutrient needs should be met primarily through a well balanced diet, which provide adequate macronutrients and micronutrients. A prenatal vitamin is often taken to ensure these needs are being met. While this is not meant as substitute for a healthy diet, increased nutrient needs are required to support both maternal and fetal health, which is sometimes difficult obtain through diet alone. For example, iron needs increase from 18 milligrams to 27 milligrams during this time. Non-pregnant women consuming the recommended amount of iron, 18 mg, absorb only about 1.8 mg (Brown et al, pg. 119). Given this consideration the likelihood of a woman consuming enough iron for the placenta, fetus, increased blood mass and her own needs is unlikely through just diet.

Healthy dietary choices are emphasized during pregnancy such as whole grains, fruits and vegetables, low fat dairy, nuts, legumes and poultry. Needs for macronutrients are increased during this time, which can be met through a well balanced diet. Emphasis is made on choosing whole grain carbohydrates, lean proteins, and healthy fats, particularly omega-3’s. Women should abstain from drinking alcohol during this time, as it readily passes through the placenta to the fetus, which may interrupt normal development (Brown, et al, pg. 110). Excessive alcohol intake also puts the baby at a high risk for being born with fetal alcohol syndrome, which has lasting implications on the child.

Water on the other hand, should be increased to maintain proper hydration. There is a common misconception that when you are pregnant you are, “eating for two”. In fact, caloric needs are not increased until the second and third trimester, and only consist of about 300 additional calories per day (Brown et al, pg. 105. For a client with a BMI of 28, the recommended weight gain throughout the pregnancy is 15-25 pounds. This gain starts off slowly and becomes more apparent during the second trimester. While a woman may be overweight, if she is metabolically healthy weight gain prior to conception may not be necessary to avoid adverse pregnancy outcomes. Instead focus should be put on healthy dietary choices, vital nutrients and appropriate weight gain for her specific BMI.

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