The second blog in the series, written by our resident nutritionist – Claire Glazzard

If you are pregnant – congratulations! There are so many wonderful experiences during pregnancy. Some days may not go to plan…nausea, sickness, tiredness, heartburn, constipation and everyday life can get in the way and these can have an impact on your food intakes during pregnancy. However this is good time to look after yourself and your baby by eating healthily and keeping active.

Healthy weight gain during pregnancy

You will gain weight in pregnancy. But keeping your weight gain to a healthy level, by eating well and keeping active, will be good for you and your baby.

Everyone’s body shape during pregnancy is different and perhaps the changes occurring in your body have made you more aware of these differences. The size and position of your bump, the weight gain or shape changes in other areas of your body can all vary from person to person.

A healthy pregnancy weight gain will help to avoid having a low birth weight baby and decrease the risks associated with it. Babies with low birth weight have an increased risk of developing various diseases in adulthood, such as heart disease, hypertension and type 2 diabetes.

Should I be eating for two?

There is a common misconception that a pregnant women needs to increase their energy requirement. Regardless of whether you are growing one, two or three babies, there is no need to increase the amount you are eating. Overeating can put you at risk of gaining excessive weight during pregnancy, this can lead to complications, such as gestational diabetes, pre-eclampsia (high blood pressure), thromboembolism (blood clots). This risk of complications during labour are also increased.

The actual recommended increase in energy requirement is in the last 12 weeks of your pregnancy – about 200 calories per day. Below are some healthy snack ideas, which are all about 200 calories:

• Any fruits and vegetables
• Beans on toast
• Peanut butter on apple slices, toast or crackers
• Plain yogurt
• Egg and toast

 

Food safety and hygiene

Whether you are pregnant, planning a baby or have just had your baby, it is more important than ever to be careful about how you prepare and store food in the home to avoid the nasty bugs that can cause food poisoning. Some basic guidelines below can really help to reduce your risk of getting food poisoning:

• Wash your hands with soap and warm water and dry them – before handling and preparing food
• Clean work surfaces including your chopping boards and utensils thoroughly before and after preparing food, especially if you are preparing raw foods such as raw meat.
• Wash fruit, vegetables and salads to remove all traces of soil, which may contain toxoplasma (a parasite that can cause toxoplasmosis) which can harm your unborn baby.
• Use a separate knife and chopping board for raw meats.
• Make sure that raw foods are stored separately from ready-to-eat foods, otherwise there’s a risk of contamination.
• When you cook food, make sure that it is piping hot all the way through. Make sure that any meat, whether cooked in your kitchen or on the barbeque is thoroughly cooked. During pregnancy, all rare (pink) meats should be avoided, including lamb and beef.
• Do not refreeze raw foods or foods meant to be frozen. Defrosted raw foods can be stored in the fridge for up to 2 days before being cooked. Defrosted cooked food must be reheated and eaten immediately.

 

Are there any foods to avoid?

A healthy balanced diet during pregnancy will help your baby to grow healthily and give them the best start in life, as well as helping you to feel your best. However, when you are pregnant there are certain foods that you are recommended to avoid or take care with as there is a small risk they may make you ill or harm your baby.

If you are concerned about anything you have eaten or drunk you should talk to your GP or midwife, but it is important to recognise that the risk of getting food related illnesses during pregnancy is low.

1.       Cheese

Pregnant women are advised to avoid some soft cheeses as they are less acidic than hard cheese, this means they can be an ideal environment for harmful bacteria, such as listeria, to grow.

 

Soft cheeses with white rinds: Do not eat mould-ripened soft cheese (cheeses with a white rind) such as brie and Camembert (unless they have been cooked thoroughly, until steaming hot all the way through).

Soft blue cheeses: You should also avoid soft blue-veined cheeses such as Danish blue, Gorgonzola and Roquefort (unless they have been cooked thoroughly, until steaming hot all the way through).

Enjoy all hard cheeses, these are safe in pregnancy, such as cheddar, parmesan and Stilton, even if they’re made with unpasteurised milk. Other than mould-ripened soft cheeses, all other soft types of cheese are OK to eat, provided they’re made from pasteurised milk (cottage cheese, mozzarella, feta, cream cheese, ricotta, halloumi).

2.       Raw or partially cooked eggs

Some eggs are produced under a food safety standard called the British Lion Code of Practice. Eggs produced in this way have a logo stamped on their shell, showing a red lion. Lion Code eggs are considered very low risk for salmonella, and safe for pregnant women to eat raw or partially cooked.

Salmonella food poisoning is unlikely to harm your baby, but it can give you a severe bout of diarrhoea and vomiting.

If you do not know whether the eggs used are Lion Code or not (for example, in a restaurant or cafe), ask the staff or, to be on the safe side, follow the advice for non-Lion Code eggs.

Non-hen eggs such as duck, goose and quail eggs should always be cooked thoroughly.

3.       Pâté

Avoid all types of pâté in pregnancy, including vegetable pâtés, as they may contain listeria. Liver and liver products can have high levels of vitamin A, which can be harmful to baby.

4.       Meat and game

• Do not eat raw or undercooked meat, including meat joints and steaks cooked rare, because of the potential risk of toxoplasmosis.
• Toxoplasmosis is an infection caused by a parasite found in raw and undercooked meat, unpasteurised goats’ milk, soil, cat poo, and untreated water. It is important to remember toxoplasmosis in pregnancy is very rare.

·         Be cautious with cold cured meats in pregnancy. Many cold meats, such as salami, prosciutto, chorizo and pepperoni, are not cooked, they’re just cured and fermented. This means there’s a risk they contain toxoplasmosis-causing parasites.

• It’s best to check the instructions on the packet to see whether the product is ready to eat or needs cooking first.
• Enjoy pre-packed meats such as ham and corned beef are safe to eat in pregnancy. Some websites based in other countries may suggest that you avoid pre-packed meats when pregnant, but this is not the advice in the UK.
• Do not eat liver or products containing liver, such as liver pâté, liver sausage or haggis, as they may contain a lot of vitamin A. Too much vitamin A can harm your baby.
• It is best to avoid eating game that has been shot with lead pellets while you’re pregnant, as it may contain high levels of lead. Venison and other large game sold in supermarkets is usually farmed and contains no or very low levels of lead.

5.       Fish and shellfish

• You can enjoy most types of fish when you’re pregnant. Eating fish is good for your health and the development of your baby, but you should avoid some types of fish and limit the amount you eat of some others.
• You should not eat shark, swordfish or marlin.
• You should limit the amount of tuna you eat to:

• • no more than 2 tuna steaks a week (about 140g cooked, or 170g raw each), or
  • 4 medium-size cans of tuna a week (about 140g when drained)

• This is because tuna contains more mercury than other types of fish. The amount of mercury we get from food is not harmful for most people, but could affect your baby’s developing nervous system if you take in high levels of mercury when you are pregnant.
• When you are pregnant, you should also avoid having more than 2 portions of oily fish a week, such as salmon, trout, mackerel and herring.
• Remember, tuna does not count as oily fish, so you can eat tuna (2 tuna steaks or 4 medium-size cans) on top of the maximum amount of 2 portions of oily fish.
• Always choose cooked, rather than raw, shellfish – including mussels, lobster, crab, prawns, scallops and clams – when you’re pregnant, as raw shellfish can contain harmful bacteria and viruses that can cause food poisoning. Cold pre-cooked prawns are fine.

6.       Vitamin and fish oil supplements

Do not take high-dose multivitamin supplements, fish liver oil supplements, or any supplements containing vitamin A.

7.       Milk and yoghurt

• Enjoy pasteurised or ultra-heat treated (UHT) milk, which is sometimes called long-life milk.
• Do not drink unpasteurised goats’ or sheep’s’ milk, or eat foods made from them, such as soft goats’ cheese.

What about peanuts?

You can eat peanuts or food containing peanuts, such as peanut butter, during pregnancy, unless you’re allergic to them or a health professional advises you not to.

This advice has now changed because the latest research has shown no clear evidence that eating peanuts during pregnancy affects the chances of your baby developing a peanut allergy.

What about tea and coffee?

It is important that you remember to drink plenty of fluid during pregnancy and water and reduced fat milks are good choices.

Is recommended that caffeine intake during pregnancy should be limited to 200 mg per day. Caffeine is found in coffee, tea, chocolate, some sports/energy drinks, some soft drinks and some cold and flu remedies.

• a mug of instant coffee: 100mg

• a mug of filter coffee: 140mg
• a mug of tea: 75mg
• a can of cola: 40mg
• a 250ml can of energy drink: 80mg (larger cans of energy drink may have up to 160mg caffeine)
• a 50g bar of plain (dark) chocolate: most UK brands contain less than 25mg
• a 50g bar of milk chocolate: most UK brands contain less than 10mg

To cut down on caffeine intakes you could try decaffeinated versions of tea, coffee and cola.

Do not worry if you occasionally have more than this amount, as the risks are small.

Note. Coffee from a coffee shop or restaurant may contain higher levels of caffeine compared to coffee made at home.

 

Herbal and green teas

Little is known about the safety of herbal and green teas in pregnancy so it is advised that you drink them in moderation and stick to those made with ingredients that tend to be a normal part of the diet – for example mint or blackcurrant tea. Remember that green tea contains caffeine.

The Food Standards Agency advises that pregnant women should not drink more than 4 cups a day.

Alcohol – see Planning for Pregnancy Blog

What about supplements?

Eating a healthy, varied diet during pregnancy will help you to get most of the vitamins and minerals you and baby need. There are a few really important micronutrients that supplements are recommended for during pregnancy.

Folic Acid: see Planning for Pregnancy Blog

Vitamin D

Everyone needs vitamin D – it helps us absorb the right amount of calcium and phosphate in the body (needed to keep our bones, teeth and muscles healthy). If you’re pregnant, or breastfeeding, you should consider taking a daily vitamin D supplement.

Foods like oily fish (salmon, mackerel, herring and sardines), eggs, red meat and fortified foods (such as fat spreads and some breakfast cereals) contain vitamin D. However, it would be difficult to get the amount of vitamin D you need from food alone.

From late March/early April to the end of September, most of us should be able to get enough vitamin D from the sunlight.

To make sure that you get enough vitamin D all year round, all pregnant and breastfeeding women are advised to take a daily supplement containing 10 μg of vitamin D. This will also help to provide your baby with enough vitamin D for the first few months of his or her life.

If you have dark skin or always cover your skin

If you have dark skin (for example, if you’re of African, African Caribbean or south Asian origin) or always cover your skin when outside, you may be at particular risk of not having enough vitamin D (vitamin D insufficiency). Talk to a midwife or doctor if this applies to you.

You may be able to get free vitamins if you qualify for the Healthy Start scheme

Avoid too much vitamin A

Vitamin A is important for good health and for the healthy development of your baby, but large amounts during pregnancy is linked to a higher risk of birth defects. You should not take any supplements containing vitamin A or retinol (also watch out for multivitamin supplements which may contain these and fish liver oil supplements such as cod liver oil).

I am a vegetarian, do I require any additional supplements? (vegan and special diets in pregnancy)

Overall, well-planned vegan and vegetarian diets are perfectly healthy during pregnancy. There are however, some nutrients, that can be harder to get in sufficient amounts from plant-based sources. Including iodine, iron, omega-3 fatty acids and vitamin B12. If you’re concerned that your intake might be low and are unsure whether to supplement, you can discuss with your GP, pharmacist or midwife.

Cravings…

It is thought that hormonal changes and high energy needs simply lead to us wanting certain tastes and disliking others. There is no evidence to demonstrate specific nutritional benefit or safety reasons for cravings or aversions, as these vary from person to person. Listen to your body and as long as it is safe to do so, go with it. Maintaining a healthy balanced diet as much as possible is still a good idea.

Top tips:

Constipation: eat wholemeal bread, fibre rich foods, fruit and vegetables and stay hydrated. Gentle exercise.

Nausea and sickness: eat little and often, choose foods that are starch based (bread, crackers, breadsticks, rice cakes), stay hydrated (drink little and often). Try ginger-rich foods or drinks.

Indigestion: try eating smaller meals regularly and snacks. Avoid fatty, fried or spicy foods. Try keeping a food diary to help find out if there is a food causing the indigestion.

Tiredness: eat little and often, stay hydrated, rest when you can, slow down. Get your iron levels checked, speak to you GP or midwife.

If you would like to discuss any of the above information in more detail, get top tips specific to you and your pregnancy, ask personal questions or seek advice. Please book a one hour one to one online appointment with Claire. We are taking bookings now for appointments from May 1^st 2020.

 

References

• British Nutrition Foundation (BNF). (2016). Pregnancy and Preconception. Available at:https://www.nutrition.org.uk/nutritionscience/life.html
• Gordon, J. (2019). Pregnancy and Diet: Food Fact Sheet. British Dietetic Association. Available at: uk.com/foodfacts
• National Health Service (NHS). (2020a) Start4Life. Available at:https://www.nhs.uk/start4life
• National Health Service (NHS). (2020b). Healthy Start at: https://www.healthystart.nhs.uk/
• National Institute of Health and Care Excellence (NICE) (2010) Public Health Guideline (PH27) Weight management before, during and after pregnancy. Available at: https://www.nice.org.uk/guidance/ph27
• Scientific Advisory Committee on Nutrition (SACN) (2004) Advice on fish consumption: benefits & risks. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/338801/SACN_Advice_on_Fish_Consumption.pdf