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    Recommended diet during pregnancy

    • Calorie intake

      During pregnancy the nutritional needs of the mother are increased and extra caloric intake is required for the normal fetal growth and for the maternal metabolism. The calorie requirements vary, depending on the mother’s basic metabolism, her pre-pregnancy weight, her physical activity and the stage of pregnancy. The needs of an adult pregnant woman with a singleton pregnancydo not change during the 1st trimester. However, an additional 200-300 daily calorie intake is recommended during the 2nd and 3rd trimesters of pregnancy, depending on the pre-pregnancy weight and on the physical activity of the mother during pregnancy. For example, if a woman who consumes 1700 calories daily and maintains a normal weight gets pregnant, she could consume the same amount of calories until the 3rd month of pregnancy. After the 4th month of pregnancy and until term, it is recommended that she consumes 1900-2000 calories daily. However, if for some reason her physical activity is reduced, then she might not have to increase her calorie intake. The energy needs are influenced by many factors and can differ significantly between individuals. Therefore, close monitoring of the weight gain during pregnancy is the most reliable method to ensure adequate calorie intake.

    • What is the recommended weight gain?

      The weight gain during pregnancy for a woman with healthy pre-pregnancy weight should be around 10-12 kg. The increase in the maternal weight is recommended to be around 2 kg in the first trimester, 4kg in the second and 5 kg in the third trimester of pregnancy. However, this also needs to be individualized. According to studies, the aforementioned recommended weight gain is associated with the risk of 1-2 extra kilograms remaining after delivery. A woman who is overweight is advised to gain 7-10 kg, whereas an obese woman 6-9 kg. Weight increase above 18 kg is usually associated with increased risk of extra weight remaining after delivery. Similarly, significant weight gain during the first trimester is associated with increase in the adipose tissue and difficulty to lose the extra weight post-delivery.

      Is your weight within normal limits?
      Body mass index = weight (kg)/height² (meters)
      18,5 - 24,9 Normal weight
      25 – 29,9 Overweight
      ≥ 30 Obese
    • Proteins

      Proteins are found in meat, poultry, fish, cheese, egg white and dairy. During pregnancy there is a slight increase in the nutritional need for proteins.

      The recommended protein intake for the average pregnant woman is covered by daily consumption of 90-120 gr of cooked meat/fish + 3 portions of dairy and 4-5 portions of starchy food (bread, pasta, pulses, cereals). You can cover these needs by consuming fatless red meat, skinless poultry, fish and dairy low in fat content, in order to reduce the consumption of saturated fat.

    • Carbohydrates

      Carbohydrates contain essential nutrients and need to be part of a balanced diet, as long as almost half of the daily caloric intake comes from them. The various types of carbohydrates are:

      Simple carbohydrates that can be found in sugar, glucose, fructose, honey, white bread, jam etc. as well as in food that contains the above (sweets, fizzy drinks). Increased consumption of simple carbohydrates should be avoided.

      Complex carbohydrates that can be found in wholegrain bread, cereals and pasta, pulses, rice (prefer brown rice), starchy vegetables (potato, peas corn), fruits and vegetables that need to be consumed daily and ideally with every meal. The above contain large quantities of natural fibers that are important for the regulation of the blood sugar and for the normal bowel function. They are also a good source of vitamins and minerals. Complex carbohydrates can also be found in milk and yogurt.

      Every 6-8 hours you need a meal that contains carbohydrates. You can have a snack rich in carbohydrates every day before bedtime. It is also recommended that you accompany meat or fish with a portion of preferably wholegrain pasta, rice, chips or bread.

    • Fat

      Fatty acids are a good source of energy. It is estimated that 1gr of protein or 1 gr of carbohydrates give 4 kcal, whereas 1 gr of fat gives 9 kcal. Increased consumption of fat causes increase of the body weight, so it is recommended that you do not consume too much fat.

      There are 3 types of fat:

      Saturated fat that is found in whole-fat dairy, meat, poultry skin and in other food of animal origin like sausages, butter, fresh cream, mayonnaise etc. Overconsumption of this type of fat is associated with increase of the lipid concentration in the blood and raises the risk of high blood pressure, coronary heart disease and metabolic diseases like diabetes.

      Monounsaturated fat that can be found mainly in olive oil.

      Polyunsaturated fat. This type of fat contain omega-6 essential fatty acids (sunflower oil, margarine, eggs, milk, meat) and omega-3 fatty acids (fish, nuts) and it is recommended that they are consumed during pregnancy for normal fetal growth.

      In order to reduce the consumption of the 'harmful fat':

      Choose olive oil, but with caution, because it contains many calories.

      Try to replace whole-fat dairy products and cheese with low-fat alternatives.

      You should remove the fat from the meat before and after every meal and avoid consuming poultry skin. You should also avoid the consumption of liver,pâté, foie gras etc.

      Try also to reduce the consumption of ready-made pastries, pies, biscuits and sweets because of the high content in saturated fat.

      Avoid frying or sautéing and opt for boiling or grilling your food instead.

      You can consume oily fish that contains omega-3 fatty acids (salmon, mackerel, mullet, dorado, sea bream, sardines) 1-2 times per week (90-120 gr of cooked fish is sufficient). In case you are allergic to fish or you do not like it, discuss with your doctor the possibility of taking omega-3 as a diet supplement. You should not consume cod liver oil because it is high in vitamin A which is teratogenic.

    • Other important nutrients to consume during pregnancy

      Folic acid

      Folic acid is a vitamin that can be found in dark-green vegetables such as broccoli, peas, lentils, beans, sunflower seeds, walnuts and fortified cereals. The adult woman needs around 400 mcg (micrograms) of folic acid daily and 600 mcg daily during pregnancy. Folic acid deficiency during pregnancy is associated with various complications. It is therefore important that women take folic acid when they try to conceive and also during pregnancy. For this reason every woman who tries to conceive should try to optimize the folic acid stores and take folic acid supplements (400 mcg/daily) for at least 1 month prior to conception until the 12th week of pregnancy and in addition to the folic acid that is contained in food.

      Iron

      Pregnant women have increased needs for iron in order to support fetal growth. Despite the fact that during pregnancy there is increased absorption of iron, women with low iron stores (low ferritin levels) are advised to use iron supplements in order to avoid becoming anaemic. Food with high iron content is food of animal origin such as red meat, poultry, fish and eggs. Although that liver (and foods like pâté) is considered to be an excellent source of iron, is not recommended during pregnancy because it contains high-levels of vitamin A and other toxic substances that can cause damage to the fetus.

      Iron supplementation is recommended after the 12th week of pregnancy, whereas in cases of anaemia it could start earlier. It is possible that iron supplements cause gastrointestinal disturbances (mainly dyspepsia and constipation) and make the stool darker.

      It is advised not to take iron supplements with calcium or calcium supplements.

      Calcium

      The daily recommended consumption of calcium during pregnancy is the same as during the rest of the adult life (1000 mg), without however ignoring the fact that in some cases the needs are increased.

      During pregnancy, and under the influence of various hormones, there is a 50% increase in the intestinal absorption of calcium and reduction in its loss through the urine. As a result, fetal needs are covered without needing to increase the maternal daily consumption of calcium. The maternal needs for calcium can be covered by consuming maximum 3 portions of dairy, depending on the calcium contain of the food. If you do not like dairy products, you could choose food rich in calcium to consume in smaller quantities. The following list shows which food contains 300 mg of calcium. You could choose 3 of the following per day.

      List of food containing 300 mg of absorbable calcium:
      250 ml milk
      2,5 cups* of boiled broccoli
      150 gr of yogurt
      7 cups of boiled spinach
      30 gr of parmesan or graviera
      2 cups of boiled white beans
      40 gr Gouda, Edam or kefalotyri cheese
      120 gr of almonds (many calories!!!)
      70 gr of feta cheese
      140 gr of anthotyro
      *1 cup= 240 ml

      Calcium supplements are recommended only if women cannot cover their daily needs for calcium through diet due to food intolerance or due to the fact that they do not like the above food.

    • Drinks and beverages

      It is recommended that you drink 6-8 glasses of fluids daily to improve hydration. Opt for water, as it is the best method of hydration and does not contain any calories. As far as other drinks are concerned, choose soda or carbonated water with or without added flavour, beverages without caffeine (i.e. sage, chamomile, mint etc.), 100% natural juices (avoid nectar or fruit drinks that contain sugar). It is advised that you do not drink more than 2 small glasses of juice daily because juices, even though they contain vitamins, are also rich in calories.

      In case that you are constipated, increase fluid and fiber intake.

    • Additional information

      Alcohol consumption

      There is no consensus over the safe amount of alcohol consumption during pregnancy. The Royal College of Obstetricians and Gynaecologists (RCOG) of the UK warns that consumption of more than 3 drinks per week, during the 1st trimester of pregnancy, leads to increased risk of miscarriages. The latest RCOG guideline for pregnant women, or those who are planning to get pregnant, recommends that the maximum alcohol intake is 1-2 units, one or two times per week and that binge drinking is avoided (1 unit of alcohol=120 ml of wine, 330 ml of beer or 30 ml of a drink with high alcohol content). In some countries, including USA, Canada and Australia, abstinence from alcohol during pregnancy is recommended.

      Caffeine consumption

      According to studies, consumption of small amount of caffeine (i.e. 2 cups of instant or filtered coffee or 3 cups of tea, 4 cups of cocoa or 3 glasses of caffeine-containing beverages daily) is safe during pregnancy. Decaffeinated products are also a good alternative.

      Smoking

      Smoking during pregnancy causes various adverse effects, mainly due to the reduced supply of oxygen to the developing fetus and as a result to the reduced supply of nutrients. Therefore, the best recommendation for women who are pregnant, or are planning to get pregnant, is to stop smoking (active and passive), before and during pregnancy.

      Safe food handling

      The hormonal changes during pregnancy weaken the immune system making it more susceptible to infections and diseases. It is important to avoid diseases caused by the consumption of infected food, as they can adversely affect the fetal development. For this reason, pregnant women should not consume non-pasteurized dairy products, cooked or semi-cooked food (pâté, soft cheeses, blue cheese like Brie, Camembert, Blue cheese, Roquefort, raw seafood, sushi, soft-boiled eggs, meringue and sauces/dressings), products that are not kept in the correct temperature, ready-made salads and food that is precooked and kept in the fridge for more than one day.

      Every food, and especially meat, needs to be well cooked. It is also recommended washing very wellall fruits and vegetablesthat are going to be consumed fresh. Appropriate food storage is also important. Do not leave food, which needs to be in the fridge or to be frozen, in lower temperature. Check the temperature of your fridge and do not forget that the fridge needs to maintain a temperature of around 4oC and the freezer of around -17oC. Warm food should be kept in temperatures above 60oC and cold food in temperatures less than 4oC. Infections can also be caused by microorganisms found in the soil or in the stools of pets, therefore you should wear glovesif you are working in the garden or you come in contact with your cat or dog’s excrements.

      Vitamin and mineral supplements

      A pregnant woman who maintains a balanced diet by eating a variety of foods (mainly fruits and vegetables) does not need food supplements, with the exception of folic acid and iron.

      Medicines

      Throughout pregnancy it is recommended that you do not take medicines without asking your doctor first.

      Exercise

      Mild daily aerobic activities, like walking and swimming, help to maintain your fitness and are recommended during pregnancy, unless if there are complications that impose to minimize your physical activity.

      Number of meals

      The number or meals varies depending your appetite and habits. It is recommended that you have 4-6 meals and small snacks daily. If you have dinner too early, you could have a snack rich in carbohydrates (i.e. milk, yogurt, fruit), just before you go to sleep. Breakfast is very important. If you do not feel like eating when you wake up, try to have your breakfast 1 hour later.

      Breakfast choices

      You could choose amongst milk or yogurt with wholegrain cereal, toast with wholegrain bread and cheese rich in calcium, 2-3 wholegrain French toast, natural margarine, honey, 30gr of cheese. You could add fruit or fresh juice to the above choices.

      Dessert choices

      Dessert is not necessary in your daily diet. However, if you feel like having a dessert, it is best to choose something with low fat content, like a cereal bar with chocolate, jelly, fruit compote or dried fruits, yogurt with honey, crème with low fat content, home-made cake with olive oil, simple ice cream (not parfait or ice-cream covered with chocolate or nuts), 1-2 small chocolates.

      Salt

      In general, it is best to avoid food high in salt content (salted food, pickles, sausages, salted snack, potato chips, dried nuts) and adding too much salt in your food.

    • Consumedaily

      (In order to get all the necessary nutrients):

      3 portions of diary or other sources of calcium

      2-3 fruits (1 fruit=1 small apple/orange/peach, half banana,15 small grapes/cherries, 1 small portion of watermelon, ½ glass of fresh fruit juice)

      2 salads (1 salad=1.5 cup of boiled vegetable or 3 cups of fresh green vegetables)

      90-120 gr of cooked meat/chicken/fish or 2 cups of cooked pulses or 60 gr of cheese and 1 egg

    • In case of dizziness or “morning sickness”

      Try to have small and frequent meals that do not cause abdominal swelling.
      However, it is also important to avoid been starved.
      It is important to drink as much fluids as you can tolerate. Avoid drinking with meals.
      It is better to have fluids between meals, and at least 1 hour before or after meals, by small sips or by using a drinking straw. Cold beverages are usually better tolerated than hot.
      Carbonated beverages and sucking on ice cubes can sometimes reduce the feeling of nausea.
      Consumption of French toast, crackers, bread or cereals could help with nausea, especially in the morning.
      Prefer dry and soft food. Cold food without a strong odour is usually better tolerated.
      Avoid food that is poorly tolerated by most people, like vegetables with strong odour (onions, garlic, cabbage, broccoli, cauliflower), coffee, spicy food, as well as fried food that contains a lot of fat.It would be better to replace whole with skimmed milk.
      Avoid unpleasant and strong odours, as well as the smell of the food during cooking.
      Avoid lying flat just after a meal.

    • What if you suffer from acid reflux?

      Acid reflux is a condition that causes the acid content of the stomach to regurgitate back to the oesophagus. The most common symptoms are “burning” sensation behind the sternum, acidic burping and less often pain with swallowing. In severe cases, medical treatment is recommended. However, in milder cases the following measures could help alleviate the symptoms:

      Avoid lying flat after a meal.
      Use 1-2 pillows underneath your back and waist, in order to reduce the reflux of gastric content to the oesophagus. Avoid wearing tight clothes and belts.

      In addition, as far as diet is concerned:

      Try to have small and frequent meals.
      Avoid large quantities of fizzy drinks and acidic citrus juices.
      Avoid consuming coffee and chocolate and sweets in general.
      Avoid food that usually causes you dyspepsia, such as fatty sauces, spicy, fried or fatty food, pulses, cabbage and cauliflower. Opt for grilled or steamed meat, chicken or fish and cook the vegetables adding small amount of oil at the end of the cooking.
      Avoid bending over or any kind of physical exercise after meals.

    • What happens if you suffer from constipation?

      Constipation is defined as less than 3 bowel movements per week. It is a common problem in pregnancy and is due to the slowing down of the bowel movements under the influence of the pregnancy hormones like progesterone. These hormones cause uterine relaxation and also affect the muscles of the large bowel, delaying its emptying. Iron supplements could make constipation worse.

      Increase fluid and especially water intake by having 2-4 extra glasses of fluids daily and try to have a glass of water with empty stomach every morning.

      It is recommended that you include in your diet food rich in fibers such as wholegrain cereal, pulses, and green leafy vegetables, fruits such as kiwi, prunes, and figs fresh or dry. Some women find that the consumption of wheat bran helps, as it increases the stool volume by absorbing water and stimulating bowel emptying. The recommended daily intake is 1 small to 4-6 large spoons daily, combined with increased fluid intake.

      Breakfast should not be omitted.

      Increase your physical activity, especially in the morning.

      Do not suppress the need to open your bowels.

    • Exercise during pregnancy

      Many pregnant women ask if it is safe to exercise during pregnancy. The answer is “yes”. Exercise is not only allowed but also has many benefits:
       

      • It keeps the body in good shape and makes the woman feel well, especially as her body changes during pregnancy.
      • Labour is made easier.
      • It helps the mother to get in shape after delivery.


      Exercise during pregnancy
       
      • Strengthens the muscles and improves flexibility. As a result, it becomes easier to endure the increase in the fetal weight and to move more comfortably, as the pregnancy progresses.
      • It strengthens the heart and the respiratory system and women get stronger (they do not get tired easily).
      • It helps alleviate mild pregnancy symptoms such as backache, constipation, leg cramps or swelling.
      • It makes your sleep deeper and less restless, so you feel that you get enough rest during the night.
      • Finally, it is important to remember that hormones released during exercise (endorphins) trigger positives feelings making you feel happy!


      However, you should follow 2 basic rules:
       
      1. You should have your doctor’s approval, especially if you were not regularly exercising before pregnancy. The doctor will assess if there are any factors that do not allow you to exercise, like history of miscarriage or preterm delivery, cervical incompetence, bleeding or another factor from your personal or family history (heart disease, hypertension etc.).

        If you were regularly exercising before pregnancy and your pregnancy is uncomplicated, then you could continue exercising. However, you should adjust your routine to the changes that happen to your body and take into consideration that your body is not as fit as before (you feel tired easier, you are not as flexible as before etc.). In general, you should avoid any excess, getting too tired and dehydrated or exercising in extreme weather conditions i.e. too hot or too humid.

        In any case, you should stop exercising if you feel dizzy, fainting, if you have uterine contractions or vaginal bleeding.
      2. It is important to choose the right type of exercise. Intense aerobic exercise or sports like tennis, volleyball, basketball, cyclingare not considered ideal, because they put the body of the pregnant woman under a lot of physical stress (demand a lot of effort) and there is increased risk of fall (and as a result trauma to the fetus).


      The most suitable forms of exercise are:

      Swimming. In the water the body is free of its weight so you feel much lighter. Also, the muscles and joints are not stressed.

      Walking. It is the best form of aerobic exercise. Be careful: it is important to wear the appropriate type of shoes, in order to protect your knees and ankles. Opt for clothes made of cotton that allow your body to breath and do not trap the sweat. Mild jogging is allowed during the first months of pregnancy.

      Prefer mild exercise as yoga or Pilates, as they can strengthen the muscles, increase flexibility and teach you how to relax and control your breathing.

      In general, it is recommended that you exercise regularly. Opt for example for mild daily exercise than for intense infrequent exercise.

      Three tips for exercising:
       
      1. In order not to get bored, try to alternate various forms of exercise i.e. walk one day and try yoga the next. Also, try different workout routines.
      2. When you finish exercising, you should feel good and relaxed and not as if you have reached your limit. If you are exhausted, you have negative feelings and then you unconsciously do not want to exercise the following day.
      3. Promise yourself that you will exercise for at least 10-15 minutes. You are going to realize that afterwards you do not want to stop.

       


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