Specialist advice on second trimester nutrition

Fertility Associates dietitian, Alice Gormack shares her advice on second trimester nutrition

Think of your body as a messenger. When you are pregnant, the only information that your baby gets about the world comes via you. The messages that your body gives help to program your baby for the world it will be born into. What you eat and how active you are provides information that affects your baby’s development in the womb. If we eat a sensible amount of mostly nutritious foods, keep active most days and gain the recommended amount of weight during pregnancy, then we reduce the risks of obesity, diabetes and metabolic disease in our children. Right from day one of your pregnancy, it is important to know that what you choose to eat when you are pregnant will have a long-term impact on your child’s health. Don’t let this knowledge stress you out – it is a wonderful privilege to be able to influence your child’s development and wellbeing. Remember too that food safety recommendations apply throughout your whole pregnancy, not just during the first trimester. Let’s look at how we can have a positive impact on a growing baby.

NUTRITION CHOICES IN PREGNANCY

What you eat plays a key role in conception itself, as well as contributing to a healthy pregnancy. Women of all sizes can have low nutrient stores and malnutrition; in our modern day environment it is unfortunately easy to get lots of calories with few actual nutrients. Here are some superfoods that will give you plenty of vitamins and minerals during pregnancy.

EMBRACE THE RAINBOW

Colourful veggies are hugely important for a number of reasons. They are rich in dietary folate, vitamin C, and fibre, and help to fill us up. The latest recommendation for pregnant women is to include five handfuls of vegetables each day, and include a wide variety to help boost your gut health.

FOCUS ON FATS

Not all fats are created equal. Some, such as omega-3 fats, are really good for us and our growing baby. Found in fish (especially oily fish like salmon, tuna, mackerel and sardines), walnuts, chia seeds, flaxseeds, and edamame beans, omega-3 fats help with embryo brain development and improve the health of mum too.

Saturated fat on the other hand should be limited as much as possible. A high saturated fat intake can increase insulin resistance, cholesterol, the storage of fat around your tummy and organs, and the risk of developing gestational diabetes. Saturated fat is found in meat fat and chicken skin, high-fat dairy products, coconut products, and less nutritious foods like biscuits and chocolate. Being pregnant is a great opportunity to work on improving your nutritional intake long-term, such as experimenting with new foods and recipes, and cutting back on fast foods.

KEY NUTRIENTS FOR PREGNANCY

+ Dietary iron is used to make haemoglobin, a substance in red blood cells that transports oxygen around your body. During pregnancy, your body supplies blood and oxygen to your baby so you need around twice as much iron as usual. Iron is also crucial for your baby’s optimal brain development and developing their immune system. Red meat is the best source of dietary iron. Fish, chicken and seafood are also good sources. Vegetarian foods and eggs also contain iron but in a less absorbable form. Eating colourful vegetables or fruit as part of the same meal will help to increase the amount of iron you absorb.

+ Calcium is used in building your baby’s bones and teeth, and adequate calcium may also reduce the risk of pre-eclampsia. The best sources are cow’s milk dairy products, followed by soy products with added calcium. Popular plant milks like almond, coconut, rice and oat milk tend to be low in protein; if you prefer one of these then make sure that they contain added calcium.

+ Folate is incredibly important for the proper development of the brain and spinal cord in early pregnancy. The best sources of dietary folate are leafy dark green vegetables, oranges, beans and legumes, bananas and foods with added folate/folic acid.

LIMIT SUGAR

Reducing your intake of processed sugars is important during pregnancy. There are large amounts of sugar in fizzy drinks, juice, chocolate, lollies, snack bars and biscuits.

A high sugar intake increases insulin production in both mum and baby. Insulin is a growth hormone, so higher levels of circulating insulin can mean your baby grows larger than they are meant to. We all love chubby bubbas but being bigger has some downsides. It can make delivery more tricky and put more stress on your baby’s organs. Large babies (more than 4kg at birth) are also more at risk of long term health conditions like obesity, diabetes and heart disease. Babies exposed to a higher sugar intake in the womb appear to have a greater preference for sweet foods as they grow up. A 2018 study found that children of mothers who drank lots of sugary drinks in pregnancy had worse cognition scores. Proving that all dietary sugars aren’t equal, the same study showed greater cognition scores in children whose mothers ate lots of fruit in pregnancy. The take home message? Ditch sugary drinks and highly processed sweet foods and include at least two handfuls of fruit each day in pregnancy.

LIFESTYLE CHOICES IN PREGNANCY

+ Alcohol: The safest option is to avoid all alcohol when you are pregnant. Yes, it might seem like a very long nine months but it is so worth it! Alcohol travels across the placenta so if you drink alcohol, so does your unborn baby.  Drinking alcohol in pregnancy can damage your baby’s brain and have lifelong consequences, there really is no safe amount. Some foods and drinks can be unexpected alcohol sources, eg fermented drinks such as kombucha.

+ Caffeine: Too much caffeine may increase the risk of early miscarriage and affect your baby’s growth during pregnancy. The good news is that 1-2 cups of coffee or tea per day appears to be okay. If you have more than this, swap the rest to decaf varieties. Avoid energy drinks and coffee shots while you are pregnant or breastfeeding as these contain a lot of caffeine.

SUPPLEMENTS

+ Folic acid: Even if you are eating a lot of high folate foods, a folic acid supplement is required for the first three months of pregnancy. In New Zealand, the recommendation is for 800 mcg folic acid each day until the end of the first trimester. Some women will require more than this so ask your specialist/dietitian/GP what dose is right for you. Regular folic acid is fine for all pregnant women; despite what you might read online, methylated folate is not a better option.

+ Iodine: Iodine is low in NZ and is very important for your baby’s brain development. Take a 150 mcg iodine supplement each day during pregnancy and continue while breastfeeding too.

+ Iron: As pregnancy progresses, your requirements for iron increase. Iron is essential for both you and your growing baby and it can be hard to get enough, even with an iron-rich diet. If your iron levels are low, a prescription iron supplement will be more effective than taking
a pregnancy multi-vitamin or an over the counter iron supplement.

+ Vegetarian/vegan: If you are vegetarian or vegan (or do not eat fish or seafood), it may be helpful to take an omega-3 DHA supplement in pregnancy; a sensible dose would be 200 mg DHA/day. It is recommended that you stop taking this at around 35-36 weeks of pregnancy and potentially reintroduce it if you are breastfeeding.

Alice Gormack specialises in nutrition for women's health, conception and pregnancy. She works as the Fertility Associates dietitian (since 2013) and also runs her own business Oestro Nutrition. Find out more at oestronutrition.co.nz