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By Nutrition & Dietetics, KK Women's and Children's Hospital

Good nutrition is important during pregnancy. A nutritious diet will help you meet the needs of your growing baby, maintain your health and prepare you for lactation. However, you do not have to eat for two. All you need is a wellbalanced diet.

A Balanced Diet
Mothers should eat a variety of foods from the 4 food groups, namely, rice and alternatives, fruits, vegetables, and meat and alternatives. This is because different food groups contain different types of nutrients. For instance, meat and alternatives are rich in protein but have no Vitamin C. Choosing a variety of foods ensures that you get the right balance of nutrients from the 4 food groups. In addition, pregnant women should also consume adequate amounts of milk and alternatives to meet their calcium needs.

Table 1 serves as a dietary guide for pregnant mothers on the types and portions of food to consume.

Rice and Alternatives
Foods in this group provides energy as well as fibre, vitamins and minerals. The amount of energy an individual needs varies with age, weight and activity level. Usually, 6 - 7 servings will be required, including 3 servings from whole grains.

Fruits
The requirement for most minerals and vitamins increases during pregnancy. These are necessary for the normal functioning of the body. Fruits are good sources of vitamins and minerals, as well as dietary fibre. 2 servings a day are required.

Vegetables
Like fruits, vegetables are good sources of vitamins, minerals and dietary fibre. 3 servings a day are required. 
 
Meat and Alternatives
This food group provides protein, necessary for the growth and repair of body tissues such as those that make up the muscles, heart, lungs, eyes and skin. Pregnant women require more protein, which is used for the formation of the fetus' organs. In our affluent society however protein deficiency is rarely a concern. You should have 2.5 servings of protein per day.

Milk and Alternatives
Milk and alternatives provide calcium which is needed for the formation of baby's bones and teeth, and to maintain the pregnant woman's body stores. 2-4 servings of milk and alternatives are required.

Additional Nutrients Needs
Iron
Iron is essential during pregnancy to prevent the mother from becoming anaemic (a condition of insufficient red blood cells or haemoglobin in the blood). An anaemic mother tends to look pale and feels tired easily. 
 
Additional intake is also required to build up the baby's iron stores, in order to last baby for the 1st 6 months of life. Iron is found in liver, meat, fish, beancurd, wholegrain cereals, green leafy vegetables and eggs. Whilst heme iron (found in meat, fish, liver) is better absorbed than non-heme iron (found in beancurd, wholegrain cereals, green leafy vegetables), absorption of non-heme iron can be enhanced by consuming vitamin-C rich foods at the same meal. Care should also be taken to limit liver consumption to no more than 50g per week in the 1st trimester as liver is high in Vitamin A. Excessive intake of Vitamin A in the 1st trimester can lead to birth defects.

Folic acid
This is needed for cell growth and cell reproduction. Cells are basic building blocks for tissues. Since folic acid is involved in the formation of blood, a deficiency in folic acid can also cause the mother to be anaemic. Folic acid is found in green leafy vegetables, yeast and meat extracts, citrus fruits and juices (e.g. oranges), beans and fortified foods like cereals.

Vitamin C
We need this vitamin every day because our body cannot store it. Vitamin C increases your body’s ability to absorb iron. It is important to note that Vitamin C and folic acid are easily destroyed by cooking and heat. Vitamin C can be found in fruits especially oranges, guavas, papayas, kiwis, lemons, as well as vegetables.

To prevent destruction of Vitamin C, avoid storing fruits and vegetables for long periods of time. Vegetables should also be cooked in small amounts of water to prevent water-soluble nutrients like Vitamin C from being leached out into the cooking water, and in as short a time as possible.

Calcium
During pregnancy, you need more calcium to maintain your own calcium stores as well as for the development of your baby's bones and teeth. Your calcium requirement during pregnancy is 1000 mg a day.
 
Table 1:
Food GroupRecommended no.
of servings
Example of 1 ServingRemarks
Rice and alternatives
(including 3 servings from
whole grains)
6 - 71/2 medium bowlrice/noodles
2 slices bread
2 small chappatis
1 large potato
1.5 cups cornflakes
wholegrain choices include
multigrain bread, brown rice
beehoon and brown rice                                
Fruits21 wedge papaya/honeydew
1 small apple/pear/orange
 
Vegetables3¾ cup (100 g) cooked
vegetables
 
Protein2.51 medium drumstick
90 g (1 palm-sized piece) lean meat/fish
¾ cup cooked beans/lentils
2 small squares beancurd
For heart-health, Remove the skin
from chicken and fat from meat.
Milk and alternatives2 - 4
1 cup high-calcium milk or high-calcium soybean milk
2 slices cheese
1 small tub yoghurt
Choose low-fat or non-fat dairy
products.
 
Weight Gain
Mothers should not gain excessive weight during pregnancy. During pregnancy, an additional 300 calories per day is required.

You can obtain the additional 300 calories from any one of the following :
  • 1 chicken curry bun and 1 cup skimmed milk
  • 1 plain thosai with dahl curry and 1/2 tub low fat yoghurt
  • 1 roll popiah and 1 cup reduced sugar soybean milk
It is not necessary to calculate your calorie intake per day. Use your pre-pregnant body mass index (BMI) as a guide as to how much weight you should gain. As per Table 2 below, pregnant women who were of normal weight before pregnancy (i.e. BMI 18.5-24.9) should aim for an average of 0.5-2kg during the 1st trimester, and an average of 0.36-0.45 kg a week during the 2nd and 3rd trimesters for a total weight gain of 11.3 - 15.9 kg. However, if you were overweight before your pregnancy, you should aim to keep your total weight gain to 6.8 - 11.3 kg.
 
Table 2
Gestational Age                                                    Acceptable weight gain based on pre-pregnancy BMI
                                                                < 18.518.5 to 24.925 to 29.9>/= 30
1st trimester (kg)    0.5 - 20.5 - 20.5 - 20.5 - 2
2nd & 3rd trimesters (kg/wk)0.45 - 0.590.36 - 0.450.23 - 0.320.18 - 0.27
Recommended total weight gain (kg)12.7 -18.111.3 - 15.96.8 - 11.35.0 - 9.1
Ref : HPB 2012
 
To control excessive weight gain, you should limit sugary foods such as sweets and sweetened drinks. You should also reduce your fat intake by eating less fried foods, chocolate and kuehs. Other ways of reducing fat intake include: removing the skin and fat on chicken, and removing fat from meat before eating, opting for soup noodles instead of fried noodles, and stewing, steaming or grilling foods instead of deep frying. Lastly, remember to eat all foods in moderation. So you don’t have to give up chocolate and other sugary and fatty foods completely, just have a small portion once or twice a week!

This featured article is contributed by Nutrition & Dietetics, KK Women's and Children's Hospital. To read more please visit www.kkh.com.sg/HealthPedia.

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