Nutrition during pregnancy

Biologically speaking, pregnancy is the time when a woman should be healthy. Unfortunately, for the most part, in our modern society, pregnant women tend to be sick women. They are often too fat, swollen, constipated, uncomfortable and lethargic.

Many of them take medication to treat diabetes and high blood pressure. Every fourth desired pregnancy ends in miscarriage and surgical removal of the embryo. Often at the root of all this trouble are doctors, nutritionists, mothers and mothers-in-law telling the mother-to-be that she needs to drink at least four glasses of milk a day to get enough calcium and eat plenty of meat every day to get protein.

Most of us love to experiment with our own diet, but when it comes to our unborn children, we become ultra-conservative. I know it happened to us. Mary and I made the final adjustments to our strict vegetarian diet shortly after the birth of our second child in 1975.

Five years later, Mary became pregnant with our third. In the blink of an eye, she began buying cheese, fish and eggs, reverting to the old logic that these foods are good for high protein and calcium and go a long way towards a healthy pregnancy. I doubted, but relied on what she knew best. She had a miscarriage in the third month. This unfortunate event forced her to reconsider her decisions.

Two years later, she was pregnant again. I waited for the return of cheese, or at least the appearance of fish in our house, but this did not happen. Her experience of losing a previous child cured her of her habit of being driven by fear. During the entire nine months of pregnancy, she did not eat meat, eggs, fish or dairy products.

Please note: I am not claiming that it was these foods that caused her to miscarry during her previous pregnancy, but only that the introduction of these foods last time was not actually a guarantee of a successful pregnancy.

Mary says she has fond memories of this last pregnancy, she felt energized every day and the rings always fit her fingers, she didn’t feel the slightest bit of swelling. At the time of Craig’s birth, she had recovered only 9 kg, and after giving birth she was only 2,2 kg heavier than before pregnancy. A week later she lost those 2,2 kg and she did not get better for the next three years. She feels that this was one of the happiest and healthiest periods of her life.

Different cultures offer a wide range of dietary advice for pregnant women. Sometimes special foods are recommended, other times foods are excluded from the diet.

In ancient China, women refused to eat foods that were believed to affect the appearance of unborn children. Turtle meat, for example, was thought to cause a baby to have a short neck, while goat meat was thought to give the baby a stubborn temper.

In 1889, Dr. Prochownik in New England prescribed special diets for his pregnant patients. As a result of insufficient exposure to sunlight, women who worked in factories developed rickets, which led to deformities of the pelvic bones and difficult childbirth. Believe it or not, his diet was designed to stop fetal growth in the final months of pregnancy! To get these results, the women ate a high-protein diet, but low in fluids and calories.

Thirty years ago, the Joint Panel of Experts of the Food and Agriculture Group of the World Health Organization declared that nutrition is of little importance during pregnancy. Today, experts disagree about the importance of weight gain and the importance of carbohydrate, protein, and micronutrients in a pregnant woman’s diet.

Preeclampsia is a condition that occurs in pregnant women and is characterized by high blood pressure and protein in the urine. In addition, patients with preeclampsia often have swelling in the legs and arms.

In the early 1940s, in an attempt to reduce the risk of developing preeclampsia, pregnant women were advised to reduce their salt intake and were sometimes prescribed appetite suppressants and diuretics to limit weight gain to 6,8-9,06 kg. Unfortunately, one of the undesirable side effects of this diet was the birth of children with low birth weight and high mortality.

The need to avoid excess body weight was part of medical doctrine and practice until 1960, when it was found that this restriction too often led to the birth of small children with a high risk of death. Most doctors since that time do not restrict pregnant women in food and advise not to worry about excessive weight gain. Both mother and child are now too often too large, and this also increases the risk of death and the need for a caesarean section.

The birth canal of a woman, as a rule, can easily miss a child weighing from 2,2 to 3,6 kg, which is the weight the fetus reaches by the time of birth if the mother eats healthy plant foods. But if a mother overeats, the baby in her womb reaches a weight of 4,5 to 5,4 kg – a size too large to pass through the mother’s pelvis. Larger children are more difficult to give birth to, and as a result, the risk of injury and death is more likely. Also, the risk of harm to the health of the mother and the need for a caesarean section increases by about 50%. So, if the mother gets too little food, then the child is too small, and if there is too much food, the child is too big.

You don’t need too many extra calories to carry a baby. Just 250 to 300 calories per day during the second and third trimesters. Pregnant women feel an increase in appetite, especially during the last two trimesters of pregnancy. As a result, they eat more food, getting more calories and more of all the necessary nutrients. Caloric intake is estimated to increase from 2200 kcal to 2500 kcal per day.

However, in many parts of the world, women do not increase their food intake. Instead, they receive additional physical activity. Hard-working pregnant women from the Philippines and rural Africa often get fewer calories than before pregnancy. Luckily, their diet is rich in nutrients, plant foods easily provide everything you need to carry a healthy baby.

Protein is, of course, an essential nutrient, but most of us have come to regard it as an almost magical determinant of health and successful pregnancy. A study of pregnant Guatemalan women who ate infrequently found that birth weight was determined by the amount of calories the mother consumed, rather than the presence or absence of protein supplements in her diet.

Women who received supplemental protein showed worse results. Protein supplements taken by pregnant women in the 70s led to weight gain in babies, an increase in preterm births and an increase in neonatal deaths. Despite claims that pregnancy-related hypertension can be prevented by a high-protein diet, there is no evidence that high protein intake per se during pregnancy is beneficial—in some cases, it may actually be harmful.

During the last six months of pregnancy, only 5-6 grams per day are needed by the mother and baby. The World Health Organization recommends 6% of calories from protein for pregnant women and 7% for breastfeeding mothers. These amounts of protein can easily be obtained from plant sources: rice, corn, potatoes, beans, broccoli, zucchini, oranges and strawberries.  

John McDougall, MD  


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