The health of the mother is crucial for healthy birth outcomes hence, there is a need to meet the high nutritional demands of a woman during pregnancy. Preconception care optimizes both a mother’s health and that of her child.
Preconception means knowing how health conditions and risk factors could affect a woman or her unborn baby if she becomes pregnant. Preconception care involves a visit to health centers in the months before pregnancy.
It includes routine checkups, behavioral and social health-related interventions, to both husbands and wives that involve nutrition counseling, diet diversity, healthy weight gain, and exercise tips before actual pregnancy.
First 1000 days of life: A milestone for brain development
The first 1000 days of life from the time of conception to the second birthday of the child is the opportunity window for laying the foundation of cognitive development, optimal health, and growth of the baby.
Milestones of brain development:
In the first trimester– Nervous system of the baby develops rapidly
Second trimester- Brain, spinal cord, and nerve network becomes fully functional. Also, the baby’s reflexes and hearing improve making the baby respond better to sound and touch.
Third trimester- Fat stores build-up and the brain grows in size along with lungs and other vital organs
The process of brain development is adversely affected if malnutrition occurs in a pregnant woman. A healthy woman will give birth to a healthy child a vice versa.
A developing fetus is highly vulnerable to birth defects such as intrauterine growth rate and other problems during the first eight weeks of pregnancy, a time when women may not realize they are expecting.
In South Asia, one out of every five women is underweight, one in ten is malnourished as per UNICEF report.
In developing countries, many children are devoid of proper nutrition during their early years of brain development.
Moreover, there is a prevalence of pre-pregnancy overweight over underweight in developing countries like India and Bangladesh.
The majority of adults are not aware of the importance of nutrition and lifestyle factors such as diet and exercise, including obesity and underweight impact maternal nutrition status and health of a child.
Malnutrition is an umbrella term that includes both undernutrition and overnutrition that has the potential to affect brain development.
Undernutrition is the unavailability of proper diet along with the inadequacy of nutrients in it, whereas overnutrition is the unbalanced diet leading to obesity and foods contaminated with potential toxins.
A healthy weight at BMI 18.5- 23.9 improves a woman’s chances of conception, while excess body fat or insufficient amounts may interfere with her fertility.
Pregnancy when maintained at healthy weight results in lower pregnancy-related complications for mother and the baby.
Pregnant women with anemia, gestational diabetes, and hypertension are at higher risk of preterm deliveries, increased bleeding during and after delivery, stillbirth and low birth weight babies.
In India, according to the 2015-16 National Family Health Survey (NFHS-4), 50% of pregnant women in the country are anemic. Despite the government mandate of consumption of iron-folic acid tablets for 100 days during pregnancy, only 30 % of pregnant women have consumed iron-folic acid tablets for at least 100 days (NFHS-4).
Role of nutrients during Pregnancy:
To maintain good health during pregnancy, macronutrients (energy, protein) and essential micronutrients (iron, iodine, calcium, vitamin A) are important for the body.
Also, the consumption of Iron-Folic acid (IFA) rich foods and supplements from the 4th month of pregnancy helps in the prevention of neural tube defects such as spina bifida and anencephaly.
During pregnancy, the consumption of calcium from the 4th month helps in bone strengthening. The use of iodine fortified salt in food helps in the mental development of the child.
Inclusion of vitamin A sources such as milk and milk products, fish, yellow and orange-colored fruits and vegetables in the diet helps in eyesight improvement.
Diet rich in protein such as milk and milk products, pulses, eggs, meat (fish and chicken) and vitamin C such as lemon, guava, oranges, and amla) enhances iron absorption.
Point to remember: It is normal to experience morning sickness (or vomiting and nausea) in the first trimester of pregnancy.
Note: Meals should be made primarily from whole foods, including vegetables, fruits, cereals, and legumes, healthy fats, and proteins.
Caffeine intake during Pregnancy
Caffeine is a stimulant found in tea, coffee, cola-type soft drinks, chocolate, and also in some over-the-counter medicines. Reduce the daily consumption of caffeinated beverages to 2 cups of coffee and/or tea/green tea/soft drink. Excess caffeine may be associated with a higher risk for low birth weight and pregnancy loss.
Close the Micronutrient gap during Pregnancy:
During pregnancy, there is a need to maintain a nutrient reserve of the pregnant woman to ensure proper growth and development of the fetus.
Consume iron and folate-rich foods like Bengal gram whole, soybean, fenugreek leaves, mustard leaves, chickpea, pumpkin and carrot, spinach, orange, beans, fish respectively.
Calcium-rich foods such as milk, buttermilk, curd, cottage cheese, sesame seeds, ragi and green leafy vegetables (spinach, amaranth leaves) are beneficial for the proper development of baby’s brain and spinal cord.
Along with dietary sources of folate and calcium through foods, consumption of iron-folic acid and calcium supplements/tablets is also advised from the second trimester of pregnancy until 6 months after delivery of the baby.
Importance of Iron folic acid (IFA) in pregnancy
Women should consume one folic acid tablet (400 micrograms) daily in the first trimester only. Folic acid helps prevent neural tube defects such as spina bifida within the first month of pregnancy when the neural tube forms. The neural tube develops into the spine and brain.
IFA tablets help in blood formation and prevent anemia and other pregnancy-related complications like fatigue, shortness of breath, etc. As anemia during pregnancy increases the risk of preterm birth, low birth weight, infections.
Dosage recommended: In the second and third trimester consume one IFA (400mg) tablet daily till 6 months after delivery. It is recommended to consume IFA tablets one hour after the meal in case of gastritis, nausea, and vomiting.
Note: IFA tablet when consumed with citrus food sources (lemon, guava, oranges) enhances iron absorption.
Do not consume IFA tablets along with tea, coffee, milk, or calcium tablet.
Importance of calcium in pregnancy
Consumption of calcium alleviates the risk of pre-eclampsia/eclampsia and high blood pressure during pregnancy and delivery. Therefore it is recommended to take 2 calcium tablets daily from the second trimester till delivery and continue for six months post-delivery. Calcium also helps in strengthening bones.
Dosage recommended: Consume one calcium tablet in the morning or afternoon meal and one in the evening meal. Avoid eating calcium tablets on an empty stomach as it may cause gastritis.
Note: Calcium and IFA tablets should not be taken together as calcium interferes in the proper absorption of iron in the body and vice versa.
Pregnancy and physical activity:
Women who are overweight are more susceptible to type 2 diabetes and during pregnancy have a greater risk of developing gestational diabetes and other related complications. Regular exercise before pregnancy is beneficial to both mom and baby, and it may involve light exercise, yoga, and meditation.
A pregnant woman should undertake regular physical activity as it helps in improving physical fitness, preventing metabolic disorders, reducing stress.
It also helps maintain healthy weight gain during pregnancy. With the help of a yoga increase in flexibility, strength, endurance, and proper breathing are attainable for healthy childbirth.
Two and a half hours of yoga or brisk walk per week for about 20-25 minutes every day is beneficial during pregnancy. Always begin with 5 minutes of slow walking or stationary cycling with a low resistance to warm up your muscles.
Note: Exercise is essential to a healthy lifestyle and is a key to maintain a healthy weight.
Pregnancy and Rest:
Adequate rest of 2 hours during the day and sleep of 8 hours at night daily is beneficial during pregnancy as sleeping for 6 or fewer hours is associated with the risk of preterm birth.
Sleep on the left side to increase blood flow to the fetus as reduced blood flow can lead to late stillbirths. Whereas, sleeping flat on the back, especially in late pregnancy can cause a reduced supply of oxygen to the women’s brain leading to a fainting attack.
Avoid doing heavy physical work such as lifting heavy equipment and work requiring a long duration of standing time or 46 hours or more hours of work in a week as they may lead to preterm birth or low birth weight baby or fetal growth retardation.
Husbands play an important role in pregnancy. Their contribution helps in healthy motherhood and safe child.
As a responsible husband and future father they can encourage right nutrition practices for their wife for healthy birth of baby.
There is no greater gift you can give to your wife allowing them to be positive throughout the pregnancy. Support of husband only becomes useful when you incorporate the pregnancy related knowledge and awareness in practice.
- India Fact Sheet. National Family Health Survey (NFHS-4). International Institute for Population Sciences. Mumbai. 2015-16. Available at: http://rchiips.org/nfhs/pdf/NFHS4/India.pdf. Accessed on 15 May 2019.
- WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization (WHO); 2016.
- United Nations Children’s Fund (UNICEF)Stop Stunting: Power of Maternal Nutrition. Scaling-up the Nutritional Care of Women in South Asia 2018. UNICEF Regional Office for South Asia: Kathmandu, Nepal.
- Pietro Cavalli. Prevention of Neural Tube Defects and proper folate periconceptional supplementation. J Prenat Med. 2008; 2(4): 40–41.
- National Iron Plus Initiative for Anemia control, Operational Guidelines. Available from: http://www.nrhmhp.gov.in/sites/default/files/files/Iron%20plus%20initiative%20for%206%20months%20-5%20 years.pdf