Your Health in Pregnancy

What should you eat?

A healthy diet is an important part of a healthy lifestyle at any time, but particularly if you are pregnant or are planning a pregnancy. Eating healthily during pregnancy will help your baby develop and grow and will help keep you fit and well. You don't need to go on a special diet, but make sure that you eat a variety of different foods every day in order to get the right balance of nutrients that you and your baby need.

You should also avoid certain foods to be on the safe side.

There's no need to 'eat for two' when you are pregnant. It's the quality not the quantity that's important. With a few exceptions you can continue to eat all the foods you enjoy (see *Take care with some foods). Eating healthily often means just changing the amounts of different foods that you eat rather than cutting out all your favourites.

The Balance of Good Health illustrates the mixture of different foods you need in your diet and the proportions you should eat them in.

Fruit and vegetables

Try to eat at least five servings a day. This can include a glass of pure fruit juice.

This food group includes fresh frozen and canned fruit and vegetables, salads, dried fruit, fruit.

Meat. fish and alternatives

Eat one or two servings a day. Choose lean meat, remove the skin from poultry and cook using

the minimum of fat. Try to eat oily fish at least once a week.

Foods containing fat, foods containing sugar

Limit the amount you eat. This food group includes all spreading fats, oils, salad dressings, cream, chocolate, crisps, biscuits, pastries, ice-cream, cake, puddings, fizzy drinks.

Milk and dairy foods

Try to eat several servings a day,using low-fat varieties whenever you can. This food group includes milk, yoghurt, meat (except liver), fish, poultry, eggs, beans, pulses, nuts (except peanuts).

Bread, other cereals and potatoes

Make these the main part of every meal, eat wholegrain varieties when you can.

This food group includes bread, potatoes, breakfast cereals, pasta, rice, oats, noodles, maize, millet, yams, cornmeal, sweet potatoes.

Eat plenty of fruit and vegetables as these provide the vitamins and minerals, as well as fibre which helps digestion and prevents constipation. Eat them lightly cooked in a little water or raw to get the most out of them. Frozen, tinned and dried fruit and vegetables are good too.

Starchy foods like bread, potatoes, rice, pasta, chapatis, yams and breakfast cereals are an important part of any diet and should, with vegetables, form the main part of any meal. They are satisfying, without containing too many calories, and are an important source of vitamins and fibre.

Try eating wholemeal bread and wholegrain cereals when you can.

Lean meat, fish, poultry, eggs, cheese, beans and pulses are all good sources of nutrients. Eat some every day.

Dairy foods, like milk, cheese and yoghurt are important as they contain calcium and other nutrients needed for your baby's development. Choose low-fat varieties wherever possible. You can get seven pints of milk free per week if you are on income Support or income-based Jobseeker's Allowance.

Try to cut down on sugar and sugary foods like sweets, biscuits and cakes and sugary drinks like cola. Sugar contains calories without providing any other nutrients the body needs. It also adds to the risk of tooth decay.

Cut down on fat and fatty foods as well. Most of us eat far more fat than we need. Fat is very high in calories and too much can cause excess weight gain and increase the risk of heart disease and it

Have drinks which contain caffeine - coffee, tea and colas - in moderation, as there may be a slight risk that too much caffeine will affect your baby's birthweight. Try decaffeinated tea and coffee , fruit juice or mineral water.

Vitamins and minerals

Green, leafy vegetables, lean meat, dried fruit and nuts (see paragraph on peanuts) contain iron. If you are short of iron you're likely to get very tired and may suffer from anaemia.

Citrus fruit, tomatoes, broccoli, blackcurrants and potatoes are good sources of vitamin C, which you need to help you to absorb iron.

Dairy products, fish with edible bones like sardines, bread, *nuts and green vegetables are rich in calcium, which is vital for making bones and teeth.

Margarine, oily fish (like sardines) and taramasalata contain vitamin D to keep your bones healthy and to provide your baby with vitamin D to last during the first few months of life. The best source of vitamin D is summer sunlight, but make sure that you wear a high protection sunblock when you are in the sunlight and never burn. If you have dark skin, or always cover your skin, you

may be particularly at risk of vitamin D deficiency. Ask your doctor if you need to take a vitamin D supplement.

You need extra folic acid from the time you start trying to conceive until the 12th week of pregnancy. This can help prevent birth defects, which are known asneural tube defects, such as spinabifida. You can get folic acid from green, leafy vegetables, but don't overcook them as this destroys the vitamin. Some breakfast cereals and breads have had folic acid added to them, so look at the label. Regardless of what you eat, always take a 400 microgram (0.4 milligram) folic acid tablet every day.

These are available from pharmacies and supermarkets or your GP may able to prescribe them for you. Ask your GP or pharmacist for advice if you are unsure.

Vitamin supplements

It's best to get the vitamins and minerals you need from the food you eat.

Some people, like those on a restricted diet, need extra, especially vitamin D.

Ask your doctor whether you should take vitamin supplements. Don't take extra vitamin A supplements without advice as too much could harm your baby.

Folic acid

This vitamin is special (see this page). You need to take a 400 microgram (0.4 milligram) tablet every day from the time you start trying to conceive. Continue taking the supplement right up until you're 12 weeks pregnant. Even if you didn't take folic acid before conceiving, it's worth starting as soon as you find out that you're pregnant and you should still continue until you're 12 weeks pregnant.

If you have had a baby with spina bifida before, or are taking medication for epilepsy, you will need to take a bigger dose of folic acid. Speak to your doctor about this.

Welfare food scheme

If you receive* Income Support or a *Jobseeker's Allowance, you are entitled to:

supplements of vitamins A, C and D;

seven pints of cow's milk per week.

These are free to pregnant and breastfeeding mothers and supplements are available at very low cost to all mothers from maternity and child health clinics. For further information see leaflet Welfare Milk and Vitamins - a guide for families (WMV:G1) (in Northern Ireland see Free milk and vitamins - a guide for families WM V1 G1 (NI) ), available from social security offices or the Benefits Agency.

Vegetarian, vegan and special diets

Providing a vegetarian diet is varied and balanced, it will provide adequate nutrients for you and your baby during pregnancy. However, iron and vitamin B12 can be hard to obtain from a vegetarian diet. Talk to your doctor or midwife about ways to increase intakes of these important nutrients. If you are vegan (i.e. you cut out all animal products from your diet), or you follow another type of restricted diet such as gluten free, for example, because of food intolerance e.g Coeliac disease or for religious reasons, talk to your doctor or midwife. Ask to be referred to a dietitian for advice on how to eat healthily during pregnancy.

Healthy snacks

Sandwiches or pitta bread filled with grated cheese, lean ham, mashed tuna, salmon or sardines and salad

Salad vegetables washed thoroughly

Low-fat yoghurt and fromage frais

Hummus and bread or vegetable sticks

Ready-to-eat apricots, figs or prunes

Vegetable and bean soups

Unsweetened breakfast cereals or porridge and mil

Milky drinks or unsweetened fruit juices

Fresh fruit

Baked beans on toast or baked potato

Take care with some foods

Besides eating a wide variety of foods, there are certain precautions you should take in order to safeguard your baby's well being as well as your own.

Cook all meat and poultry thoroughly so that there is no trace of pink or blood and wash all surfaces and utensils after preparing raw meat.

This will help to avoid infection with Toxoplasma, which may cause toxoplasmosis and can harm your baby.

Wash fruit, vegetables and salads to remove all traces of soil which may contain Toxoplasma.

Make sure eggs are thoroughly cooked until the whites and yolks are solid, to prevent the risk of Salmonella food poisoning, and avoid foods containing raw and undercooked eggs like home-made mayonnaise, ice-cream, cheesecake or mousse.

Avoid eating all types of paté and mould-ripened soft cheese, like Brie and Camembert, and similar blue-veined varieties, like Stilton or Danish blue, because of the risk of Listeria infection. You can eat hard cheeses such as cheddar and parmesan, and other cheeses made from pasteurised milk such as cottage cheese, mozzarella cheese and cheese spreads. Although Listeria is a very rare disease, it is important to take special precautions during pregnancy because even the mild form of the illness can lead to miscarriage, stillbirth or severe illness in the newborn.

Pregnancy and weight

Most women gain between 10-12.5 kg (22-28 lb). Weight gain varies a great deal and depends on your weight before pregnancy. If you're concerned, talk to your midwife or GP. They may have special advice for you if you weigh more than 100 kg or less than 50 kg.

Drink only pasteurised or UHT milk which has had the harmful germs destroyed. If only raw or green-top milk is available, boil it before you drink it. Don't drink unpasteurised goat's or sheep's milk or eat their milk products.

Don't eat liver or liver products, like liver paté or liver sausage, as they may contain a lot of vitamin A. Too much vitamin A could harm your baby.

Avoid eating peanuts and foods containing peanut products (e.g. peanut butter, unrefined groundnut oil, some snacks, etc.) if you or your baby's father or any previous children have a history of hayfever, asthma, eczema or other allergies. This may reduce the risk of your baby developing a potentially serious allergy to peanuts. Read food labels carefully and, if you are still in doubt about the contents, avoid these foods.

For general hygiene

Wash your hands before and after handling any food.

Thoroughly wash all fruit and vegetables, including ready-prepared salads, before eating. Peel and top carrots before eating them.

Cook raw meat and poultry thoroughly and make sure that ready-to-eat poultry and cooked chilled meals are reheated thoroughly and are piping hot before they are eaten.

Always wash your hands after handling raw meat or poultry and make sure that raw foods are stored separately from prepared foods. Otherwise there is a risk of contamination. Use a separate

chopping board for raw meats.

Wear gloves and wash them and then your hands thoroughly after gardening or handling soil.

If you are in England or Wales ask your doctor or clinic for a copy of Enjoy healthy eating, a free booklet published by the Health Education Authority, and also the free Department of Health leaflet, While you are pregnant: how to avoid infection from food and from contact with animals.

Smoking

When you smoke, carbon monoxide and nicotine pass into your lungs and bloodstream. This means that:

a) your baby gets less oxygen and cannot grow as well as it should, and

b) the nicotine makes your baby's heart beat faster.

Breathing in other people's smoke makes the baby more likely to suffer from asthma attacks, chest infections, coughs and colds, and to be admitted to hospital.

If you stop smoking now:

you're more likely to have a healthier pregnancy and a healthier baby;

you'll cope better with the birth;

your baby will cope better with any birth complication;

your baby is less likely to be born too early and have to face the additional breathing, feeding and health problems which so often go with prematurity

your baby is less likely to be born underweight and have extra problems in keeping warm. Babies of mothers who smoke are, on average, 200 g (about 8 oz) lighter than other babies. These babies may have problems during and after labour and are more prone to infection;

it will be better for your baby later too. Children whose parents smoke are more likely to suffer later on from illnesses which need hospital treatment (such as asthma);

you will reduce the risk of cot death.

The sooner you stop, the better. But stopping even in the last few weeks of pregnancy can be beneficial. If any members of your household smoke, their smoke can affect you and the baby both before and after birth. They can help you and the baby by giving up now. Perhaps you could try to stop together.

Protecting the fetus and the new baby from tobacco smoke is one of the best things you can do to give your child a healthy start in life.

Smoking - your action plan

Stop completely - it's never too late.

Choose a day. Will the first few days be easier during a working week or over a weekend? When you're busy or relaxed? Whatever you choose, stop completely on that day.

The day before. Get everything ready; review your plan. Get rid of cigarettes.

Get help. Ask friends for understanding and support. Consider asking your midwife, health visitor or practice nurse for advice.

It might help to:

change the habits you associate with smoking;

anticipate problems - plan to deal with difficult situations without the use of cigarettes;

take one day at a time and reward yourself for success

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