Nourishing nutrition in pregnancy

Strike a balance between healthy weight gain and nutritional intake. Try to keep in mind that you are not eating for two, you are eating carefully for one."
—Catherine Jones and Rose Hudson, authors of Eating for Pregnancy: The Essential Nutrition Guide and Cookbook for Today's Mothers-To-Be.

Preparing for pregnancy—a healthy eating guide

Eating well when trying to become pregnant is important; a balanced diet plus a folate supplement is essential. Losing weight if you are above the healthy weight range, is recommended for good health now and will also increase your chances of falling pregnant and having a healthier pregnancy. Following a healthier lifestyle is a positive change for you to make at this time. Eating nourishing food, getting more exercise, quitting smoking (if you smoke) and cutting back on alcohol are all helpful changes for you to make that may also help reduce the impact of some underlying medical conditions on your fertility.

For women with polycystic ovary syndrome (PCOS) in particular, the type of carbohydrates in their diet and maintaining a healthy weight are important for fertility. The process of successful conception requires a balance of the right hormones, at the right levels, at the right time. It is known that higher levels of circulating insulin can have a negative impact on a woman’s hormone cycles – specifically ovulation and that this is more common in women with PCOS.  Incorporating low glycaemic index (GI) foods into your diet will assist you keep your blood glucose levels steadier and consistent, thus minimising insulin spikes, and the amount of circulating insulin in general. This, in turn, can improve fertility. 

Why is folate important?

Folate is needed for healthy growth and development. Taking folate reduces the chance of neural tube defects (e.g. spina bifida) in your baby. It is recommended that women trying to conceive take an extra 400 mcg/day of folic acid. The best way to get this is from a supplement. It is important to take this at least one month before and three months after you become pregnant. You still need to eat foods that contain folate. Rich dietary sources of folate include green vegetables, fruit, and fortified cereals.

It is also recommended to take a supplement of iodine 150mcg daily, ideally prior to pregnancy, to support healthy brain and nervous system development in your baby.

Listeria

When you become pregnant, it is important to be careful with food that might be contaminated with Listeria. These bacteria move into the placenta and can cause premature birth or miscarriage. Foods that might carry Listeria and should be avoided include: 

• raw/uncooked/smoked meat and seafood, ready to eat chilled seafood
• deli meats, cooked cold meat, pate, meat spreads
• leftovers (more than 24 hours after cooking)
• pre-prepared salads, smorgasbords, buffets
• unpasteurised milk and soft serve ice cream
• soft cheeses (brie, camembert, ricotta, feta, blue). Hard cheeses like cheddar and tasty are safe. Processed cheese, plain cream cheese and plain cottage cheese are fine if purchased sealed and stored in the fridge
• unwashed raw fruit and vegetables
• raw eggs or foods containing raw or partially cooked eggs.

It is easy to make safe choices by following these tips:

• Freshly prepared and cooked foods have low levels of bacteria. Bacteria grow over time, so avoid eating food if it has been made more than 24 hours since being prepared. Always reheat to steaming hot.
• Raw fruit and vegetables should be washed thoroughly before eating.
• Listeria is destroyed in normal cooking, so freshly cooked hot food is safe if eaten straight away.

Weight loss versus weight gain

Being in the healthy weight range gives you the best chance of falling pregnant and then having the healthiest pregnancy possible. If you are below the healthy weight range when you fall pregnant you have an increased risk of preterm birth. If you are above the healthy weight range you have an increased risk of longer hospital stays, caesarean births, high blood pressure and diabetes. However, risks can be managed with healthy weight gain, whatever you weigh at the beginning of your pregnancy. 

Please be aware, that Mater Mothers’ Hospitals follows the Queensland Health Guidelines, which states that ovulation induction treatments cannot be given to women with a Body Mass Index of greater than 35.

If you would like further support, speak with your fertility team about a referral to Mater Mothers’ Hospitals' dietitians.

Six tips for nourishing nutrition

1. Eat colourful meals: As well as knowing the vegetables and legumes group is the main food groups on which to base each meal, we now know that you need to keep your meals colourful! Include your “greens” (brassica/cruciferous veggies), orange, raw leafy, starchy vegetables and others, such as red and yellow veggies each day.
2. Eat less processed foods: We need to recognise that there’s processing (making pasta, fermenting yoghurt, snap-freezing vegetables) and 'ultra-processing'. What we really want to avoid are ultra-processed foods—these generally contain multiple ingredients to enhance flavour, texture and stability. In the end, these foods resumble nothing like anything  naturally grown. A good rule of thumb is to choose foods from around the outside of the supermarket aisles or only choose to eat what your grandmother would recognise.
3. Eat across all food groups: It’s one of the dietary guidelines for a reason—it’s important to eat a wide variety of foods every day. This gives you the benefit from all nutrients each group has to offer. Need a reminder of the groups? They are: vegetables, fruit, grain foods (preferably wholegrain), protein foods (e.g. meat, fish, eggs, nuts, legumes), and dairy (mostly reduced fat). 
4. Eat for your pregnancy stage: you are not eating for two, but need to eat twice as well! In the first trimester your energy (kilojoule) needs are about the same as when you weren’t pregnant. It’s only when you get into your second and third trimesters that you need more protein and energy—an extra 1400kJ (second trimester) and 1900kJ (third trimester) is all you need. Your protein needs are only 60grams per day. What is this in ‘real food’? An extra serve from the meat and alternatives group and two to three serves from the breads/cereals/grains group. 
5. Eat safe: Due to immune system changes in pregnancy, women are more susceptible to food poisoning. But by avoiding all foods that carry a risk for harbouring listeria, women are consuming fewer nutrients. You don’t have to go without. For every item on the “no” list, there are a number of alternatives.
6. Stick with the evidence for multivitamins: Only folic acid and iodine have been shown to be essential to supplement in pregnancy. While it may seem like “more is better” with supplements, this is not necessarily correct in many cases. Most of the vitamins and minerals in a pregnancy multivitamin supplement are water soluble and end up in your urine if you don’t need them. For some women, a blood test may indicate that a separate supplement containing iron or Vitamin D may be required. It is also important to aim for the right amounts of fruit, vegetables and foods from the other food groups to ensure you provide your body with the best balance of nutrients for pregnancy.