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Safe Food: What to eat and drink in pregnancy
Rosie Dodds
Hannah Hunter Hulme
Key issues for pregnant and breastfeeding women. Practical help and the latest research from the NCTWhat you eat and drink in pregnancy and the choices you need to make may seem like a minefield to a first-time mother.Safe foods and those to avoid such as soft cheese, shellfish, unwashed salads, pate and liver are listed in this book as well as information on the supplements it is wise to take, including folic acid and the calories you need to feed your growing foetus.Alcohol and common drugs such as aspirin add to the information on safe or unsafe substances.The book also covers eating during breastfeeding – do the same rules apply?
NCT Book of
Safe foods
Hannah Hulme Hunter and Rosemary Dodds
Copyright (#ulink_21ca445a-e98c-57d9-a6dd-4bf821fdde56)
Thorsons/National Childbirth Trust Publishing
Thorsons is an imprint of HarperCollinsPublishers Ltd. 1 London Bridge Street London SE1 9GF
www.harpercollins.co.uk (http://www.harpercollins.co.uk/)
First published by Thorsons and National Childbirth Trust 1998
Copyright В© NCT Publishing 1998
Hannah Hulme Hunter and Rosemary Dodds assert the moral right to be identified as the authors of this work
A catalogue record for this book is available from the British Library
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Contents
Cover (#ueb033061-60c9-5d01-abea-192fc843d350)
Title Page (#u547961fe-6ab2-571a-b240-56ad26ba500c)
Copyright (#u16b8d387-1a11-593a-a949-c358f3e978ed)
Introduction (#u9ad81cf3-6ac9-5493-b302-b67d0804d8f7)
1 What is �healthy eating’? (#u64051a10-d636-528f-bcc2-02e2521fa819)
2 More about healthy eating (#u75bfaf00-ca22-550b-acdd-4e132b10fe76)
3 Safety first (#uc91ce99c-66ca-5c98-bb28-fb7c23d8fe2d)
4 �But I feel so awful’ (#litres_trial_promo)
5 Eating for two? (#litres_trial_promo)
6 Healthy eating and lifestyle (#litres_trial_promo)
7 Questions and (some) answers (#litres_trial_promo)
8 After the birth (#litres_trial_promo)
9 Breastfeeding (#litres_trial_promo)
Index (#litres_trial_promo)
About the authors (#litres_trial_promo)
Other Titles in this Series (#litres_trial_promo)
About the Publisher (#litres_trial_promo)
Introduction (#ulink_15a8f08a-03fa-573f-9370-3ab9baf7240d)
Meals should be times when we can sit back and enjoy the taste of good food. They should be times when our busy lives slow down a little, when we can chat with friends or family – or simply think our own thoughts. They should be times for rebuilding our energy, so we return to our work or our play with enthusiasm.
But eating is, of course, more than occasions. Eating a balanced diet is perhaps the single most important contribution we can make to our own wellbeing.
During pregnancy you are sharing your food and drink with your unborn baby. You are responsible for her growth and healthy development, as well as your own wellbeing. A good eating pattern during pregnancy: helps your body cope with the special demands of being pregnant; has a positive influence on the future health of your baby; builds up stores of energy and nutrients for times of need; and prepares your body for breastfeeding and nurturing your baby.
But it may not be easy during pregnancy to change your eating habits. Pregnancy is a very busy time for many women – working, looking after a home and family and fitting in clinic appointments. At the same time, you may not be feeling well – you may have pregnancy sickness or tiredness, and you may feel uncomfortably full and big. You may worry about putting on too much weight – or about not putting on enough. Many women are concerned about food safety – there seem to be so many rules and warnings about paté and eggs and soft cheeses. Sometimes it just seems easier to open another packet of chocolate biscuits! And so we decided to write this book.
The information in this book is based on sound scientific research. If the findings of the research are unclear, we say so. We offer you clear and unbiased information – but we do not make decisions for you. Each woman reading this will have unique needs and priorities, and you alone can make the decisions that suit your life. Only when risks are clear-cut do we firmly state a recommended course of action.
Whether you are planning to get pregnant, are newly pregnant or due to have your baby next month, we hope that this book will guide you, ease some of your anxieties – and support you when making food decisions during pregnancy. Above all, we hope this book will help make eating fun.
Hannah Hulme Hunter
Rosemary Dodds
September 1998
1 What is �healthy eating’? (#ulink_374d5004-9d6c-5c53-88eb-9590a6efd2a3)
Healthy eating is about choosing a balance of food, and feeling your best physically and mentally. Healthy eating is about real food – and enjoying eating.
In this chapter we describe the main food groups, explain why they are important and talk about the part that each group plays in a healthy and balanced diet.
Getting the balance right
Imagine an empty plate. Mentally divide the plate into three.
One-third will be full of energy foods: the starchy carbohydrates – pasta, potatoes, rice, yam, bread or cereals. Another third will be packed with fruit and vegetables. Divide the remaining third of the plate into three unequal sections, one a lot smaller than the other two. One of these sections is for protein foods, needed for growth and repair of our bodies – meat, fish, nuts, cooked beans and so on. The other section is for dairy products: the milk-based foods, rich in calcium and other minerals – fresh milk, yoghurt, cheese. The tiny bit in the middle is for fatty and sugary foods.
Now put some food onto your plate. Fill one whole third with rice, potatoes or pasta. Pack another third with lightly cooked vegetables. Put a small portion of fish or lean meat in one of the remaining bigger bits. In the other, put a tub of plain yoghurt. In the tiny bit in the middle, put a teaspoonful of honey to mix into the yoghurt. Pour yourself a glass or two of water. There – a balanced meal!
What about breakfast? Fill one-third of your plate with tinned grapefruit segments. Fill the next third with 2–3 slices of wholemeal toast. If you want to (and it doesn’t matter if you don’t for one meal), add an egg or a slice of lean ham. Place a glass of semi-skimmed milk in one of the smaller sections, and a pat of butter for the toast in the tiny one in the middle. Another balanced meal.
A quick working lunch? Fill one-third of your plate with a large roll of wholemeal bread. Pack the next third with some well-washed salad leaves, a sliced tomato and a crisp, green apple. In the small protein section put a hard-boiled egg or some slices of tasty Cheddar. (Don’t worry about the milk section; the cheese has taken care of that one this time.) Spread the bread roll with a small knob of low-fat spread, and wash down your meal with a carton of unsweetened orange juice.
Treats
Some women find it more helpful to imagine the plate filled with food for the whole day – or even for several days. So long as we get the balance right over about a week, that’s OK. This means that the bag of crisps we couldn’t resist in the cinema can fill up the tiny fatty foods section for several days – provided we don’t try to squeeze in extra dollops of cream as well! And the second helping of roast lamb enjoyed at the weekend can take care of our protein needs for a while, too.
But beware: many foods overlap the sections on the plate and need to be counted into both. Streaky bacon, for example, and ham with the fat still attached, will fill the small protein section – and overlap into the tiny fat section. (So no extra butter or spread for that meal.) Likewise, breakfast cereals are an excellent way of filling the carbohydrate section, but if they contain added sugar, that’s the sugar section overflowing as well. This is why it’s a good idea to choose low-fat and low-sugar foods – and leave the fat and sugar section free for the odd sweet or bag of crisps or whatever other treats we fancy.
Food choices from across the world
Wherever you come from, and whatever the origins of your choice of food, you can use these guidelines for a balanced diet. Simply decide in which group the foods you enjoy belong, and plan your meals around the same proportions described above.
In fact, we can all learn a lot about balanced eating from the food of other countries. Most Indian meals are based on plenty of rice or chapati, a vegetable curry and occasional fish or eggs. Traditional Italian meals generally involve lots of pasta, tasty tomato or milk-based sauces and perhaps a small quantity of meat. Much Chinese cooking centres on stir-fries of noodles, lightly cooked vegetables and seafood. Many traditional African meals involve plenty of starchy carbohydrate – yam, maybe, or pounded cassava – a spicy stew and green leafy vegetables.
Just one word of caution: if you also enjoy fatty foods such as chips, pies and crisps, keep a close eye on the total amount of fat in your diet.
Now let’s look more closely at the foods in each section of our plate.
What is a nutrient?
A nutrient is any substance that gives us nourishment and contributes to the smooth working of our bodies.
What are carbohydrates?
A third of our plate is packed with starchy carbohydrate foods. Carbohydrates should be the main food group that give us energy (calories). We all need energy foods, simply to keep our bodies working well. Some of us need more energy than others; a farmer, active all day in the open air, will need more energy than a secretary sitting at a desk. But even sitting and thinking uses up energy!
Caring for young children and running a home is particularly demanding work. An adequate intake of energy foods is very important, not only to give us the strength to keep going but to help us feel enthusiastic and happy doing so. During late pregnancy you need slightly more energy than at other times – but not much! It is certainly not true that you need to �eat for two’. We talk more about this in Chapter 5 (#litres_trial_promo).
There are two types of carbohydrates – starches and sugars.
Starchy carbohydrates
Starchy foods include things like breakfast cereals, bread, chapati, nan, pitta, rice, pasta, noodles, potatoes, yam and plantain. These foods tend to be good and filling. The energy from starchy foods is slowly converted into sugars and gradually absorbed by our bodies. This means we feel satisfied for longer.
Starchy carbohydrate foods give us more than just energy. They are also important sources of other valuable nutrients – protein, vitamins, minerals and fibre. Starchy carbohydrate foods tend to be fairly cheap to buy.
Sugary carbohydrates
Sugary carbohydrate are found in foods such as sweet biscuits, cakes, jellies, puddings and sweets. These foods are not very filling and they can be expensive to buy. Sugary carbohydrates give us a quick boost of energy, but this energy is only short-lasting so we are likely to feel hungry again soon afterwards.
Sugary carbohydrates have very little nutritional value. This is why it is best not to eat too many sugary foods. It is far better to eat plenty of the starchy carbohydrate foods mentioned above – foods that give us more than just energy. We talk more about sugary foods a little later in this chapter.
Wholemeal foods
Generally, wholemeal or brown varieties of rice, pasta, cereals and bread tend to contain more vitamins, minerals and fibre than the refined or white kinds. For example, wholemeal bread contains half as much again of some of the important B group of vitamins than the same amount of white bread – and twice as much fibre. Wholemeal foods are very useful during pregnancy, when sometimes you may not feel like eating much, because even a relatively small quantity of a wholemeal food will still give you plenty of energy and other nutrients.
Wholemeal breakfast cereals are especially good value in nutritional terms. All breakfast cereals are good energy foods, and most are fortified. (Fortified means that extra vitamins or iron have been added.) Wholemeal cereals are also particularly rich in fibre. Add milk, maybe a few pieces of fresh or tinned fruit, and you have a balanced, get-up-and-go breakfast. Many people enjoy breakfast cereals at other times of the day, too.
How much starchy carbohydrate?
Along with fruit and vegetables, starchy carbohydrates make up the bulk of a balanced diet. Try to include some starchy foods in each meal – and aim for a total of six servings throughout the day. A �serving’ of starchy carbohydrates is equivalent to:
2 large slices of bread
1 large bread roll, a pitta or a nan
2 Weetabix
a large bowl of breakfast cereal �flakes’
a large bowl of porridge
2 fist-sized potatoes or 2 pieces of yam
a portion (about 6 tablespoons) of cooked pasta
a portion (about 4 heaped tablespoons) of rice
What are minerals?
Minerals are inorganic (not living) nutrients found naturally in many foods. Iron, calcium and zinc are examples of important minerals. Minerals are necessary for many body functions, including control of the balance of fluids in our bodies, as well as strong bones and teeth. As with vitamins, it is best to get minerals from our food, rather than take supplements.
What are vitamins?
Vitamins are special substances that our bodies need in order to function normally. Vitamins occur naturally in many foods – but no single food contains all vitamins except breast milk. Only one vitamin (vitamin D) can be made within our bodies – most have to be obtained from our food. Some vitamins can be stored in our bodies while others need to be eaten each day. We only need very small amounts of each vitamin. It is best to get vitamins from our food, rather than from supplements (except for folic acid). Too much vitamin A can be harmful during pregnancy.
Why are vegetables and fruit so important?
The next third of our plate is filled with vegetables and fruit. These foods are bursting with valuable nutrients including vitamins (especially vitamin C and folic acid) and minerals. Fruit and vegetables are our main source of antioxidants – special chemicals found naturally in foods that help protect our bodies against heart disease, cancer and the effects of pollution.
Fruit and vegetables are also a good source of fibre. Fibre (also found in cereals) is the part of our food that is not digested by our bodies. It passes through our digestive system and makes up the bulk of our faeces (bowel motion or poo). Fibre plays an important part in keeping our digestive systems running smoothly and preventing bowel diseases. If we do not have enough fibre in our diet, we may become constipated (have difficulty in passing a bowel motion).
Shopping for fruit and vegetables
If you can, buy fresh fruit and vegetables. Green leafy vegetables are good sources of folic acid. Yellow fruit such as mangoes and apricots, and citrus fruits such as oranges and grapefruits, are rich in vitamin C. But the main thing is to choose fruit and vegetables that you enjoy – and eat plenty!
Try to choose clean, undamaged items, store in a cool place and wash them well at home. Fruit and vegetables sold loose tend to be cheaper than trimmed and packaged items. Some market stall holders and green grocers sell their produce off at reduced prices at the end of the shopping day. Eat fruit and vegetables within a few days, while they are still fresh. And remember that over-cooking of vegetables will greatly reduce their vitamin content – and spoil their taste.
How much vegetables and fruit?
We cannot eat too much fruit and too many vegetables! We should all aim to eat five servings each day. A serving of fruit and vegetables is equivalent to:
a piece of fruit – one apple, a single banana, a large slice of melon and so on
12 chunks of tinned pineapple
a small glass of unsweetened fruit juice
a large bowl of salad
a large tomato
3 tablespoons of peas
2 tablespoons of carrots or cabbage
a handful of raisins
vegetable curry or vegetable stir-fry (counts as two servings if eaten as a main meal)
What about protein?
Protein foods fit into one of the smaller sections of our plate. This may surprise some people. The traditional approach to English meal planning tended to over-emphasise our need for protein – especially for meat protein. Nutritionists now know that we do not need as much protein as previously thought.
But protein is still a very important part of our diet. We need it to repair and maintain the basic building blocks of our bodies – our cells. We also need it to grow new cells; in particular, we need protein while pregnant to grow our babies. We need protein, too, to grow new blood cells and to produce antibodies (the special cells that help our bodies fight infection). Meat protein, in particular, is rich in valuable minerals such as iron and zinc. We talk more about these nutrients in Chapter 2 (#u75bfaf00-ca22-550b-acdd-4e132b10fe76).
Protein comes from two food sources – animal and vegetable. Whatever the source, the basic component of protein is the amino acid. There are many different amino acids. Our bodies can make some, but most need to be taken in our diet. The balance of amino acids in animal protein (in meat, milk and eggs) is similar to the balance required by our bodies. The balance of amino acids in vegetable protein (in nuts and lentils, for example) varies from food to food. This is why people who do not eat meat or drink milk need to eat a wide range of vegetable protein in order to get a good balance of amino acids.
Pregnancy increases the need for protein – but only by a small amount. A balanced diet including 2–3 servings of protein – vegetable, meat or a mixture of both – will easily take care of the extra bit required during pregnancy.
Animal protein
Animal sources of protein include all kinds of meat and fish. Turkey, chicken and fish tend to contain less saturated fat than red meat. (Saturated fat is the most harmful type of fat.) So, if you eat red meat (such as beef, lamb and pork), try to choose lean cuts – remember, you don’t need much!
Oily fish, such as mackerel, tuna and sardines (fresh or tinned), are particularly recommended as sources of protein – because they also give us essential fatty acids. We explain more about fatty acids later in this chapter.
Vegetable protein
Vegetable sources of protein include:
nuts and seeds
peanut butter (peanuts contain as much protein as most cheeses and twice as much as eggs – but see the note about peanut allergy at the end of Chapter 7 (#litres_trial_promo))
meat substitutes, tofu (made from soya beans) and Quorn (made from a fungus)
pulses including lentils (such as masur dhal), baked beans, kidney beans, black-eyed beans, butter beans, borlotti beans, mung beans, broad beans and all kinds of peas.
A well-planned vegetarian diet is extremely healthy. Vegetable protein foods are rich in fibre as well as protein, and contain many vitamins and minerals. Avoiding meat and using vegetable protein foods can be a good way of reducing your intake of saturated fat, and increasing your intake of fibre.
The protein in vegetable protein foods is less concentrated than the protein in animal protein foods. Servings tend to be larger. If you do not eat meat or drink milk, it is a good idea to include a serving of vegetable protein at each meal. Some other important nutrients are less concentrated in vegetable protein. Choose vegetable protein foods rich in iron, zinc, calcium and vitamin B
(more about all of these nutrients in Chapter 2 (#u75bfaf00-ca22-550b-acdd-4e132b10fe76)).
How much animal protein?
We can get enough protein from just two servings of meat protein foods each day. A serving of animal protein is equivalent to:
2 slices of roast chicken or turkey
half a small mackerel fillet
2 rounded tablespoons of tinned tuna chunks
1 small fillet of white fish such as cod
2 slices of lamb, beef or pork
1 small lamb or pork chop
2 eggs
1 slice of tinned corned beef
How much vegetable protein?
Aim for 2–3 servings of vegetable protein foods each day. A serving of vegetable protein is equivalent to:
1 tablespoon of peanut butter
2 heaped tablespoons of nuts or seeds
3 tablespoonfuls of cooked kidney beans or chick-peas
one-third of a large tin (420g) of baked beans
2–3 tablespoons of thick lentil dhal
a small pot (100g) of hummus (try the low-fat variety)
a large cup of soya milk
one-third of a packet of tofu
What about milk foods?
The second of the small sections on our imaginary plate is for milk-based foods, or dairy products. Milk – and foods made from it, such as cheese, yoghurt and fromage frais – is an excellent and convenient source of calcium, zinc, some B group vitamins and protein.
Milk and milk products contain varying amounts of fat, depending on the type of milk and the way in which it has been processed. �Skimmed’ milk has had all the fat removed and �semi-skimmed’ milk has had half the fat removed. Both have the same amount of protein as whole milk – and slightly more calcium.
Liquid milk also contains plenty of water, so a glass of chilled, semi-skimmed milk is a refreshing and nutritious drink. If you do not like the taste of milk, try flavouring it with mashed banana or pulped mango. Use unsweetened cocoa powder in hot milk for a comforting evening drink.
The calcium in milk and other foods is very important. Calcium is a mineral needed by our bodies to ensure strong bones and teeth. A good supply of calcium is especially important during pregnancy (when your baby’s bones and teeth are developing) and while breastfeeding.
Can’t drink milk?
Some people strongly dislike milk and feel that it disagrees with their digestion. They may be allergic to milk or they may react badly to lactose, the sugar in milk.
In order to digest lactose, our bodies need an enzyme (special chemical) called lactase. Babies have plenty of lactase, but some adults have very little. These adults are unable to drink milk – but may find they can eat cheese and yoghurt because the lactose in these foods has been changed or removed. They may also be able to tolerate butter.
All of these nutrients in milk can be found in other foods, but it may be hard to get enough calcium if you dislike all dairy products. We suggest other sources of calcium in Chapter 2 (#u75bfaf00-ca22-550b-acdd-4e132b10fe76).
How much milk?
We need three servings of milk, or milk-based food, each day. A serving of milk is equivalent to:
a full glass of milk (one-third of a pint or 200ml), or the milk in 5–6 cups of tea or coffee
a small carton of yoghurt
a piece of hard cheese the size of a small matchbox
half a small tub of cottage cheese (55g)
half a small tub of fromage frais (100g)
What is so bad about fats and sugar?
The tiny section remaining on our plate is for fatty and sugary foods. Fats and sugar are found in many, many foods – not only in butter, cream and all types of sugar, but �hidden’ in lots of processed foods. Did you know, for example, that a large sausage contains the equivalent of 3 teaspoons of fat, and a can of soft drink 8 teaspoons of sugar?
We do need some fat in our diet. Fat is a source of vitamins A, D and E and essential fatty acids. But we don’t need to deliberately choose fatty foods – because we get quite enough of both from other, more healthy foods.
The problem with fats
There are several different types of fat; some are more healthy than others. The three main types of fat are:
saturated
monounsaturated, and
polyunsaturated.
The basic building blocks of fat are called fatty acids. Each type of fat is made up of different fatty acids.
Most adults in the UK eat too much fat – especially saturated fat. Too much saturated fat increases our risk of heart disease. All types of fat can contribute to an unhealthy weight gain. This is because fats are a very concentrated source of energy. They also tend to make foods taste good.
Saturated fats
Saturated fats are found mainly in foods that come directly, or indirectly, from animals – lard, butter, cream, fatty meat, hard cheese, and foods made using animal fats, like biscuits and ready-made pastry. Coconut oil, palm oil and ghee are also rich in saturated fats – as is chocolate. We should all eat a lot less saturated fat.
Meat and cheese, however, supply other valuable nutrients as well as containing saturated fat. The way around this dilemma is to try to choose lean cuts of meat (we only need a little, remember). It is also a good idea to trim away visible fat, and avoid using extra fat when cooking the meat. If you eat a lot of cheese, you may like to choose a low-fat variety. And, if you enjoy the taste of butter, try a low-fat, �buttery’ spread instead. Semi-skimmed milk (or normal milk with the cream poured off) contains a lot less fat than whole milk – and is just as nutritious.
Mono and poly: the unsaturated fats
Monounsaturated fats are found in many foods, including vegetable oil, olive oil, soft margarines, meat, fish, avocado, eggs and peanuts. Check the �nutritional information’ label on packaged food to see what type of fat each food contains.
Monounsaturated and polyunsaturated fats are better for you than saturated fats. Polyunsaturated fats tend to be liquid at room temperature – in contrast to saturated fats which are usually hard (think of butter, lard, fat on meat and so on). Polyunsaturated fats are found in soya and sunflower cooking oils, sunflower margarine, oily fish, nuts and seeds.
Essential fatty acids
Polyunsaturated fats are important because they contain essential fatty acids. These special fatty acids are called �essential’ because (unlike other fatty acids) they cannot be made in our bodies – we have to get them from our food. The essential fatty acids are needed for normal brain development and the production of some of the hormones necessary for a healthy pregnancy. (Hormones are special chemicals working in our bodies.)
There are two essential fatty acids: linoleic acid and linolenic acid. Linoleic acid is found mainly in nuts, and in plant oils such as sunflower, soya or corn oil. Good sources of the other essential fatty acid – linolenic acid – are oily fish (tinned or fresh sardines, mackerel and salmon), eggs and lean meat.
It is important to take in a balance of the two fatty acids. Unless you are on a very low-fat diet, you are probably taking enough linoleic acid, but most of us would benefit from eating more oily fish and so increasing our intake of the second essential fatty acid, linolenic acid. Scientific research suggests that women who eat more oily fish tend to have longer pregnancies and bigger babies. There may also be a link between taking fish oil during pregnancy and a reduction in the risk of pre-eclampsia, a serious disorder of pregnancy.
Trans fats
Finally, we need to mention a special group of fatty acids called �trans fats’. You may notice on some low-fat spreads a label stating that �This product contains virtually no trans fats’. These products are good ones to choose because high intakes of trans fats have been linked with heart disease.
Trans fats are found in polyunsaturated fats that have been artificially processed in some way. For example, reheating vegetable oil changes the (healthy) fatty acids in that oil to (unhealthy) trans fats. A similar thing happens when liquid fats are hardened to use in factory-produced pastry and hard margarine. Butter, cream and cream cheese also contain some trans fats. The words �hydrogenated vegetable oil (or fat)’ on food labels means that the food probably contains trans fats.
We talk more about avoiding the unhealthy types of fats in Chapter 8 (#litres_trial_promo).
What’s wrong with sugar?
There are two main types of sugar:
sugar added to foods during processing or cooking, and
basic sugars that are a natural part of nutritious foods like fruit, vegetables and milk.
The main problem with added sugar is that, although it gives us an energy boost, it contains no other nutrients at all. In fact, because our bodies need to work to digest sugar, nutrients from other foods eaten at the same time are wasted. Too much added sugar actually drains nutrients from our bodies.
Eating sugary foods fills us up – so we can’t eat other, healthier foods. Too much added sugar contributes to tooth decay and to an unhealthy weight gain. Sugary foods don’t satisfy us for long – so we soon feel hungry again. Finally, sugary foods – cakes, chocolates and sweets – tend to be expensive. So, bad food value all round!
The problem is that many of us really like the taste of sugar. Some women find that they want to eat more sugary foods at certain times of their menstrual cycle – or at different stages of pregnancy. It can be very hard saying �no’ to a tube of sweets or bar of chocolate at times like this. Try to think instead about the other type of sugar – the natural sugar found in fruit or in milk. Foods containing this kind of sugar are rich in many nutrients. When you crave a sugary snack, reach for things like kiwi fruit, bananas and cherries, dried fruit, a slice of fresh bread, a couple of digestive biscuits or some unsalted nuts.
We talk more about cutting down on sugar and sugary foods in Chapter 8 (#litres_trial_promo).
Last, but not least – water!
We all need to drink plenty of water and other fluids. A good intake of liquid throughout the day helps with the smooth running of virtually every part of our body. When we drink enough water our digestion works better, our joints ache less and our skin is softer. Drinking plenty of water can relieve and help prevent many ailments – headaches, constipation, urine infections.
Drinking more while you are pregnant may seem odd, because many women already find they need to go to the toilet more often, especially at night. But there is a reason for this. When you are pregnant, your body contains extra blood and other fluids, to meet the needs of your baby – and your kidneys need to work harder to cope with the additional demands. It is important that you drink plenty to meet your baby’s needs, and to keep yourself in good health. Cutting back on what you drink to avoid getting up to go to the toilet at night can be harmful. Pregnant women are prone to urine infections and constipation and a good intake of fluid will help prevent both of these problems.
During pregnancy, try to drink 6–8 glasses of water, or other fluids, each day – not counting milk or alcohol. Some women find cold tap water very refreshing; others prefer bottled or fizzy water, unsweetened fruit juices or weak squash (avoid those with added sugar!). Many women enjoy coffee or tea, including the fruit and herbal types, or alcohol-free wines and beers. (More about tea, coffee and alcohol in Chapter 7 (#litres_trial_promo).) The main thing is to find drinks that you enjoy.
Urine infection
Signs of a urine infection may include pain when passing urine, needing to go to the toilet often, or needing to go very urgently. Your urine may be dark in colour, cloudy or smelly. If you are worried that you may have a urine infection, start drinking plenty of water to wash out the germs, and contact your family doctor or midwife.
In this chapter we have described a basic plan for balanced eating: plenty of starchy carbohydrates, lots and lots of fruit and vegetables, small amounts of protein and milk foods, tiny quantities of fatty and sugary food – and plenty of water and other fluids. Enjoy your food!
Key points
A balanced meal contains plenty of starchy carbohydrates, lots of vegetables and fruit, small amounts of protein and dairy produce, and tiny quantities of fatty and sugary foods.
Try to eat five servings of fruit and vegetables each day (fresh, tinned, frozen or dried). Remember that over-cooking will reduce the vitamin content of these foods.
Aim for two servings of animal protein, or two to three servings of vegetable protein, each day.
Try to have three servings of milk, or milk-based foods (cheese, yoghurt, and so on) each day.
Choose foods low in fat and sugar to allow for the occasional treat of sweets or crisps. Remember that unsaturated fats are healthier than saturated fats.
Water is important! Try to drink 6–8 glasses of water, or other fluid, each day. (This does not include milk or alcohol!)
2 More about healthy eating (#ulink_13af0c33-f8ff-5d78-8055-a9d139dc16f9)
In this chapter, we talk in more detail about some of the vitamins, minerals and other nutrients mentioned in Chapter 1 (#u64051a10-d636-528f-bcc2-02e2521fa819).
Eating the kind of balanced diet described in Chapter 1 (#u64051a10-d636-528f-bcc2-02e2521fa819) will ensure that you take in plenty of most vitamins and minerals without worrying about any extra foods or supplements. There are a few exceptions to this – the most significant one being folic acid, one of the B group of vitamins. This is a very important vitamin for pregnant women – and for women planning a pregnancy.
There are a few other vitamins and minerals that certain groups of women may need to take special note of: for example, vitamin B
if you eat a vegan diet, iron if you had very heavy periods before pregnancy, and vitamin D if you rarely go out of doors. Read on to find out more.
Folic acid: a very important vitamin for babies
Important: if you suffer from epilepsy, it is important to see your doctor before taking a folic acid supplement. Better still talk to him or her before you become pregnant.
Our bodies need folic acid (sometimes called folate) to make DNA. DNA carries the genetic information that controls the correct development and function of every single cell in our bodies. When you are pregnant, you need extra folic acid – especially in the first 12 weeks while your baby’s body is being formed.
Insufficient folic acid at this time can contribute to problems with the neural tube of your developing baby. The neural tube develops in the very early weeks of pregnancy. It eventually forms your baby’s brain and spinal cord (the long bundle of nerves inside our backbones that connects our brains with the rest of our bodies). You may have seen, or heard, the abbreviation NTD – this stands for neural tube defect. The most common type of neural tube defect is spina bifida. If you decide to have an ultrasound scan during your pregnancy, your baby’s spine will be checked for signs of spina bifida.
Although NTDs are rare, the UK government advises all pregnant women to take folic acid supplements and eat more foods rich in folic acid. Extra folic acid is particularly important for women who have already had a baby with a neural tube problem.
Folic acid supplements
Folic acid supplements are available on prescription from your GP or midwife. NHS prescriptions are free to pregnant women. If you are not pregnant, you may have to pay for your prescription. In this case, it is cheaper to buy a folic acid supplement from a chemist or supermarket. Ask the pharmacist for advice.
Most folic acid supplements are small, white tablets. The recommended dose is 0.4mg each day. (This is sometimes written as 400μg, 400mcg or 400 microgrammes.) Much higher doses are given to women who have already had a baby with an NTD – ask your GP for guidance.
As well as taking a folic acid supplement, increase the amount of folic acid in your diet. This is good advice for all women – pregnant or not! Remember that folic acid, like most vitamins, is easily destroyed by cooking. It is therefore best to steam, microwave or stir-fry vegetables rich in folic acid – or cook in the minimum of water. Don’t overcook!
Planning a pregnancy?
The government also advises that women planning to become pregnant should take folic acid supplements. This is because the neural tube develops during the first four weeks of pregnancy – when a woman may not realise she is pregnant. However, because many pregnancies are unplanned, this is not always possible. If you find yourself in this position, start taking a folic acid supplement as soon as possible, and increase the amount of folic acid in your diet. Remember that NTDs are relatively uncommon.
Foods rich in folic acid (best first)
green leafy vegetables – brussels sprouts, spinach and broccoli
other vegetables – green beans, potatoes, cauliflower, peas and cabbage
tinned baked beans
citrus fruits – oranges, orange juice and grapefruit
fortified breakfast cereals (fortified means that extra nutrients have been added to the food – check the nutritional information chart on the packet)
bread – especially fortified bread (check the label) and wholemeal bread
yeast extract and beef extract
milk
Vitamin B
: another B group vitamin
There are many B group vitamins. Eating a balanced diet will give us plenty of all of them – except perhaps for folic acid and vitamin B
.
Vitamin B
(or �cobalamin’) is needed, like folic acid, for the production of new cells – especially new red blood cells. It also contributes to a healthy nervous system and is involved in the making of fatty acids. Vitamin B
is therefore particularly important during pregnancy.
Vitamin B
is found naturally only in foods that come from animals – meat, fish, eggs, milk and so on. It is also added to some breakfast cereals during their manufacture. It is very rare for women who eat animal foods to be deficient in vitamin B
.
Women who do not eat meat will probably still get enough vitamin B
from other animal foods, but women who do not eat any animal produce at all (a vegan diet) can become short of vitamin B
. If you follow a vegan (or near vegan) diet, it is a good idea to eat plenty of fortified foods, and consider a B
supplement. Ask your family doctor or a pharmacist to recommend a suitable supplement.
Foods rich in vitamin B
(best first)
lamb’s kidney
other meat – beef, pork, lamb, sausages
fish – such as cod, tinned sardines and pilchards
eggs
milk and hard cheese
breakfast cereals – only fortified ones (check the nutritional information chart on the carton)
soy �meat’ and soya milk are often fortified with vitamin B
Vitamin A: harmful if you have too much
We all need small amounts of vitamin A to keep our skin healthy. A balanced diet containing a range of fruit and vegetables, margarine and eggs will provide all the vitamin A we need. There is no need to take extra during pregnancy.
It may be harmful to your developing baby to have too much vitamin A. There are two ways in which this may happen: first, if you eat large amounts of liver, and second, if you take supplements of either vitamin A or fish oil.
Animal liver and liver products may contain high levels of vitamin A. This is related to the type of food on which the animals have been fed. It is therefore best that you do not eat liver, or foods made from liver (such as pate) while you are pregnant. It is OK to eat these foods once you have had your baby.
Fish oil supplements (tablets, capsules or medicine) may also contain high levels of the wrong type of vitamin A. Fish oil contains essential fatty acids – but it is better to eat oily fish like mackerel, herrings, pilchards and salmon, rather than take a supplement.
If you feel you need to take a vitamin supplement, avoid ones that contain the �retinol’ form of vitamin A. Too much (more than 3,300 microgrammes, or mcg or μg) of this type of vitamin A may harm your developing baby. The �carotene’ form of vitamin A is safe – so check the label carefully and ask your pharmacist for advice.
Vitamin C: needed every day
Our bodies need a good supply of vitamin C to help fight infection and disease, to repair damage within our bodies, and to help heal wounds. Vitamin C also plays a role in preventing anaemia (lack of iron in the blood). Unlike other vitamins, vitamin C cannot be stored in our bodies – so we need to eat some foods rich in vitamin C each day.
Some women may need more vitamin C than others. If you smoke, or cannot avoid the smoke of other people’s cigarettes, your body needs more vitamin C. Similarly, if you have been ill, or have had surgery, or have suffered an injury, your body will be using large amounts of vitamin C. In these circumstances, it is a good idea to increase your intake of foods rich in vitamin C.
Foods rich in vitamin C (best first)
citrus fruits – oranges, grapefruits
citrus fruit juices – fresh juice can be expensive; carton juice is just as good
green vegetables – brussels sprouts, broccoli, cabbage
other fruit and vegetables – kiwi fruit, blackcurrants, tomatoes, green peppers
potatoes (yes, really! – especially if thinly peeled or scraped)
Tips for preserving vitamins
Cook vegetables whole or cut into large pieces – this reduces the loss of vitamins during cooking. Try not to leave peeled vegetables soaking in water for a long time before cooking.
When cooking vegetables on the hob, use only enough water to cover the vegetables. Bring the water to the boil, add the vegetables, cover the pan and boil briskly for a few minutes. Test the vegetables with a fork or knifepoint and stop cooking while the vegetables are still crisp. Leafy vegetables such as cabbage or spinach may only take 2–3 minutes to soften.
Use the cooking water to make gravy or stock – to save some of the vitamins that have seeped out into the water during cooking.
Try steaming vegetables – it takes longer but is an excellent way of preserving both vitamins and taste (as is cooking in a microwave oven).
Eat some vegetables raw: grated carrot and finely chopped white cabbage in coleslaw, chunks of sweet pepper, crispy stalks of celery – maximum vitamins and maximum taste!
Eat most fruit raw – but do wash first in plenty of cold running water.
If you wish to cook fruit on the hob, use only a small amount of water and cook gently, for as little time as possible. Redcurrants or ripe plums need only a moment’s cooking – delicious on breakfast cereals or mixed into plain yoghurt.
Try baking large apples or bananas in the oven, wrapped in foil with a sprinkling of dried fruit and served with a dollop of low-fat fromage frais.
Vitamin C is easily destroyed by cooking. If you need to cook vitamin C foods, use only a small amount of water and cook for as little time as possible.
Antioxidants: nutrients fighting pollution
Antioxidants are a special group of nutrients that work to protect our bodies by blocking the action of �free radicals’.
Free radicals are molecules (groups of particles) produced by our bodies. They are produced during many normal body processes – for example, the destruction of bacteria (germs) by our white blood cells, and the digestion of essential fatty acids. A certain level of free radicals is therefore normal.
The problem is that levels of free radicals within our bodies seem to be rising, as more and more are produced in response to pollutants such as cigarette smoke, exhaust fumes, and other toxic substances. If left unchecked, free radicals damage the cells of our bodies and weaken our defences against diseases such as heart disease and cancer.
The main antioxidants are:
vitamins C and E
two minerals called selenium and zinc
beta carotene (the safe form of vitamin A).
Vitamin C is probably the most effective antioxidant. Most fruit and vegetables are good sources of vitamin C, especially citrus fruits, kiwi fruit, blackcurrants, peppers, tomatoes and green leafy vegetables. Vitamin E is found in vegetable oils, wholegrain bread and cereals, avocado pears and other green vegetables, eggs, butter and margarine.
We can get zinc from lean meat, cheese, milk, wholemeal bread and cereals. Cereals are also a good source of selenium, along with fish, pork, cheese, eggs and brazil nuts. Two other mineral antioxidants – copper and manganese – are found in wholegrain cereals, nuts, vegetables, meat and fish.
Beta carotene (and similar nutrients) are found in yellow and orange fruits such as mangoes, apricots, peaches and plums. Green leafy vegetables are rich in beta carotene, as are carrots, pumpkins and tomatoes. Cooked and processed tomatoes, in particular, are considered to be an excellent source of lycopene, another useful antioxidant.
Antioxidants are important for all of us, whether pregnant or not. A balanced diet, with plenty of fruit, vegetables and wholegrain bread and cereals will provide plenty of antioxidants.
Vitamin D: the sunlight vitamin
Vitamin D helps our bodies absorb and use a mineral called calcium. Calcium is needed for strong bones and teeth. A good intake of calcium is especially important during pregnancy when your baby’s bones and teeth are developing.
Vitamin D is found in oily fish, such as sardines and mackerel, eggs, milk and other dairy products, and fortified foods such as margarine and breakfast cereals. Vitamin D is also made within our bodies, a process started by sun-light on our skins. People who spend some time out of doors each day, and who eat plenty of foods rich in vitamin D, usually have good stores of the vitamin.
The UK government recommends that pregnant (and breastfeeding) women should take a supplement of 10Ојg of vitamin D each day (sometimes written as 10mcg or 10 microgrammes). This is because some women in the UK may not build up adequate stores of vitamin D to meet the extra needs of pregnancy. You may like to talk to your GP about a vitamin D supplement if:
you do not eat milk foods, and other animal foods such as fish and eggs
you do not spend some time out of doors between 11am and 3pm each day (it doesn’t matter if the sun isn’t shining)
you usually cover your arms, legs and head when out of doors
you live in the north of England or in Scotland, where the winter days are short.
Calcium: a mineral for strong bones and teeth
Calcium and vitamin D are closely connected because we need vitamin D to help our bones and teeth make use of calcium. Dairy products are the best source of calcium.
One piece of research suggests that not having enough calcium may mean that some women are more likely to develop pre-eclampsia – but more proof is needed.
Foods rich in calcium (best first)
milk, yoghurt and hard cheese (soft cheeses, like cottage cheese and cream cheese, also contain calcium – but less than hard cheeses such as parmesan, Cheddar and Double Gloucester)
tinned fish – especially sardines and pilchards (including the soft bones!) and salmon
soya milk and tofu (made from soya) often have calcium added (check the labels – the normal level for cow’s milk is 120mg in 100ml)
foods made using white flour (which is fortified with calcium) – white bread, pizza bases and pastry
spinach and spring greens
chick-peas, kidney beans and tinned baked beans
sesame seeds and almonds
oranges and dried figs
Zinc: the fertility mineral
Zinc plays an important part in fertility (getting pregnant) and healthy pregnancy. It is also needed for growth and healing, and for good immunity to infections and disease. Meat, milk foods and seafood are all good sources of zinc. Some experts are concerned that the absorption of zinc by our bodies can be reduced by an excessive amount of fibre in our diets, and by unnecessary iron and folic acid supplements. This is one reason why it is important to consult your GP, midwife or pharmacist before taking any nutritional supplements during pregnancy.
Foods rich in zinc (best first)
meat – beef, lamb
sardines – especially good for zinc!
cashew nuts, lentils and chick-peas
wholemeal bread
other fish – smoked mackerel and prawns
hard cheese, milk and eggs
baked potatoes
sunflower seeds and peanuts
Iron: for healthy blood
Iron is needed to make haemoglobin, a pigment that is found in our red blood cells. Haemoglobin carries oxygen around our bodies. If our red blood cells are not healthy, the transport of oxygen around our bodies may not be good enough. We may begin to feel tired, breathless, dizzy and miserable. These are some of the signs of anaemia.
Doctors and midwives used to give all pregnant women supplements of iron routinely. We now know that unnecessary iron supplements may interfere with the absorption of other minerals, such as zinc. They may also cause constipation. It is usually better to prevent anaemia by eating more iron-rich foods. Iron supplements are, however, necessary to treat anaemia; your doctor or midwife will advise you as to whether you need an iron supplement.
Foods rich in iron (best first)
lean beef, lamb and kidney
dark chicken or turkey meat
fortified breakfast cereals
sardines
wholemeal bread
red lentils, chick-peas, baked beans, kidney beans
leafy vegetables – broccoli, peas, curly kale, spring greens, spring onions, spinach
cashew nuts, sunflower seeds
dried fruits – apricots, prunes and figs
baked potatoes
eggs
Tips on getting plenty of iron from your food
Eat some food rich in vitamin C with every meal – fresh fruit or vegetables. This will help your body absorb iron, especially from non-meat iron foods. Vegetables such as peas, broccoli and spinach contain vitamin C as well as iron – provided they are not over-cooked. Spring onions are also full of vitamin C and iron – a convenient no-cook snack!
Eat a variety of leafy green vegetables. (Spinach contains plenty of iron but this iron is not well absorbed by our bodies – so try other vegetables as well.)
Eat meat or fish with non-meat iron foods. This will help you absorb as much iron as possible from the non-meat food – for example, minced beef eaten with leafy green vegetables.
Drink tea and coffee between meals – rather than with your food. Both drinks contain chemicals that can reduce the amount of iron that your body can absorb from food. If you drink tea, have a cup an hour before your meal – or two hours afterwards.
Certain foods reduce the amount of iron that our bodies can absorb from a meal. One example is rhubarb!
What about salt?
Most of us eat more salt than we need. Processed foods – such as ham, cheese, bread, baked beans and biscuits – all contain lots of salt. Savoury spreads (like yeast extract and beef extract), crisps, olives and salted nuts are obviously salty foods. In the long term, too much salt in your diet may contribute to high blood pressure and related health problems later in your life.
During pregnancy, however, the situation is more complicated. Restricting your salt intake at this time has not been shown to reduce the risk of high blood pressure during pregnancy. But this does not mean that you should add extra salt to your food. Use salt to flavour your food, as you would normally.
When you have had your baby, you can try reducing the amount of salt you use in cooking and on your food. This will help when your baby starts taking solid food, since babies should not have any salt at all added to their food.
There is no proof that cutting your salt intake during pregnancy will reduce swollen ankles. Similarly, there is no proof that leg cramps during pregnancy are caused by a lack of salt or of any other minerals.
Understanding food labels
What are calories?
A calorie (cal or kcal, for short) is a measure of how much energy a particular food gives us. Calories are sometimes called �kilocalories’. They mean the same thing. A �kilojoule’ (kJ) is another measure of food energy. One calorie is equal to about 4 kilojoules.
What is the �RDA’?
RDA stands for �recommended daily amount’. The recommended daily amount of a certain nutrient is the amount that most of us need to keep healthy. RDAs vary from person to person. For example, children’s nutritional needs are different from those of older people, and pregnant women’s nutritional needs are different from those of men, or women who are not pregnant. Very active people need more energy than people who don’t exercise much. The RDAs given on food labels usually refer to adult men.
Food labels usually list the RDAs of vitamins and minerals. The percentage figure given after each nutrient tells us how much of our RDA would be met by a portion of that particular food. For example, �Folic acid 34mg (17%)’ means that the food would give us 34mg of folic acid – or 17% of the daily requirement. This sounds very good – but remember that the RDA used is that of an adult man, rather than a pregnant woman whose need is much greater.
Next time you pick up an item of packaged food – a loaf of bread or a tin of baked beans, maybe – take a look at the panel of �Nutritional Information’ on the label. This information can be very useful when planning a balanced diet – especially when deciding whether or not to include a new food.
In Chapter 1 we used �servings’ to describe how much of each food group we need. We did not include weights because we feel that most women prefer not to spend their time weighing food and calculating the nutritional content of each item. Sometimes, however, it is useful to know just what a new food would contribute to your diet.
Imagine, for example, that you are trying to choose between two brands of breakfast cereal. The short list below suggests how much of each food group we need, in grams (usually written simply as �g’). With these figures in mind, you can look at the amounts written on the Nutritional Information of the two cereals and see what proportion of that need would be met by an average portion of each one.
Each day during pregnancy the average woman needs:
about 51g protein
about 18g fibre
as little sugar as possible – ideally no more than 50g
as little saturated fat as possible – certainly no more than 23g
no more than 53g of other fats
about 15mg (milligrams) of iron
about 2,000kcal of energy – or 8,100kJ (with an additional 200kcal during the last three months).
But things are not always as they appear! Sometimes interpreting food labels needs a bit of detective work.
Key points
Folic acid is very important, especially during early pregnancy. Take a 0.4mg supplement each day, and eat more foods rich in folic acid (leafy vegetables, tinned baked beans, fortified breakfast cereals).
Women who eat a vegan, or near vegan, diet generally need a vitamin B
supplement. Other women will get enough vitamin B
from a balanced and varied diet.
A balanced diet will provide all the vitamin A you need. Do not take a supplement.
Try to eat some foods rich in vitamin C every day. A good intake of vitamin C is needed to fight infection and disease, and boost the absorption of iron from food. Remember that vitamin C is easily destroyed by cooking.
Women who do not eat milk-based foods, or who do not spend much time out of doors may need a supplement of vitamin D.
It is better to prevent anaemia by eating more iron-rich foods (meat, fortified breakfast cereals, beans, leafy vegetables) than to take an iron supplement.
3 Safety first (#ulink_400f6bcb-330a-5970-944e-dc023537eac0)
Pregnancy is a time to enjoy a rich variety of foods. It is also a time to take care of yourself and your growing baby by keeping in mind a few basic guidelines on food choice and preparation.
In this chapter we talk about the foods that may cause problems for you and your baby during pregnancy, and suggest ways in which you can avoid these problems.
�Why do I have to be so careful?’
�It’s all so confusing. There seems to be endless lists of things I can’t eat. When I was pregnant last time, I went to a family party. I put some home-made mayonnaise on my salad without thinking and spent the next six months worrying.’
�I feel like a child again with people saying “don’t eat this, don’t eat that”. It’s all rather patronising.’
Throughout pregnancy your baby is protected, floating in warm fluid contained within a bag of strong membranes, safe inside your uterus (womb). Her gateway to the world – to your body – is the placenta (afterbirth). Within the placenta, oxygen and nutrients pass from your blood to your baby’s circulation, and carbon dioxide and other waste products are washed away.
The placenta is also a protective barrier. It filters out most bacteria, some drugs and other harmful substances. However, viruses (germs which are smaller than bacteria) and some bacteria can pass through.
Most of the germs with which we come into contact are harmless. There are, however, a few germs that may cause severe illness in babies. Examples include the virus that causes rubella (German measles), the listeria bacteria and the toxoplasmosis parasite.
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