Consultancy Corner: Nutritious food will boost foetus growth

Early Nutrition Care through pregnancy and first 1,000 days will ensure a well-nourished child who will learn better in school, be healthier and grow into productive contributors to their economies.

Pregnancy and lactation are associated with major metabolic and physiologic changes in the mother. Nutritional requirements increase to optimize both maternal adaptation and foetal development. Improving the mother’s diet before and during pregnancy reduces the risk of medical problems for her and her infant.

Unlike the old school of thought, energy requirements   are only marginally increased during pregnancy. The additional energy increment needed to support appropriate weight gain during pregnancy is 90 to 125 kcal/d in the first trimester, 286 to 350 kcal/d (ICMR) in the second trimester and third trimester and may be increased during lactation. For diabetic women, there is evidence that weight gain at the lower edge of the recommended range or even below this range leads to better maternal and foetal outcomes. Furthermore, it will be beneficial to shift low-nutritional calories into more nutrient-dense calories rather than to increase caloric intake in pregnancy given the average caloric intake of many individuals.

The expansion of maternal blood volume and growth of foetus, placenta and maternal tissues requires additional protein. The RDA of protein during pregnancy is an additional 27.2 g/day. A balanced energy/protein supplementation appears to lead to a lower risk of small-for-gestational-age (SGA) births, as well as a small increase in mean birth weight and maternal weight gain. Optimum Milk, meat, egg and cheese are complete proteins with high biological value. Additional protein may be obtained from legumes and whole grains, nuts and oil seeds.

Fat is a concentrated source of energy and about 30g of fat should be included in the diet of a pregnant woman. Care should be exercised to avoid excess of fat as this could lead to excessive increase in weight. A deficiency of B 6 vitamin in early pregnancy could impair cell growth and replication resulting in placental and foetal abnormalities. The requirement for folate is 500 micrograms/day during pregnancy. Folate can easily be obtained from the diet by including green leafy vegetables, spinach, and beans, whole grains etc but if it is inadequate, supplementation may be carried out.

B12 is also necessary for normal cell division and protein synthesis. It also activates the folate enzyme. The slight increase in need for B12 can be met through diet. Strict vegetarians may need a supplement of 1.2 micro grams /day to prevent deficiency. Increased intake of calcium is highly essential for calcification of foetal bones and teeth and for protection of calcium depletion from mother to meet high demands during lactation. An intake of 1200mg/day (ICMR) is recommended. 

Mother’s diet should contain less of phytic acid, adequate amount of Vitamin D and sufficient amount of calcium. Adequate milk and other dairy products and green leafy vegetables should be consumed (supplements if necessary).Iron is required for the growth of foetus and placenta .It is also required for the formation of haemoglobin as there is 40 -50 per cent increase in maternal blood volume. Hence the recommendation for iron during pregnancy is 35 mg/ day(ICMR). Liver, dried beans, dried fruits, green leafy vegetables,eggs, enriched cereals and iron fortified salt provide additional sources of iron.

Iron deficiency raises the risk of low birth weight, preterm birth and perinatal mortality. A daily supplement of 60mg of iron is recommended in such cases. Zinc is required for cell development and low levels of zinc during pregnancy lead to low birth weight. Therefore slightly higher levels of zinc are recommended