Nutrition guide for pregnant women

Losing weight
after pregnancy

It is important to know that during pregnancy the fatty tissue might increase by more than one third of the total quantity that the woman has had before becoming pregnant.
If weight gain during pregnancy is not excessive, for the most part returning to the basic weight will only take a few weeks or months. Difficulty in losing weight may occur if there has been considerable weight gain during the pregnancy.
Breast-feeding burns around 500 calories a day, and can help reduce the excess fat that has accumulated during the pregnancy.

Vegetarian nutrition
during pregnancy

In principle, vegetarian women need the same nutrition as women who are not vegetarian, other than the fact that they need to pay attention to their consumption of protein, iron and B12 vitamins from animal-based sources:
	Protein - it is recommended to consume enriched soya milk, tofu, cooked pulses and walnuts. It is important to maintain a varied diet.
	Vitamin B12 - is found only in animal-based foods. Other sources of vitamin B12 (although less good) are enriched soya milk, enriched soya, and enriched cereals. It is highly important to check the blood level of B12, and to take a supplement as necessary.
	Iron - it is important to eat green-leaved vegetables, dried pulses, vegetables, dried fruit, and iron-enriched foods, accompanied by vitamin C-enriched foods, such as citrus fruit, to help the absorption of the iron.
Blood iron levels should be checked and, if necessary, a supplement should be taken.

One of the most important issues that affect pregnancy and pregnant women is nutrition. What is recommended to eat and drink during pregnancy? What is the normal range of weight gain, and how to get rid of excess weight after childbirth? Here you will find answers to questions that concern every future mother.

Dr. Sarah Kaplan, chief dietician, Meuhedet

There is a direct connection between proper nutrition and health, at all ages and all times in our lives, and especially during pregnancy.
A woman's state of health and nutrition before and during pregnancy is important and affects the development of the fetus. The physiological changes that take place in the pregnant woman's body require appropriate and balanced supply of food and energy.
Today, it is known that proper nutrition during pregnancy reduces the risk of gestational diabetes, pre-eclampsia and hypertension, and can also prevent excessive weight gain. In addition, since the fetus's food is a product of the mother's food, her nutrition during pregnancy is of greatest importance. The conclusion is that the mother's nutrition during pregnancy is important both for her health and for the sound development of the fetus growing in her womb.

Wise nutrition

It is important to know that during pregnancy there is an increase in the nutritional components required, and that pregnant women need additional 350- 440 kcal. The basic principles of wise nutrition, which are more valid than ever during pregnancy, involve eating orderly meals and a variety of foods from all the food groups. The additional calories should ideally come from all the food groups - carbohydrates, proteins, fats, vegetables and fruit.
There is no justification for "eating for two", but each meal should be slightly increased, as detailed below. A sensible daily menu (even before pregnancy) is important for the health of the mother and the baby. The menu, before and during pregnancy, must contain all the essential food elements, including the vitamins and minerals needed for the baby to develop properly.

How does the menu during pregnancy differ from the previous one?

If you have been careful to maintain a healthy diet before becoming pregnant, it is recommended that you make only small changes in your diet, such as slightly increasing the amount of daily calories consumed (mainly with foods rich in protein, iron, folic acid and calcium, vegetables and fruit).

How much weight should be gained?

The average weight gain during pregnancy ranges between 8 - 13 kg for women who start their pregnancy with normal weight per height. Weight gain is personal, depending, among others, on the basic weight, and it differs from one woman to another.
Too little weight gain by the pregnant mother is related to low birth weight of the baby, and to premature births. Excessive weight gain increases the risk for gestational diabetes, hypertension and complications in childbirth.
In addition, newborns of obese women have low Apgar scores and are at risk of becoming overweight children in the future.
Excess weight gain in pregnant women increases the risk of neural tube defects in children, regardless of the consumption of folic acid. One should not forget that most women wish to complete their pregnancy and return to normal weight, and that a moderate proper weight gain during pregnancy will increase the chances of returning to the previous weight more quickly and easily.
Women who are underweight at the start of their pregnancy should gain an average of 12.5 kg (+/- 5 kg), while overweight women should gain an average of 8 kg.

Is it true that during pregnancy one needs to eat for two?

The exact recommendations regarding the additional calories are still a matter of discussion, due to contradictory data regarding metabolism, accumulation of adipose tissue, and reduced physical activity as the pregnancy advances. It is obvious that additional calories are required, depending on the basic weight of the pregnant woman, but it is not necessary to eat for two.
The current recommendations are aimed at a desirable range of weight gain during pregnancy in accordance with the body mass index (BMI) before pregnancy:

BMI - body mass index - is obtained by dividing weight (kg) by square height (in squared meters)

For a BMI lower than 19.5 (underweight) - an average weight gain of 12.5 kg(12.5 - 18) during pregnancy is recommended.

For a BMI of 19.5 - 25 (normal weight) - an average weight gain of 11.5 kg (11.5 - 16) during pregnancy is recommended.

For a BMI of 26 - 30 (overweight) - an average weight gain of 8 kg (7 - 11) during pregnancy is recommended.

For a BMI higher than 30 (obese) - a weight gain of 6 Kg is recommended.

The above recommendations have been set following a statistical analysis of births in which the newborns were of optimal weights and the mothers did not suffer from complications during childbirth or from losing weight after childbirth.

Is it allowed to follow a slimming diet during pregnancy?

Increased weight gain during pregnancy is liable to increase a woman's desire to lose weight. It is important to know that losing weight by following a very low calorie diet (during pregnancy and breastfeeding) is liable to reduce the quantity and quality of milk, and as a result, harm the baby's health and rate of growth. On the other hand, a moderate and balanced diet containing all the essential food elements and an appropriate amount of calories, under the supervision of a clinical dietician, may contribute to improving self image and preventing excess weight gain.

Vitamins and minerals during pregnancy

During pregnancy, there is an increased need for vitamins and minerals. Some of these can be provided through varied nutrition, including vegetables, fruit, meat, chicken, fish, milk and dairy products, pulses and seeds. Sometimes nutrition alone cannot supply the required quantity, and food supplements should be taken (in consultation with a physician or dietician):

B12 - a vitamin that is involved in building the nervous system of the fetus and building tissue from proteins. Since the only sources of this vitamin are animal-based - meat, fish, milk and eggs - it is recommended that women who follow a vegetarian or naturalist diet check the level of B12 in their blood and take a food supplement as required (in consultation with a dietician and a physician).

Folic acid - belongs to the B group vitamins and is particularly important for the development of the brain and nervous system of the fetus, which develop during the first weeks of pregnancy. Folic acid taken before and during the first months of pregnancy reduce the risk of neural tube defects in the fetus. The Ministry of Health therefore recommends every woman of childbearing age, especially before and during pregnancy, to take a daily 400 µg folic acid supplement. As of the 4th month of pregnancy, this should be replaced by a combined preparation of 100 mg iron and 5 mg folic acid, until the end of the pregnancy. It is also recommended to eat food that is rich in folic acid, such as: pulses, walnuts, green-leaved vegetables (lettuce, celery, cabbage), cauliflower, broccoli, liver, and citrus fruit

Iron - an important mineral for forming the hemoglobin in the red blood cells of the mother and the fetus. During the second half of the pregnancy, the need for iron increases due to the increased blood volume. The fetus absorbs the iron that it requires from the mother's stores. A lack of iron is liable to cause anemia, which can result in premature birth, low birth weight, weakness and over-tiredness of the mother. Pregnant women are recommended to consume food rich in iron: beef, turkey, fish, pulses, dried fruit, walnuts and almonds, and breakfast cereals enriched with iron.
It is important to know that iron from animal sources is absorbed better than iron from vegetable sources. Foods rich in vitamin C (citrus fruit, tomatoes, peppers, kiwi) increase the absorption of iron, and it is recommended to eat them in conjunction with iron-rich food - for example, a side dish of green salad dressed with fresh lemon juice alongside a main course of meat and pulses. It is recommended to reduce the consumption of tea, coffee and cola, which contain caffeine and retard the absorption of iron.
Since it is not possible to obtain all the iron required from food alone, the Ministry of Health recommends a daily 100 mg iron supplement as of the 9th week of pregnancy, to be taken until 6 weeks after giving birth. Taking iron supplement is liable to reduce the mother's zinc levels. Zinc is necessary for better absorption of folic acid, and plays a part in the growth and division of cells in the body. It is therefore recommended that women taking a high dose of iron, enrich their diet with meat, chicken, fish, seeds, walnuts and wheat germ, which are rich in zinc.

Calcium - a mineral required by the fetus for building bones and teeth, for the nervous conduction mechanism, and for muscle contraction. An appropriate supply of calcium is also important for the health of the mother's teeth and bones and for blood clotting, and is likely to help prevent hypertension. The need for calcium increases during pregnancy, and the body's ability to absorb calcium becomes more effective.
The recommended quantity of calcium for pregnant women is not different from that for all women - 1,000 - 1,200 mg a day, which can be obtained from 4 - 5 portions from the dairy group (please see food groups below). It is recommended to choose dairy products that are calcium-enriched and low-fat (up to 5% fat). Other sources of calcium include calcium-enriched soya milk, green-leaved vegetables, sardines and tehina. Women who do not eat dairy products or other food containing calcium should consider taking a calcium and vitamin D supplement in tablet form (it is recommended to consult a dietician and a physician).

Vitamin C - vegetables and fruit containing vitamin C help the baby develop body tissues. Vitamin C also supports iron absorption. Examples of fruit and vegetables containing vitamin C: melon, citrus fruit, papaya, tomato, pepper, cabbage, broccoli, cranberries, etc.

Fatty acids during pregnancy

Unsaturated fatty acids are of particular importance in pregnancy, since they build the baby's brain.
There are two types of fatty acids that are essential for the proper functioning of the brain: Omega 3 and Omega 6. A good source of Omega 3 is northern seas fish, such as salmon and herring, tuna and sardines, and also walnuts, flaxseed, and canola and soya oil. A good source of Omega 6 is sunflower seeds and oil. One of the active components in Omega 3 is DHA (Docosahexaenoic acid), which makes up the brain cell membrane. Sufficient levels of Omega 3 are likely to reduce the risk of premature birth, improve the cerebral and cognitive function of the fetus, and protect both baby and mother from heart disease.

Eating fish during pregnancy

Fish play an important part in a balanced diet during pregnancy. They are considered to be a source of good quality protein, B group vitamins, minerals such as iron and zinc, and Omega 3 type fatty acids, which are important for the development of the brain and the visual system of infants and children. However, certain types of fish are liable to contain chemicals and heavy metals such as mercury, lead and industrial pollutants, and large quantities of these could be harmful to the fetus.
The U.S Food and Drug Administration, the FDA, recommends that pregnant women and nursing mothers avoid eating swordfish, shark, kingfish and mackerel. Other types of fish may be eaten, but it is worth limiting their consumption to 2 or 3 portions a week, and to combine different types of fish. Fresh tuna and tuna steak are liable to contain high levels of mercury and it is recommended to avoid eating them. Canned tuna is considered safe to eat, but should be eaten as part of the weekly fish portion (the amount of contaminants can be reduced by removing the skin and fatty layer from the fish before cooking).

Drinking during pregnancy

Water plays a very important role in the nutrition of the pregnant woman, especially with regard to the increasing volume of blood circulation. Water carries the essential nutrients to the fetus. For the mother, it aids chewing and swallowing, prevents constipation, and reduces urinary tract infections. Drinking enough water will prevent the mother from dehydrating.
Pregnant women need at least 6 glasses of water a day, plus another glass for each hour of activity (a total of no less than 10 glasses of water a day). Water, soft drinks and juices may be drunk, but it should be remembered that soft drinks and juices contain sugar and calories that need to be taken into account in the daily menu. It is important to note that coffee, soft drinks and tea containing caffeine reduce the quantity of liquid in the body, and therefore are not calculated in the total daily intake of liquids. Particular care should be taken to drink enough especially during the last trimester of pregnancy.

Are artificial sweeteners allowed for use during pregnancy?

As a rule, the use of artificial sweeteners is not recommended during pregnancy. It is important to notice that some dietetic drinks contain artificial sweeteners. Women diagnosed with gestational diabetes will receive personal advice on the subject from the health fund dietician.

How much caffeine is allowed to drink each day?

It is recommended to reduce the caffeine intake. Caffeine can pass through the placenta easily and increase the rate of the fetal heartbeat. Caffeine also retards the absorption of vitamins and of minerals such as iron, calcium and zinc. High levels of caffeine are liable to result in low birth weight, and other complications of pregnancy.
Consumption of up to 150 - 200 mg of caffeine a day is considered safe. For example: a cup of tea, a glass of cola or a cup of instant coffee contains around 65 mg of caffeine. Black coffee contains higher concentrations of caffeine, up to 150 mg, and it is recommended to reduce its consumption.

Is alcohol consumption allowed during pregnancy?

Women who are pregnant or planning to become pregnant are recommended to avoid alcoholic drinks altogether. Drinking large quantities of alcohol increases the risk of mental retardation and other defects in the fetus. Even moderate drinking, defined as one portion of alcohol a day, is connected with slowing the growth of the fetus in the womb.

Multivitamin supplements

Even if your diet is balanced and healthy, it can be assumed that you will not be getting some vitamins and minerals in sufficient quantity. One multivitamin tablet a day (specially formulated for pregnant women) could be beneficial and will certainly not be harmful. Taking a daily multivitamin tablet is particularly recommended for women with iron-deficiency anemia, for vegetarians, for women with a poor and unvarying diet, and for multiple fetus pregnancy. One should be careful not to take too much vitamin A (over 10,000 units/day), which could harm the fetus. Such high levels of vitamin A can result from taking food supplements (vitamin A tablets or regular multivitamins that are not adjusted for pregnancy). Before taking multivitamins, it is recommended to consult a dietician.

Smoking during pregnancy

Smoking is always prohibited, and especially so during pregnancy. When a woman smokes, toxins accumulate in her body (nicotine, carbon monoxide) that may pass through the umbilical cord to the fetus. This can affect the growth of the fetus in the womb, and the baby's weight is liable to be lower than expected. In addition, smoking during pregnancy reduces the supply of oxygen and nutrition to the baby, and increases the risk of miscarriage, premature birth and low birth weight. Even passive exposure to smoking is related to low birth weight.
A smoker who plans to become pregnant must stop smoking even before becoming pregnant. It is also recommended to avoid being among smokers.

Common symptoms during pregnancy
Nausea and vomiting

Many pregnant women suffer from varying degrees of nausea and vomiting, mainly during the first three months of pregnancy. Their occurrence can be reduced by the following actions:

Distributing food into small and frequent meals

Spreading drinks throughout the entire day

Breathing fresh air

Adding a carbohydrate, such as crackers, between meals can sometimes help

Avoiding an empty stomach

Resting when tired (sometimes an extra hour or two of sleep a day helps to reduce nausea and vomiting)

It is recommended that each woman learns by "trial and error" which food causes nausea and vomiting, and which eases the problem.

It is important to notice that if serious nausea and vomiting continue beyond week 14 of pregnancy, medical intervention might be needed

Cravings for particular foods

A craving for pickled cucumbers with ice cream and for other particular foods was observed among many pregnant women (for reasons which are unclear).
It is known that this may lead to changes in food consumption among these women. It is important to know that this does not have any effect on the nutrition of the fetus, since the fetus absorbs the essential nutrients that it needs, regardless of the mother's cravings.

Heartburn

Heartburn during pregnancy is usually caused by hormonal changes that slow down the passage of the food through the digestive system, and also by enlargement of the womb, which sometimes leads to pressure on the stomach, mainly during the last weeks of pregnancy. The following actions can reduce its occurrence:

Distributing food into small and frequent meals

It is recommended to avoid irritants such as hot and spicy dishes, caffeine, chocolate, cola and fried or oily food

It is recommended to avoid wearing tight clothing

It is recommended to try not to lie down immediately after eating

It is recommended to sleep with a pillow, or to raise the head of the bed (wooded blocks can be placed under the feet of the bed)

Constipation

Constipation during pregnancy is mainly caused by hormonal changes (and sometimes also by the iron supplement taken during pregnancy). Women who suffer from constipation are recommended to take the following steps:

Drink a lot of water - at least 12 - 15 glasses of liquid a day

Enrich the diet with fiber-rich foods, such as vegetables and fruit, fiber-enriched breakfast cereals, whole meal bread, whole pulses and grains;

Adding olive oil, yogurt and dried fruit can also help.

Women who suffer from severe constipation are recommended to consult a physician with regard to a suitable preparation (be careful about using preparations intended to treat constipation, such as senna and others).

Food contamination

Pregnant women are more sensitive to infections originating in food that is not fresh or not cooked. A bacterial infection can result in miscarriage or harm the fetus.
To avoid food poisoning, it is recommended to avoid eating rare meat or underdone; avoid eating raw fish such as sushi and sashimi; avoid eating dairy products that have not been pasteurized, and ripe cheeses such as Camembert, Brie or Roquefort; and only eat eggs that have been cooked (avoiding soft-boiled or fried eggs and dishes containing raw frothed egg). Maintain the rules of hygiene when preparing food: wash your hands, and cover and store cooked food in the refrigerator.

Physical activity during pregnancy

Moderate physical activity is recommended and is good for the health of both the mother and the fetus. It can help prevent excess weight gain, reduce the risk of chronic illnesses, and improve general wellbeing. Women with a normal pregnancy who have been accustomed to physical activity before becoming pregnant can continue moderate activity, such as walking or swimming (up to 30 minutes a day, most days of the week). Women who were not physically active before becoming pregnant need to consult a physician before embarking on such activity.
Activities that might endanger the fetus are ball games (fear of a blow to the belly by the ball), weight-lifting, diving, parachuting, and any other contact sport liable to cause injuries. Physical activity is not recommended for women with high blood pressure and for women with a history of miscarriage or premature birth. In case of any doubt, it is recommended to consult a physician.
It is important to know that women who engage in physical activity must make sure to drink a large quantity of water before and during the activity, to avoid dehydration, and to arrange for appropriate supply of all the essential food elements.

Medicinal herbs during pregnancy

There is a tendency to consider herbal food supplements and medicinal herbs as safe to take. It is important to know that very few studies have examined their safety during pregnancy, and that certain herbs and vitamins (including those purchased without prescriptions - over-the-counter products) may cause damage at certain times, including during pregnancy, and therefore a re prohibited for use (it is always recommended to consult a professional before taking them).
It is recommended to avoid or reduce the use of medicinal herbs, some of which have energizing effects that could pose a danger to the pregnancy and the fetus.
A (partial) list of the medicinal herbs that are liable to be harmful during pregnancy includes: cohosh, calendula, cola, ephedra, d ong-quai, ginseng, guarna, liquorice, and senna. In addition, pregnant women need to reduce their consumption of "herbal" teas to 1 - 2 cups a day at most, and prefer tea in a teabag rather than loose tealeaves.