All About Eating for Two, Part 2

If a woman's calorie intake is restricted in pregnancy, she may not get enough protein, vitamins and to adequately nourish her unborn child. Low-calorie intake can result in a breakdown of stored fat in the mother, leading to the production of substances called ketones in her blood and urine. The production of ketones is a sign of starvation of a starvation-like state. Chronic production of ketones can result in a mentally retarded child.

For these reasons, the National Academy of Sciences recommends that pregnant women eat an average of 150 calories more per day in the first trimester and 350 calories more per day in the two subsequent trimesters than they did before becoming pregnant. A total weight gain of about 25 to 30 pounds is usually recommended, with the actual pattern of gain considered more important than the number of pounds. Weight gain should be at its lowest during the first trimester, and should steadily increase, with the mother-to-be gaining the most weight in her third trimester, when the fetus and placenta are growing the most.

The effects of undernutrition on infant size is greatest when nutritional deprivation occurs during the final three months. Weight gain in the second trimester is due mostly to increases in tissue, blood volume, and fat stores, and enlargement of the uterus (womb) and breasts.

Arthur Alfin-Slater estimates that a 25-pound weight gain breaks down as follows: baby, 8 pounds; placenta, 1 pound; amniotic fluid, 1.5 pounds; breasts, 3 pounds; uterus, 2.5 pounds; and stored fat and protein, water retention, and blood volume, 8 pounds.

Along with increased total calories, pregnant women need high- quality protein daily, the approximate amount contained in two large eggs and 2 ounces of cheese or a 4-ounce serving of meat.

During pregnancy, fat deposits may increase by more than a third the total amount a woman had before she became pregnant. Most women lose this extra weight in the birth process or within several weeks thereafter. Breast-feeding helps to deplete the fat deposited during pregnancy. A woman who breast-feeds expends 600 to 800 more calories than one who doesn't. The woman who nurses he baby also has increased needs for specific nutrients.

The extra 600 to 800 calories a day includes both the nutritive value of the milk produced as well as the energy needed to synthesize the milk from lactose, protein and fat. Severely undernourished women produce less milk. However, obese women produce the same amount of milk as those of average weight.

The amount of vitamins in human milk, particularly water-soluble vitamins such as C and the B complex, is closely related to that in the mother's diet. The concentrations of trace elements such as copper fluoride, and of fat-soluble vitamins, seem to be less dependent on the fluctuations in maternal eating habits.

Pregnancy is a natural, healthy state, and most changes in pregnant women occur without harmful effects. But some physiological changes have been topics of particular medical concern. In past years, the tendency of pregnant women to retain water has led to restriction of sodium intake. When water retention was severe, diuretics were frequently prescribed to avoid toxemia. However, views on sodium restriction have changed. today, there is considerable medical opinion that pregnancy is a "salt-wasting" condition--that is, one in which the body can use more salt than usual. Further, sodium deprivation may be harmful to the fetus. The sodium intake usually recommended in pregnancy is 2,000 to 8,000 milligrams a day, compared to the normally recommended 1,100 to 3,300 milligrams per day. However, pregnant women should be careful that their sodium intake does not greatly exceed this allowance.

Sugar is also an occasional concern in pregnancy. Virtually all women excrete more glucose (a form of sugar) in their urine when they are pregnant. This is one of the normal physiological adjustments pregnancy and is not a cause for concern in the majority of women. It is significant only in the few women who have a tendency towards diabetes and who may thus become diabetic during pregnancy.

Diabetic women should be closely monitored to make sure their blood sugar values are at or near normal. If maternal blood sugar rises too high, the increased sugar crossing the placenta can result in a large, overdeveloped fetus and an infant with blood sugar level abnormalities. Diabetic women may also suffer from a greater loss of some nutrients.

Nausea in early pregnancy is another condition that often can be managed nutritionally. Dr. Alfin-Slater's booklet suggests the following:

• Keep meals small, and avoid long period without food.
• Drink fluids between, but not with, meals.
• Avoid foods that are greasy, fried or highly spiced.

Improvements in the technological ability to diagnose birth defects early in pregnancy have focused attention on ways to correct certain fetal defects by manipulating the mother's diet. For example, researchers are investigating the use of vitamin- mineral supplements to prevent neural tube defects?that is, failure of the fetus's neural tube to close because of spinal cord abnormalities. Other investigators are researching ways maternal nutrition can help fetuses with inherited birth defects, usually inborn errors of metabolism, in which certain nutrients are not processed normally.

The effects of a woman's diet on her children start long before she becomes pregnant. Stores of fat, protein, and other nutrients built up over the years are called upon during pregnancy for fetal nourishment.

According to Roy M. Pitkin, M.D., of the University of Iowa College of Medicine, in Nutritional Impacts on Women, pregnant weight and pregnancy weight exert independent and added influences on the infant's birth weight.

To what extent pregnancy affects a woman long after she has given birth is another subject under investigation. FDA's Jean Pennington, Ph.D., says it is known that a woman who has a large number of children may deplete calcium stores. Walter H. Glinsmann, M.D., chief of FDA's clinical nutrition branch, counsels that having babies should be considered a major life effort that begins long before conception.

"Getting pregnant is like running a race," Dr. Glinsmann says. "You have to get yourself in condition."

Reprinted with permission from the United States Food and Drug Association

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