Review on dietary practices and food habits of pregnant women

Introduction

According to Darnton-Hill, Nishida and James (2014), nutrition during pregnancy is a significant public health concern. Poor nutrition can lead to a range of health problems for mothers, including cardiovascular disease, diabetes, cancer, and overweight and obesity. Lack of adequate nutrition of pregnant women to the growing foetus is a key causal factor for stillbirths prior to the onset of labour. Pregnancy is characterised by additional energy requirements of approximately 300 kcals (or 1256 KJ) per day, with energy metabolism changing during pregnancy and varying considerably among women. Thus, healthy nutrition intake becomes critical for the health of the mothers and their infants. The current Australian National Dietary Guideline recommends four serves of fruit and five to six serves of vegetables daily during pregnancy (Northstone, Emmett & Rogers, 2008).

Poor nutrition that results from an inadequate dietary intake is associated with a range of social, economic and cultural factors. Some measures of poor nutrition include eating less fruit and vegetables than recommended. It is evident that social-economic status (SES) plays an important role in nutritional intake by individuals. To date, however, limited prevalence data are available for nutrition related health behaviours during pregnancy and most research of this kind is focused on specific nutrients related to dietary concerns (Cox & Phelan, 2008). This has created a challenge for health promotion or healthcare providers in developing dietary behaviour interventions appropriate to the needs of pregnant women.

The only recent study found that few pregnant women met the guidelines for recommended fruit (9%) and vegetables (3%) intake. That study recommended that research investigating patterns of occurrence of multiple risk factors for unhealthy behaviours, particularly stratification by SES would provide more information for planning interventions. Therefore, a better understanding of dietary patterns during pregnancy, which could facilitate the development of practical public health interventions, is urgently needed (Wilkinson, Miller & Watson, 2009).

Conceptual framework

According to Oluwafolahan, Catherine and Olubukunola (2014), dietary factors, including presence and absence of food restrictions, or overall quality of the diet, feeding habits, dietary indiscretions, are well documented independent variables associated with pregnancy outcome and maternal weight in pregnancy. It is a universally accepted that under nutrition can have drastic and wide-ranging effects on women and that of the unborn children, if not managed optimally. When this occurs in the severe form, usually as a result of food shortage, very high levels of morbidity and mortality are recorded (Picot, Hartwell, Harris, Mendes, Clegg & Takeda, 2012).

Maternal dietary practices have gained a lot of attention over the years. This is due to the recognition of the increased physiologic, metabolic and nutritional demands placed on the pregnant woman by her gravidity. The dietary intake of pregnant women needs to provide energy and nutrient for the mother, as well as the foetus (King, 2010). Studies have shown that inadequate dietary intake in pregnancy can lead to unfavourable outcomes. For example, insufficient intake of dietary and supplemental iron can lead to iron deficiency anaemia, with its attendant consequences, including an added risk of morbidity and labour complications (Scholl & Reilly, 2009).

A healthy and well-nourished woman bears health children, who grow to be healthy adolescents and adults. The nutrient intake of pregnant women therefore has various consequences on the health and well-being of children, households, communities and the nation at large, particularly in sub-Saharan Africa, where it is a great determinant of survival and quality of life for the offspring (Shrimpton, 2006).

Importance of good nutrition during pregnancy

Babies depend on their mothers to provide a healthy environment for them to grow and develop during pregnancy. Nutrition has always been considered an important factor in the health of the developing infant. It is well accepted that the quality of the maternal environment that the infant develops in is central to health and disease later in life. So even before pregnancy, women can prepare themselves to have a healthy pregnancy. Healthy body weight is important in reducing health risks for both mothers and babies (Abraham, Mehiza & Steyn, 2011)

During pregnancy, it is important to eat foods that provide all of the nutrients required for the increased needs of mothers and babies during pregnancy. While the “eating for two” standard is not recommended, it is important to take in enough calories, vitamins and nutrients to support the growing baby and to meet mothers’ demands experienced as a result of pregnancy. A healthy diet is the best way to assure good nutrition. Recommendations for nutrient intake (grains, vegetables, fruits, milk and meat/bean servings) are based upon age, height, pre-pregnancy weight and level of physical activity (Esmalizadeh, Serareh & Azadbaklit, 2008).

Good nutrition in pregnancy involves more than calories alone. Pregnancy increases the demand for protein, amino acids, omega-3 fatty acids, folic acid, iron, copper and other minerals. While food sources are the best way to get the additional nutrients, vitamin and mineral supplements are often required to help mothers reach the recommended levels. Prenatal vitamins contain recommended nutrient levels needed during pregnancy. Because maternal nutrition is a critical factor for risk of developing health complications during pregnancy and in the future, steps should be taken to optimize body weight through healthy nutrition and physical activity prior to pregnancy and continued during pregnancy and lactation (Oluwafolahan, et al, 2014).

Recommended diets for pregnant women

What a woman eats and drinks during pregnancy is her baby’s main source of nourishment. In line with this, Koryo-Dabrah, Nti and Adanu (2012) recommend that a mother-to-be choose a variety of healthy foods and beverages to provide the important nutrients a baby needs for growth and development. Key pregnancy nutrition according to Koryo-Dabrah et al (2012) includes diets rich in calcium, folic acid, iron and protein. Here is why these four nutrients are important:

Folic acid: Folic acid also known as folate when found in foods, is a B vitamin that is crucial in helping to prevent birth defects in the baby’s brain and spine, known as neural tube defects. It may be hard to get the recommended amount of folic acid from diet alone. For that reason it is recommended that women who are trying to have a baby take a daily vitamin supplement containing 400 micrograms of folic acid per day for at least one month before becoming pregnant. During pregnancy, women are advised to increase the amount of folic acid to 600 micrograms a day, an amount commonly found in a daily prenatal vitamin. Pregnant mothers are also encouraged to eat foods which are rich in folic acid such as leafy green vegetables, fortified or enriched cereals, breads and pastas.
Calcium: Calcium is a mineral used to build a baby’s bones and teeth. If a pregnant woman does not consume enough calcium, the mineral will be drawn from the mother’s stores in her bones and given to the baby to meet the extra demands of pregnancy. Many dairy products are also fortified with vitamin D, another nutrient that works with calcium to develop a baby’s bones and teeth. Pregnant women age 19 and over need 1,000 milligrams of calcium a day; pregnant teens, ages 14 to 18, need 1,300 milligrams daily. Some food sources that are rich in calcium include milk, yogurt, cheese, calcium-fortified juices and foods, sardines or salmon with bones and leafy greens
Iron:Pregnant women need 27 milligrams of iron a day, which is double the amount needed by women who are not expecting. Additional amounts of the mineral are needed to make more blood to supply the baby with oxygen. Getting too little iron during pregnancy can lead to anaemia, a condition resulting in fatigue and an increased risk of infections. For better absorption of the mineral, include a good source of vitamin C at the same meal when eating iron-rich foods. For example, have a glass of orange juice at breakfast with an iron-fortified cereal. Food sources that are rich in iron include meat, poultry, fish, dried beans and peas, iron-fortified cereal.
Protein: More protein is needed during pregnancy because it helps to build important organs in the baby, such as the brain and heart. Example of food sources that are rich in protein include meat, poultry, fish, dried beans and peas, eggs, nuts, tofu.

Foods to eat during frequently pregnancy

During pregnancy, the goal is to be eating nutritious foods most of the time. To maximize prenatal nutrition, Abraham et al, (2011) emphasized that pregnant women should eat consume, vegetables, lean protein, whole grains and dairy products frequently. They further stressed that pregnant mothers should fill half their plates with fruits and vegetables, a quarter of it with whole grains and a quarter of it with a source of lean protein, and to also have a dairy product at every meal.

Fruits and vegetables: Pregnant women should focus on fruits and vegetables, particularly during the second and third trimesters. Pregnant women should get between five and 10 “tennis ball”-size servings of produce every day, these foods are low in calories and filled with fibre, vitamins and minerals (Abraham et al, 2011).
Lean protein: Pregnant women should include good protein sources at every meal to support the baby’s growth, such as meat, poultry, fish, eggs, beans, tofu, cheese, milk and nuts (Abraham et al, 2011).
Whole grains: Whole grains are an important source of energy in the diet, and they also provide fibre, iron and B-vitamins. At least half of a pregnant woman’s carbohydrate choices each day should come from whole grains, such as oatmeal, whole-wheat pasta or breads and brown rice (Abraham et al, 2011).
Dairy: Pregnant women should aim for 3 to 4 servings of dairy foods a day, such as milk, yogurt and cheese, which provide good dietary sources of calcium, protein and vitamin D (Abraham et al, 2011).

Foods to limit during pregnancy

According to Abraham et al, (2011), there are some foods which are harmful to the unborn baby, so pregnant women are required to limit such foods such as:

Caffeine: Consuming fewer than 200 mg of caffeine a day, which is the amount, found in one 12-ounce cup of coffee, is generally considered safe during pregnancy, excessive intake of caffeine is associated with the risk of miscarriage or premature birth.
Some variety of fish: Fish is a good source of lean protein, and some fish, including salmon and sardines, also contain omega-3 fatty acids, a healthy fat that’s good for the heart. It is safe for pregnant women to eat 12 ounces of cooked fish and seafood a week. However, they should limit albacore or “white” tuna, which has high levels of mercury. Mercury is a metal that can be harmful to a baby’s developing brain.

Foods to avoid during pregnancy

Alcohol: Women should avoid alcohol during pregnancy. Alcohol in the mother’s blood can pass directly to the baby through the umbilical cord. Heavy use of alcohol during pregnancy has been linked with foetal alcohol spectrum disorders, a group of conditions that can include physical problems, as well as learning and behavioural difficulties in babies and children (Abraham et al, 2011).
Fish with high levels of mercury: Seafood such as swordfish, shark, king mackerel, and tilefish are high in levels of methyl mercury, and should be avoided. Methyl mercury is a toxic chemical that can pass through the placenta and can be harmful to an unborn baby’s developing brain, kidneys and nervous system (Abraham et al, 2011).
Unpasteurized food: Pregnant women are at high risk of getting sick from two different types of food poisoning: listeriosis, caused by the Listeria bacteria, and toxoplasmosis, an infection caused by a parasite. Listeria infection may cause miscarriage, stillbirth, preterm labour, and illness or death in newborns. To avoid listeriosis, it is advisable to avoid the following foods during pregnancy:
Unpasteurized (raw) milk and foods made from it. Pasteurization involves heating a product to a high temperature to kill harmful bacteria.
Hot dogs, luncheon meats and cold cuts unless heated before eating to kill any bacteria.

Store-bought deli salads, such as ham salad, chicken salad, tuna salad and seafood salad.

Unpasteurized refrigerated meat spreads or pates.
Raw meat: A pregnant mother can pass a Toxoplasmainfection on to her baby, which can cause problems such as blindness and mental disability later in life. To avoid toxoplasmosis, it is recommended that mothers should avoid the following foods during pregnancy:
Rare, raw or undercooked meats and poultry.
Raw fish, such as sushi, sashimi, ceviches and carpaccio.

Raw and undercooked shellfish, such as clams, mussels, oysters and scallops.

Some foods may increase a pregnant woman’s risk for other types of food poisoning, including illness caused by salmonella and E. coli bacteria. These foods should be avoided during pregnancy. Foods such as:

Raw or undercooked eggs, such as soft-cooked, runny or poached eggs.
Foods containing undercooked eggs, such as raw cookie dough or cake batter, tiramisu, chocolate mousse, homemade ice cream, homemade eggnog, Hollandaise sauce.

Raw or undercooked sprouts, such as alfalfa, clover.

Unpasteurized juice or cider.

Causes of poor nutrition during pregnancy

According to Ebomoyi (2008), there are several factors that cause poor nutrition during pregnancy which include:

Poverty: Poverty is one of the major causes of poor nutrition during pregnancy. This is a situation where a pregnant women due to economic reasons suffers from poor nutrition as a result of inability to afford nutritious food items.
Ignorance: Ignorance on the part of pregnant women can lead to nutrition during pregnancy. Ignorance came in form of poor decision on what to eat, when to eat, etc.
Famine: Famine which can be as a result of war, draught, natural disaster, etc. can lead to poor nutrition during pregnancy.
Food taboos: Food taboos as a result of superstitious belief on the consumption of some nutritive food items can lead to poor nutrition during pregnancy. For example, there are communities that forbid pregnant women from the consumption of snails for fear that children born by women who consume snail salivate excessively.
Health condition: Health conditions such as hypercholesterolemia, osteoporosis, diabetics, as so on that cause poor nutrition of pregnancy women leading as a result of poor utilization of nutrient intake.
Food allergies: The occurrence of food allergies can also prevent pregnant women from consuming some nutritious food needed to maintain a good health status during pregnancy.

Effects of poor nutrition during pregnancy

According to Shrimpton (2006), foetal development depends not only on maternal hormones, genetic codes and environmental factors, but on nutritional supplies within the body of the mother as well. What a pregnant woman eats during pregnancy has a great impact on the long-term health prospects of the child. Inadequate nutrition, especially early in the pregnancy, may impair foetal brain development and cause abnormalities in endocrine functioning, organ development and the energy metabolism of your child.

The following are some of the effects of poor nutrition during pregnancy as highlighted by Shrimpton (2006):

Abnormal brain development: Foetuses of poorly-fed pregnant women are deprived of nutrients, especially during the first half of pregnancy, researchers found disturbances in the development of the brains of their foetuses at both the cellular and molecular levels. Hundreds of genes were found to be disordered, impacting cell division and cell-to-cell connections. Pregnant women whose folate levels are low because of poor diets usually lack B-complex vitamin which increases the risk of defects in the neural tubes of their newborn babies that become their spines and brains. Folates are found in lemons, bananas, strawberries, leafy vegetables, dried beans, peas and fortified cereals.
Increased risk of diabetes: The way a child responds to food over a lifetime depends partly on whether or not overfeeding or underfeeding takes place during foetal development. Babies who weighed less than 3 kg at birth were more likely to suffer later from type 2 diabetes. This is attributed to the differences between the prenatal nutritional environment and the nutrition given to babies after birth. This disparity provokes abnormalities in the endocrine functions and energy metabolism.
Increased risk of heart disease and hypertension: Unless a pregnant woman consumes a balanced healthy diet of proteins, fluids, whole grains, fresh fruits, vegetables and polyunsaturated fats and avoid alcohol and caffeine, even prior to conception, the mother put at risk the cardiovascular health of your baby. Especially in the first trimester of your pregnancy, a healthy diet is crucial because the initial organ development of the foetus takes place. The calories, fluids and protein a pregnant mother eats affect the maternal blood volume and pressure, the development of the placenta, but also the cardiovascular future of the child. If mother’s nutritional support is insufficient, the mother puts the baby at greater risk for heart diseases.
Increased risk of obesity: If the foetus is exposed to high levels of blood sugar or fat in the body of the mother, this can affect the development of the fat cells of the foetus and the pathways in the foetal brain that regulate appetite. High-fat and high-sugar foods during pregnancy predispose the baby to becoming obese later in life.
Possible lowering of intelligence quotient (IQ): Poor nutrition during pregnancy can lead to possible lowering of the IQ of the unborn baby by altering the development of foetal organs, including the brain, may have lifetime effects, potentially lowering IQ and heightening the risk of behavioural problems.
Solutions to problems associated with poor dietary intake during pregnancy
Oluwafolahan et al (2014) stated that problems associated with poor nutrition during pregnancy can be managed through the following:
Adequate health education: Pregnant women should be adequately health educated on the importance of good nutrition for their health and that of the unborn baby.
Effective use of available resources: Pregnant women should be encouraged to feed well using the available nourishing resources in their locality. They should be made to understand that good nutrition do necessarily have to be expensive. They should look for cheat nutritious food items in their locality.
Careful choosing of food: Pregnant women should carefully choose their food to ensure that they reduce foods that are not healthy for their babies such as the use of alcoholic beverages, caffeinated drinks, nicotine, etc.
Strict compliance to antenatal multivitamins: Pregnant women should ensure strict compliance to the regular intake of antenatal multivitamins and also take all nutritional advice during their antenatal sessions seriously.

References

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