Nutrition for Active Pregnant Women [Kayla Kurtenbach & Mackenzie Brown]

Introduction Pregnancy is an incredible journey in a woman’s life. Pregnancy, also known as gestation, is the development of one or more offspring in a woman’s uterus. The time span of a woman’s pregnancy is divided into three trimesters. During the first trimester (first thirteen weeks after conception) significant hormonal changes occur, allowing the body to adapt to the growing fetus and placenta. During this time, the importance for additional vitamins and minerals are essential. Throughout the second and third trimester, the fetus continues to grow in size and reach full development. A crucial structure involved in fetal development is the Placenta. The placenta transports oxygen and nutrients from the mother to the fetus. It also removes waste products from the baby’s blood. A baby completely relies on the nutrients delivered from the mother. This emphasizes the importance of a mother’s nutrition during pregnancy. Because a mother now has to support their baby’s nutritional needs as well as their own, their daily caloric intake is significantly increased. Other physiological change during pregnancy also alters the recommended amounts of certain vitamins and minerals. Malnutrition during pregnancy can have severe effects on fetal development. In order to have a successful pregnancy and healthy newborn, nutritional requirements must be met. The benefits of proper diet and exercise during pregnancy are apparent. This chapter will not only discuss diet and exercise recommendations during pregnancy but will also explore further nutritional requirements for physically active pregnant women.

Literature Review The literature review for this paper includes many sources and how they pertain to nutrition and exercise for pregnant women. The majority of the sources used in the writing of this chapter focused on the positive outcomes of women who exercised during pregnancy and has nutritional control. One article discussed a pilot study with 11 active pregnant women and followed them from 18 weeks of pregnancy until birth. These women exercise for 40 minutes at 70% of their VO2 max, 3-4 times per week. The findings from this study showed the women who were physically active during pregnancy gained less gestational weight, but did not meet their dietary needs (Gerrie et al, 2006). Similarly, another study also found that exercise during pregnancy reduced gestational weight gain but their participants did not meet the recommended carbohydrate intake (Ruchart, 2012). The findings from many studies lead to the conclusion that the women were not meeting the recommended nutritional requirements when physically active. However, it has been shown that exercise during pregnancy leads to normal infant birth weight and also less weight retention for the women two months postpartum. The study discussed by Ruchart followed two intervention groups and one control group of women during their pregnancies. The two intervention groups had either low-intensity (LI) exercise with nutritional control, or moderate-intensity (MI) with nutritional control. The control group had no nutritional control and were told not to exercise. The findings from the study showed that the intervention groups had similar outcomes. The low and moderate intensity women gained less gestational weight than the women who were not exercising. The interesting aspect of this study was that the LI and MI groups gained the same amount during gestation and retained the same amount after. The intensity of exercising did not matter, but the fact that they were exercising versus not exercising made the difference. Gaining an excessive amount of weight during gestation and retaining the weight after delivery increase the risk of overweight or obesity, which is why exercising during pregnancy, is beneficial. Emphasis was also put on the women’s nutrition. Nutrition plans were made for each   woman, making it specific to their body weight, height, activity level, etc. The women were to record their food intake each day. Many studies also found that with nutritional control, women gained less weight during pregnancy.

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Literature Review Continued The human body makes many hormonal alterations during pregnancy in order to provide a proper environment for growing human child. The production of a hormone called human chorionic somatomammotropin is one example. By encouraging maternal tissues to use more lipids for energy production, it increases glucose and amino acid availability for the fetus. Because of the body’s ability to adapt, during pregnancy an increased intake of most nutrients is in fact not necessary. Another example being that during pregnancy there is an increased absorption of calcium, and iron. Therefore, calcium and iron levels are easily maintained. However, some nutrients such as energy, protein, folate, thiamin, riboflavin, and vitamins A, C, and D have an increased requirement. The increased need for folate in particular is reasonably well known and folic acid supplementation is often recommended to prevent megaloblastic anaemia (Williamson, 2006). Furthermore, the existing research on the dietary needs of pregnant women who are physically active is very limited. There is not enough results to support any appropriate recommendations for the active pregnant woman. The previously mentioned pilot study concluded that pregnant women who are also physically active may not be meeting their dietary needs of some nutrients such as potassium, folate, iron, calcium and also appear to be at risk of hypoglycemia. It was also found that most of the women’s energy intake was inadequate. However, this pilot study also concluded that more research would need to be done with larger numbers of subjects in order to properly assess the matter (Gerrie et al., 2006). While multiple sources mention that exercise paired with pregnancy would require an increased energy intake and potential increased intake of some nutrients, the primary research to support specific recommendations is non-existent. 3

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Nutritional Needs During pregnancy, the body goes through many physical and hormonal changes. With the growing fetus comes an increased need of nutrients. The body now requires more of some macro and micronutrients. The amount of nutrients and the form in which they are taken in is important to both the mother and the babies’ health. This is why correct nutrition during pregnancy is crucial. A common saying regarding the extra calories required during pregnancy is that one is now “eating for two”. However, this is not exactly the case. Yes, the nutritional needs have increased, but the calorie intake only needs to increase by 150 kcal per day during the first trimester and 350 kcal per day during the second and third trimesters (Volpe et al, 2009). A woman’s recommended gestational weight gain is determined based on their pre-pregnancy body mass index and is usually within the range of 25 to 40 lbs. No different from the usual recommendation, a diet low in high-fat and highsugar foods and high in fruits, vegetables, whole grains, and lean protein is advised. During pregnancy, most nutrient needs are surprisingly unchanged with the exception of some important nutrients, such as energy, protein, thiamin, riboflavin, and vitamins A, C, and D, as well as folate/folic acid require closer attention during pregnancy (Williamson, 2006). Protein plays a large role in the building and breaking down of structures and tissues in the body. Therefore, it is important for fetal tissue development along with the mother’s breast and uterine tissue development. Protein also increases blood supply which is beneficial to the growing fetus. It is recommended that a pregnant woman receive 75-100 grams of protein each day.

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Nutrient

RDA

Energy Folate/ Folic Acid

Excess 150 – 350 kcal 600-800 mcg.

Calcium

1,000 mg.

Vitamin D

600 mg.

Protein

71 g.

Iron

27 mg.

Good Sources Fortified cereals, leafy green vegetables, citrus fruits, etc. Dairy products, broccoli, and kale Fatty fish (e.g. Salmon), fortified milk and orange juice Lean meat, poultry, fish, eggs, etc. Lean red meat, poultry, fish, beans, and vegetables lorem ipsum :: [Date]

Due to a natural increase in absorption, calcium needs are not very hard to meet but nevertheless, calcium plays an important role in absorption and it is still very important that an expecting mother obtain enough. Calcium needs are 1000 milligrams each day. To help develop the baby’s bones and tooth buds, calcium is an important factor. Just like calcium, Vitamin C is also crucial for tooth and bone development. Vitamin C also aids in the metabolic process and it is recommended to have 85 milligrams each day (Williamson, 2006). Folic acid has been shown to reduce the risk of neural tube defects and spina bifida. Such as anencephaly, hydranencephaly, and more. Neural tube defects are when the child is born with an underdeveloped brain or at times, no brain at all. Spina bifida is the condition when the spinal cord doesn’t completely close. Folic acid or folate as it is often called also plays a role in ensuring proper growth in the fetus and the placenta. The DRI for Folate is 600 mg per day. Folate is better absorbed into the body when derived from fortified foods or supplementation. Therefore, it is recommended that 400 mg. of the total 600 mg. come from these sources to ensure proper absorption. For example, some food sources high in folate are fortified cereals, lentils, spinach, asparagus, and broccoli (Volpe et al, 2009). The large role of folate, particularly very early in the pregnancy is why many women are often advised by their physician to start taking folic acid supplementation as soon as they discover they are pregnant. Women are an at-risk population for anemia and due to their increased blood supply; pregnant women are so even more. Because of this, iron is essential during pregnancy to prevent anemia and increase blood volume. The RDA for iron in pregnant women is 27 mg. per day and supplementation is often necessary to prevent deficiency. Iron can be better absorbed when taken with vitamin C; therefore it is advised to take a multivitamin containing iron with a vitamin C rich food source such as a glass of orange juice. However, while vitamin C can increase the absorption of iron, the tannins in coffee and tea will interfere with iron absorption.  It is not recommended to drink coffee or tea with an iron supplement due to lack of absorption (Volpe et al, 2009).

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The risk of hypoglycemia is also important for pregnant women to consider. Especially during the first trimester when the mother often experiences nausea and vomiting, this is important. The excess vomiting could cause blood glucose levels to drop below the normal range and it is not uncommon for women to contract gestational diabetes during pregnancy. To prevent nausea and vomiting, eating small frequent meals is suggested. While the body’s need for some nutrients during pregnancy is increased, there are also some practices that should be avoided. These include taking herbal preparations that are not regulated by the government. Some herbs may cause miscarriages and unless regulated, the purity is not guaranteed. The consumption of too much caffeine is also unadvised due to the fact that caffeine can cross the placenta, which is the method in which the growing fetus primarily receives its’ nutrients. Another contraindicated practice to consider is vitamin overdosing. While vitamin supplementation can be good for both the mother and growing baby’s health, too much can cause some serious health issues depending on the vitamin. Birth defects could be caused by even just one megadose of vitamin A (Volpe et al, 2009). Other practices not recommended during pregnancy include smoking, drinking alcohol, and dieting. All can have some very severe effects on fetal development and should be avoided.

Pregnant Women and Physical Activity

Now that we touched on the importance of nutrition, we need to discuss the other aspect of our health and wellbeing, which is physical activity. Despite the myths, physical activity during pregnancy is NOT harmful. There are often concerns about the intensity of the activity or which activities can be done, but there are a wide variety of options to choose from. Similar to that of those who are not pregnant, 30 minutes of physical activity a day is strongly recommended for women during pregnancy. Walking is a great exercise during pregnancy. It is easy and not to mention relaxing. Walking helps the pregnant women be physically active while getting fresh air. Running is also a good form of exercise during pregnancy, but does have minimal concern. Women who were vigorous runners before becoming pregnant will need to change their intensity level for pregnancy. For these women, light jogging is a perfectly acceptable workout during pregnancy.

For women who were not runners prior to pregnancy, they are not encouraged to start. These women should continue walking, and pick up running after their pregnancy is finished if they desire to do so. Other than walking and running, there are plenty of different activities pregnant women can engage in. Certain gyms have classes specifically designed for pregnant women. Cycling is a great aerobic workout, which keeps the heart and lungs strong. Pregnancy puts a lot of added weight and stress on the mother’s joints. Therefore, swimming is also a great exercise during pregnancy because of the low impact on joints while still working many muscles. Physical activity during pregnancy keeps one fit and also helps one cope with labor. It can also relieve backaches, bloating, swelling, improve mood, posture, and energy and also help one maintain strength and endurance while pregnant. The benefits of physical activity during pregnancy are endless. Although there are many benefits, a pregnant mother must be careful not to overexert herself or do anything that could potentially harm her or the baby. Therefore, swimming is also a great exercise during pregnancy because of the low impact on joints while still working many muscles. Physical activity during pregnancy keeps one fit and also helps one cope with labor. It can also relieve backaches, bloating, swelling, improve mood, posture, and energy and also help one maintain strength and endurance while pregnant. The benefits of physical activity during pregnancy are endless. Although there are many benefits, a pregnant mother must be careful not to overexert herself or do anything that could potentially harm her or the baby. One study discussed by Ruchart followed two intervention groups and one control group of women during their pregnancies. The two intervention groups had either low-intensity (LI) exercise with nutritional control, or moderate-intensity (MI) with nutritional control. The control groups had no nutritional control and were told not to exercise. The findings from the study showed that the intervention groups had similar outcomes. The low and moderate intensity women gained less gestational weight than the women who were not exercising. The interesting aspect of this study was that the LI and MI groups gained the same amount during gestation and retained the same amount after. The intensity of exercising did not matter, but the fact that they were exercising versus not exercising made the difference. Gaining an excessive amount of weight during gestation and retaining the weight after delivery increases the risk of becoming overweight or obese, which is another reason why exercising during pregnancy is beneficial.

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Another study done by Mudd in 2003 looked at the physical activity in pregnant women and how it affected gestation diabetes, hypertensive disorders, gestational weight gain, and birth weight. The evidence found supports the benefits of physical activity on each outcome. It showed even 25 minutes of mild walking 3 to 4 times per week prevented excess gestational weight gain in these women. The study also found there were reduced odds of hypertension and gestational diabetes with physical activity during pregnancy. As you can see, all signs point to the benefits of physical activity during pregnancy. There may be some concerns with pregnancy and physical activity, so one should make sure to check with their doctor before participating in any form of physical activity. But like stated before, it is recommended for pregnant women to participate in 30 minutes of physical activity a day just like anyone else.

Conclusion In Conclusion, the health of the mother and baby rely on having the proper nutrition and activity during pregnancy. While the requirements of some nutrients remain the same, it is important to take into consideration the additional requirements of key nutrients such as energy, protein, thiamin, riboflavin, and vitamins A, C, and D, as well as folate/folic acid. Not receiving adequate absorption of these nutrients could result in the development of disease. For example, folate’s role in the prevention of developing neural tube defects as well as requiring an increased intake of iron to prevent anemia. Another concern during pregnancy is the possibility that the mother could develop gestational diabetes due to low blood glucose levels. It is important that the proper level is maintained throughout the entire pregnancy. When pregnant, women should consume about an extra 150 kcal per day. Another important aspect studied is the affects of physical activity during pregnancy. Past research has shown that exercise of a low to moderate intensity actually has many benefits. Women who were physically active during pregnancy typically gained less gestational weight, lost their weight more quickly post birth, and had a lower probability of developing gestational diabetes, hypertension, and weight gain. While it was found that exercise has many benefits, the intensity of the exercise did not appear to have much effect. Women who exercised at a low and a moderate intensity showed similar results. Although exercise during pregnancy has shown to have many benefits, it is important to be aware of any pain or discomfort. The excess weight can cause added stress on joints and exercise is only recommended for women who were consistently exercising prior to becoming pregnant. Taking these guidelines into consideration will not only ease ones pregnancy but also set the baby up for a great future ahead. 8

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