Diet in pregnancy. Nutrition & Dietetics Department. Patient information leaflet

Transcription

1 Diet in pregnancy Nutrition & Dietetics Department Patient information leaflet

2 Dietary guidance during pregnancy focuses on the need for a well balanced, nutrient dense diet to ensure you and your baby get all the required nutrients. This booklet aims to provide information on a healthy balanced diet, as well as answering frequently asked questions. Healthy eating in pregnancy is no different from at any other time in your life. It simply means eating foods from each food group and choosing them in the appropriate quantities. Which foods should I choose? Eatwell Guide Check the label on packaged foods Use the Eatwell Guide to help you get a balance of healthier and more sustainable food. It shows how much of what you eat overall should come from each food group. Each serving (150g) contains Energy 1046kJ 250kcal 13% Fat Saturates Sugars 3.0g 1.3g LOW LOW 4% 7% Salt 34g 0.9g HIGH of an adult s reference intake Typical values (as sold) per 100g: 697kJ/ 167kcal of a ui Fr Chopped t omatoe s Whole grain cereal Cous Cous Porridge Tuna Plain nuts Beans lower salt and s ugar Chick peas Rice Spaghetti L o w f at s o f t ch e es e n Leaince m Semi skimmed milk Crisps Be ans, pu Ea lses, fish so t more, eggs u Limit fruit juice and/or smoothies to a total of 150ml a day. sugar Whole wheat pasta Lentils Eat less often and in small amounts w Bagels Frozen peas Sauce ot and salt fat, Eat at leas t5 po rtio ns nd Potatoes v Water, lower fat milk, sugar-free drinks including tea and coffee all count. ed s dd drate ohy sa arb les yc rch ta rs he d Raisins 6-8 a day ith d an uit f fr les yo b t a rie et va eg ta n Choose foods lower in fat, salt and sugars Choos e wh oleg rain or h Pota toes igh, br er ead fib re, ri ce ve,p rsi as on ta s a y day ever les tab e g ve MED 38% 15%, meat and red rced beans other proteins and and fish proc per we pulses, 2 portions of sustainably ek, one esse of which is oily. Eat less d mea t Veg O il Soya drink Lower fat spread Plain Low fat y o g hu r t s tive rna alte nd fat a wer tions se lo Choo ugar op s lower and Dairy Per day 2000kcal Oil & spreads Choose unsaturated oils and use in small amounts 2500kcal = ALL FOOD + ALL DRINKS Source: Public Health England in association with the Welsh Government, Food Standards Scotland and the Food Standards Agency in Northern Ireland Try to eat three regular meals with a healthy snack in between if required. 2 Crown copyright 2016

3 Which foods should I choose Starchy foods: These include bread, cereals, potato, rice, pasta and cous cous and provide you with energy, fibre and minerals. They should make up just over a third of each meal. Snacks can be based around these foods to keep energy levels up and you should choose wholegrain or wholemeal varieties where possible. Fruit and vegetables: These provide you with vitamins, minerals (antioxidants) and are a great source of fibre. Aim to eat 5 or more different portions per day. All varieties can be included, such as fresh, frozen, canned, dried and fresh juice. One portion is approximately a handful. These foods should make up just over a third of each meal or can be used as a healthy snack. Meat, fish and alternatives: These provide you with protein and iron and include meat, poultry, fish, pulses, lentils, beans and eggs. Try to choose lean cuts of meat and remove visible fat or skin from poultry. Try not to have more than two portions of red meat every week, unless you have a history of anaemia (low iron count) or develop anaemia during pregnancy and no more than two portions of oily fish every week (i.e. salmon, herring, sardines, pilchards, mackerel). Milk and dairy foods: These are an important source of calcium and are good for bones and teeth. Aim to have three portions of these foods everyday. One portion is equal to: 1/3 pint of milk, 1x125g yogurt, 25g cheese, 1 bowl of milk pudding/custard. Choose low or reduced fat products when possible. 3

4 Foods containing fat and sugar: These include food such as, margarine/butter, oil, cakes, sweets, biscuits, chocolate, pastries and ordinary squash. Keep foods from this group to a minimum and choose low fat, low sugar varieties as much as possible. Be aware of hidden sugars in packaged foods. Try to get used to checking the labels of food that you buy. Food has a nutrition label on the back or side of the packaging. There are guidelines to tell you if a food is high in fat or sugar, or not. These are: FOOD LaBEL DECODER all MEaSURES as 100G/ML LOW HEaLTHIER CHOICE MEDIUM Ok MOST OF THE TIME HIGH just OCCaSIOnaLLy FaT SaTURaTES SUGaRS SaLT 3g or less 3.1g to 17.5g More than 17.5g 1.5g or less 1.6g to 5g More than 5g 5g or less 5.1g to 22.5g More than 22.5g 0.3g or less 0.31g to 1.5g More than 1.5g Source: BHF food label decoder How much weight should I gain? There are no official UK recommendations for weight gain during pregnancy, however as a general guide weight gain depends on your pre-pregnancy weight, which you can identify from the chart below. 4

5 Are you the right weight for your height? An acceptable weight gain in healthy weight mothers should approximately be 22 28lbs (10 13kg). If you are underweight prior to becoming pregnant you should try to gain at least this amount. If you are already overweight before you become pregnant it is advisable to gain no more than 15 25lbs (7 11kg). It is also acceptable to gain little weight or none at all. 5

6 What about vitamins and minerals? Iron In the UK, routine iron supplementation in pregnancy was common practice but is now probably unnecessary in many cases and could result in side effects such as constipation or nausea (feeling sick). Iron supplementation is only necessary for women with a history of anaemia or who develop signs of anaemia during pregnancy. Good dietary sources of iron include: Red meat Dark fleshed fish (sardines, pilchards, herrings) Eggs Pulses* Bread* Green vegetables* Fortified breakfast cereal* *For the iron in these foods to be absorbed most effectively try to eat them with a glass of pure citrus or cranberry fruit juices or with raw or lightly cooked vegetables. Try to avoid having them with a cup of tea as this will reduce the absorption of iron. Folic acid Folic acid has been shown to reduce the risk of neural tube defects (NTDs) such as spina bifida (poor development in a baby s spinal cord, leaving the cord exposed). All women who are planning a pregnancy should: a) Take a 400 micrograms (mcg/ug) of folic acid daily from the point of planning a pregnancy until the 12th week of pregnancy. (This supplement is available on prescription but, except for those on a low income and exempt from prescription charges, it is cheaper to buy it over the counter than pay the standard prescription charge). 6 b) Choose foods such as bread and breakfast cereals which are fortified with folic acid and lightly cook green vegetables, which are also good sources.

7 Women who have not been supplementing their diet with folic acid and become pregnant should immediately start supplementation and continue until the 12th week of pregnancy. If you or your partner have a Neural Tube defect (NTD) or have previously had a child with a NTD, you should take a daily supplement of 5 milligrams (mg) of folic acid (available on prescription only). Women with diabetes or who developed gestational diabetes in a previous pregnancy are also advised to take 5mg daily. (If you are unsure about the folic acid dose you should take, please discuss with your GP). Vitamin D Normally the body s requirement for vitamin D is met through exposure to sunlight and to a lesser extent, dietary sources such as vitamin D enriched margarine, cheese, oily fish and eggs. However, a daily supplement of 10 micrograms (mcg/ug) is recommended to meet the increased requirements during pregnancy. This is particularly important if your culture or religious faith requires that you cover up when outdoors and you do not have sufficient exposure to sunlight. Vitamin A Although vitamin A needs are slightly raised during pregnancy, they are usually met by eating milk or milk products, eggs, green leafy vegetables and carrots. Do not take supplements or fish oils containing Vitamin A as too much Vitamin A can be harmful to your baby. Liver is another good source of vitamin A, but you should avoid liver and liver products such as liver pate & liver sausage whilst pregnant. What else should I consider? Food safety Some types of food borne infection can be harmful, particularly during pregnancy. For a fully comprehensive, up to date list please see: 7

8 Listeria is a bacteria which can cause harm to your unborn baby. You should avoid: Soft ripened cheeses, such as camembert, brie, goats and sheep s milk cheeses, and mould ripened (blue veined) cheeses. There is no risk with hard cheeses, cottage cheese and processed cheese. Unpasteurised milk and any products made from it. Any type of pate (including vegetable). Precooked or ready prepared cold foods which will not be reheated e.g. purchased salads, quiches, meat pies eaten cold. In addition: Ready prepared meals should be cooked thoroughly and left-over cooked food should be discarded after 24 hours. Fruit and vegetables that are eaten raw should be washed thoroughly. Salmonella is a common cause of food poisoning. It is unlikely to cause harm to your baby but will give you severe diarrhoea and vomiting. You should: Be aware that some eggs may be contaminated with salmonella. Only eat eggs that are cooked until both the egg white and yolk are solid. Avoid dishes containing raw or partly cooked eggs, including home-made mayonnaise, mousse, soufflés, ready prepared egg mayonnaise and egg custard. Always thoroughly cook poultry and avoid cross contamination from food which has been in contact with raw poultry. Caffeine Too much caffeine could increase the risk of early miscarriage and babies born at a low birth weight. It is important to have no more than 200 milligrams (mg) of caffeine a day, which is equivalent to 3 cups (2 mugs) of coffee or 5 cups of tea. Other caffeine containing food and drink should also be taken into account: Cola drinks (40mg in 1 can) Energy drinks (80mg in 1 can) 8

9 Chocolate (25mg in 1 50g bar) Instant coffee (100mg in 1 mug) Filter coffee (140mg in 1 mug) Tea (75mg in 1 mug) Alcohol The current government guidelines encourage pregnant women to avoid alcohol completely during pregnancy. Peanuts and other nuts The advice regarding the consumption of nuts (particularly peanuts) during pregnancy has changed. You can eat nuts or foods containing nuts in pregnancy unless you are allergic. Latest research shows no clear evidence that eating peanuts during pregnancy affects the chance of a baby developing a nut allergy. Frequently asked questions How can I prevent constipation? Aim to eat wholegrain or wholemeal bread and high fibre breakfast cereal (e.g. porridge, Weetabix, unsweetened muesli), make sure you eat at least 5 different portions of fruit and vegetables everyday and drink at least 6 8 glasses of fluid daily. Keeping active will also help. How can I stop feeling sick? Nausea and vomiting in early pregnancy is very common. It is unpleasant but does not put your baby at any increased risk and usually clears up by week Its thought hormonal changes in pregnancy are probably the cause. Some people might find the following helpful but if you have severe sickness please see your GP or Midwife for support. Get plenty of rest as tiredness can make it worse Avoid becoming over hungry by eating small regular meals. Eat something dry before getting up in the morning (e.g. bread, cereal or a biscuit). 9

10 Try to avoid large, greasy or highly spiced foods. Food and drinks containing ginger can sometimes relieve sickness. Avoid the smell of cooking and keep rooms well ventilated and odour free. Try having cold meals rather than hot as they don t give off the smell that hot meals do. Slowly sip a fizzy drink when feeling sick or suck on something sour, such as a sour sweet or slice of lemon. Drink liquids between meals rather than with meals. What can I do for heartburn? Avoid spicy, acidic, fizzy and fatty foods. Small frequent meals or snacks are usually better tolerated than larger ones. Make sure food has settled before lying down. You may find milk and yoghurt can help to relieve symptoms. There are treatments safe for use in pregnancy please discuss with your midwife or GP. What else should I avoid? As well as those foods already discussed, you should avoid shark, swordfish, marlin and raw shellfish. You should have no more than two tuna steaks a week (about 140g cooked), or four medium-sized cans of tuna a week (about 140g when drained). Can I do exercise? All women should be doing some physical activity as part of a healthy lifestyle during pregnancy. It is generally advised if you were already very active before pregnancy, aim to maintain this level but do not try to do more than before. You will find that as your pregnancy progresses, you naturally will be able to do less. If you were not active before pregnancy try to start by doing gentle exercise such as walking or swimming for 15 minutes 3 times a week. As you become fitter aim to increase this to 30 minutes 4 5 times a week. Do not over exert yourself during pregnancy. Avoid doing floor exercises after 16 weeks gestation. You may find exercising in water easier as your pregnancy progresses. 10

11 How do I avoid gaining too much weight? Follow the Eatwell Guide as discussed within this booklet to ensure you are eating the right type of foods from each food group. If your weight gain seems excessive, check you are not having high fat/high sugar foods too often, or that your portion sizes are too large. If you are already active try to maintain this or increase your exercise gently if you are not very active. Key references and further information For any further advice relating to food or nutrition, To find a registered dietitian for specific nutritional advice: The Health Care Professions Council Park House 184 Kennington Park Road London SE11 4BU Telephone: Website: For sound nutritional advice and free Food Fact sheets: The British Dietetic Association 5th Floor, Charles House 148/9 Great Charles St Queensway Birmingham B3 3HT Telephone: Website: Compiled by the Royal Surrey Dietitians. 11

12 Nutrition & Dietetics Department contact details Telephone: PALS and Advocacy contact details Contact details of independent advocacy services can be provided by our Patient Advice and Liaison Service (PALS) who are located on the right hand side as you enter the main reception area. PALS are also your first point of contact for health related issues, questions or concerns surrounding RSCH patient services. Telephone: Opening hours: 9.00am 3.00pm, Monday to Friday If you would like information documents in large print, on tape or in another language or form please contact PALS. Past review date: May 2017 Future review date: May 2020 Author: Michelle Wells Review author: Liz Toft RD PIN Royal Surrey County Hospital NHS Foundation Trust 2017