Special ConsiderationsPregnancy is commonly accompanied by a number of physical side effects, which influence the ability to meet dietary recommendations during the gestation period. Such side effects mainly manifest themselves as nausea and vomiting (i.e. ‘morning sickness’), constipation, and/or heartburn, and occur in up to 70% of pregnant women1. In most cases, the effects are mild and can be relieved by making some small lifestyle and dietary changes.

Nausea and vomiting

Around 70% of women experience nausea and vomiting in early pregnancy (NVP)1, more commonly referred to as morning sickness. In 9 out of 10 women, the symptoms resolve by 12-14 weeks of pregnancy2,3. In around 1 in 200 pregnant women severe cases of NVP are reported4. Such cases may require medical attention to secure a positive pregnancy outcome.4

It is advised by health organizations such as the World Health Organization (WHO), the UK National Health Service (NHS) and the US Institute of Medicine (IOM) to help manage proper food intake during the first weeks of pregnancy by1-3,5

  • eating small, frequent meals (with about 2 hour intervals),
  • avoiding smells and food textures that trigger a feeling of nausea,
  • eating bland, cold foods high in complex carbohydrates and low in fat,
  • limiting highly fatty or sugary foods.

Well-being in the morning is often improved by eating crackers, toast, or dry cereal before getting out of bed3. If solid foods are intolerable, despite making the appropriate dietary changes, the IOM advises an intake of adequate fluids, such as clear juices and flat sugar-sweetened soft drinks.5

Constipation

Maintaining a proper bowel function at any point in the pregnancy is a challenge for 35-40% of the women1. According to authorities like WHO, IOM and NHS, the proper bowel function is best ensured by:

  • Drinking plenty (around 2 liter) of fluids daily. This includes water, milk, juice, and soup.
  • Eating high-fiber foods such as wholegrain bread and cereals, and generous amounts of legumes, fruits, and vegetables.1,5,6

The WHO notes that pregnant women who take iron supplements are especially advised to meet these recommendations as iron supplements can affect bowel movements.

Heartburn

Heartburn, also known as reflux, is common, with about 30-50% of pregnant women affected. It can occur at any point in the gestation period1. It is often one of the first symptoms of pregnancy, appearing within the first month of conception. Later in pregnancy, fetal development may worsen the occurrence of heartburn.5

Lifestyle and dietary advice for pregnant women who experience heartburn is the same as for the general population:

  • Eat small, low-fat meals and eat slowly
  • Avoid chocolate, mint, acidic foods such as tomato and citrus fruits/juices, and spicy foods
  • Drink fluids mainly between meals rather than with meals
  • Milk and dairy products can temporarily relieve symptoms
  • Avoid lying down for one to two hours after eating or drinking

References

  1. World Health Organization Regional Office for Europe. Healthy Eating during Pregnancy and Breastfeeding. Booklet for mothers. 2001.
  2. World Health Organization. Pregnancy, childbirth, postpartum and newborn car: a guide for essential practice. 2006.
  3. National Health Service. Nausea and morning sickness. http://www.nhs.uk/conditions/pregnancy-and-baby/pages/morning-sickness-nausea.aspx Webpage accessed on 7 June 2013
  4. Brown LS, 2010. Life Cycle Nutrition: An Evidence-Based Approach. Chapter 1: Nutrition Requirements During Pregnancy. Jones and Bartlett Publishers, Sudbury, Massachusetts, USA, 24 pp.
  5. Institute of Medicine, 1997. Nutrition During Pregnancy and Lactation: An Implementation Guide. National Academies Press, Washington D.C., USA, 133 pp.
  6. National Health Service. Common health problems in pregnancy. http://www.nhs.uk/conditions/pregnancy-and-baby/pages/common-pregnancy-problems.aspx. Webpage accessed on 7 June 2013.