A desired pregnancy is almost always an occasion for the expectant mother to think about lifestyle habits – and not least about her diet. In doing so, she will be particularly concerned about three points of view:
- How much should I eat?
- What should I eat to meet my increased needs for vitamins and minerals?
- What supplements do I need?
The statements presented in the following “ultimate Diet Regiment guide 2021” are based predominantly on the publications of the German Society for Nutrition (DGE) and other internationally recognized scientific societies, which are united in the International Union of Nutritional Sciences (IUNS).
In a nutshell
- A balanced and varied diet is important for the health of pregnant women and their children.
- Energy needs increase only slightly during the course of pregnancy. Energy needs during the final months of pregnancy are about 10% higher than before pregnancy.
- A normal weight gain during pregnancy lies between 10–16 kg.
- Pregnant women should pay special attention to include vegetables, fruit, whole grains, low-fat milk and low-fat meat products and oily fish in their regular diet
- Vegan or vegetarian diet during pregnancy is possible, but should be treated with caution and need supplements intake.
Additional food intake
The energy requirement during pregnancy is an individual quantity that shows a wide range of variation. It is therefore not possible to give generally valid recommendations for energy intake; a schematic application would burden a part of the women by too much weight gain, another part by insufficient food intake.
If the physical activity of the expectant mother does not change significantly during pregnancy, a mean value of additional energy intake is around 300 kilocalories. But as stated before, this only represents a mean value and depends on your current weight. Generally, it should not be more than 10% of the energy supply before pregnancy.
Compared to the increase in energy requirements, the need for certain vitamins and mineralsincreases significantly more during pregnancy. Pregnant women should therefore pay particular attention to the quality of their diet.
Definition of normal weight by Broca
A definition of normal weight, in which both risk ranges are as small as possible, is therefore already of great importance in early pregnancy stages – even better during pregnancy planning. The following formula is been established:
reference weight [kg] = height [cm] -100.
Exceeding 10% or more is usually considered clinically relevant overweight; women who reach only 85% of the reference weight are likely to be underweight.
Underweight women are more likely to deliver underweight newborns. This is exacerbated if weight gain during pregnancy was low. An above-average weight gain (up to 16 kg) almost completely compensates for the unfavorable effect of the mother’s underweight.
Obesity in pregnancy amplifies several risks – for the mother: Venous disease, birth complications, and for the child: Brain bleedings and birth-related fractures. To some extent, these risks are even more amplified by above-average weight gain.
Additional nutrition intake during pregnancy
No less important than a balanced energy intake is an adequate supply of essential nutrients for pregnant women: Protein, essential fatty acids, minerals, and vitamins. Table 1, shows a recommended amount of additional nutrients (German Society for Nutrition):
|Nutrition||Minimum daily additional intake|
|Essential fats||1 gram|
|Vitamin A||0.3 milligrams|
|Vitamin D||5 micrograms|
|Vitamin E||2 milligrams|
|Thiamine (Vit. B1)||0.3 milligrams|
|Riboflavin (Vit. B2)||0.3 milligrams|
|Vitamin B6||1 milligram|
|Pantothenic acid||2 milligrams|
|Vitamin B12||1 microgram|
|Vitamin C||25 milligrams|
From what has been presented so far, a varied mixed diet provides the safest basis for a diet that meets requirements, even during pregnancy.
Figure 1 shows, that during pregnancy especially an increased intake of vitamin A, vitamin B6, folate, iron and zink should be aimed for. Therefore, special emphasis should be placed on a higher consumption of
- Milk, as the main source of calcium and riboflavin (Vit. B2) (on average 1/2 L per day)
- Green vegetables – also canned – as high-yielding sources of folate, vitamin B6 and vitamin C
- Lean meat to cover iron and vitamin B6 requirements (and thiamine requirements in the case of pork)
- Whole-grain products (e.g. oatmeal) to supply thiamine and dietary fiber
Calf and pork liver are particularly rich sources of iron and numerous vitamins, especially vitamin A, vitamin B12, folate and vitamin B6. Sea fish are particularly rich in iodine and vitamin D. So one liver and fish meal a week add variety and replenish nutrient storage.
If you do not enjoy eating liver, two portions of fish should be consumed per week, with one portion of an oily fish like mackerel, herring, sardines or salmon. A high consumption of carnivorous fish types like tuna and swordfish, which are at the end of the maritime food chain and may exhibit a high amount of toxic or harmful substances, should be avoided. It is recommended that pregnant women who do not regularly eat seafood take a supplement providing the omega-3-fats, but supplements in general are discussed later on.
Pregnant women with weight problems should especially limit their consumption of sweets (including sweet drinks) and fat (hidden fat in sausages or cheese). Water intake should not be less than than 1.5 liters per day. In hot conditions or during heavy physical activities, a higher fluid intake is recommended.
Supplements during pregnancy
This section discussed which supplements and how much should be considered during pregnancy.
Folate (Folic Acid)
Folic acid intake is important for cell division and growth processes. Plant foods such as green leafy vegetables, cabbage, legumes, whole grains, tomatoes or oranges are good sources of folic acid.
Women planning pregnancy should take a folic acid supplement (400 μg folic acid daily) in addition to a balanced diet to meet the increased need for folic acid. You should continue supplementation at least until the end of the first trimester. The European Food Safety Authority considers that a daily intake of up to 1,000 μg should not be exceeded!
During pregnancy, the reference value for iodine intake increases from 200 to 230 μg/day. On average, about 120 μg of iodine is absorbed per day through food and iodized salt. Even a mild iodine deficiency can have negative effects on the baby, so pregnant women should take a daily iodine supplement in addition to dietary iodine intake.
Iodine supplementation of 100-150 μg per day are adequate. This corresponds to the lower to middle range of the safe range (100-200 μg/day) of iodine supplementation during pregnancy as defined in the German maternity guidelines . If multivitamin supplements with sufficient iodine content are taken, no additional iodine supplementation should be used.
Iron requirements increase during pregnancy because more iron is needed for the fetus, the placenta, and the increased blood volume of the expectant mother. However, during During pregnancy, iron loss stops during menstruation, and iron absorption increases.
Pregnant women should ensure an adequate intake of foods with well-absorbable iron. These include meat, meat products and fish. Some plant foods, such as whole grains and dark vegetables, have a high amount of iron, but with lower bioavailability. Simultaneous consumption of foods rich in vitamin C (such as citrus fruits) along with iron-rich grains or vegetables can improve iron absorption.
General prophylactic iron supplementation is not recommended during pregnancy because increased iron intake may have adverse effects in women with adequate iron status. Iron supplementation during pregnancy should always be individualized based on a physician’s consultation that includes a medical history and blood tests.
The vitamin D status of a pregnant woman directly affects the vitamin D status and health of the child, especially bone mineralization. Vitamin D is absorbed through food and is also synthesized in the skin when exposed to sunlight. Spending enough time outdoors can help ensure an adequate supply of vitamin D. For pale skin types, it is sufficient to expose the face and arms to sunlight around midday for 5-10 min without sunscreen. Sunburns should be avoided.
The German Society for Nutrition recommends a daily vitamin D supplement of 20 μg (800 IU) for pregnant women who do not synthesize sufficient vitamin D due to lack of or insufficient sunlight exposure. The average dietary intake of vitamin D is 2-4 μg daily. This amount is insufficient to achieve desirable status of vitamin D in winter, and in summer with limited sunlight exposure. Pregnant women who rarely spend time in sunlight, cover their skin, or use sunscreens, as well as women with darker skin types, should supplement their diet with vitamin D to achieve desirable serum concentrations.
Vegetarian nutrition during pregnancy
An ovo-lacto-vegetarian diet with adequate food choices can achieve an overall good nutrient status during pregnancy, except for vitamin D, folic acid, and iodine, which should always be supplemented, and iron, which should be supplemented as directed by a physician.
Pregnant vegetarians who do not eat fish should take a supplement containing the omega-3 fatty acid DHA, since the synthesis omega-3 acid from some vegetable oils is low and does not ensure that needs are met. Low-fat milk and dairy products, eggs, legumes, and cereal products usually provide adequate protein intake. Eggs, legumes, whole grains, and some vegetables can contribute to iron intake. However, the risk for inadequate iron intake is increased in ovo-lacto vegetarians.
Pregnant women who have been on a vegetarian diet for an extended period before pregnancy also show an increased risk of deficiencies in vitamin B 12 and zinc. Guidance to pregnant vegetarian women should therefore take into account the intake of micronutrients.
Vegan nutrition during pregnancy
With a purely plant-based (vegan) diet, sufficient nutrient intake during pregnancy, even with careful selection of foods, is not possible without supplementation. The intake of energy, protein, long-chain omega-3 fatty acids, iron, calcium, iodine, zinc, vitamin B 2, vitamin B 12 and vitamin D is often not met, with significant health risks for the child and the pregnant woman. A vegan diet with vitamin B 12 deficiency for several years can lead to severe and long-lasting damage to the nervous system of the child.
Vegans require supplementation to meet the nutrient needs of both mother and child. Therefore, women who choose a vegan diet before and during pregnancy need qualified nutritional counseling.
Smoking can increase the risk of early delivery and miscarriage, birth defects, early placental abruption, low birth weight, and later birth weight, and increase the later risk of allergies and obesity. Pregnant women should not smoke and should avoid secondhand smoke exposure.
Alcohol during pregnancy can cause birth defects, growth restriction, damage to tissues and neurons, and irreversible reduction in the child’s intelligence development, and it can also have negative effects on the child’s later behavior (hyperactivity, impulsivity, distraction, disturbances in intellectual and social development, and disturbances in social maturity). A safe and risk-free amount of maternal alcohol consumption for the fetus or a window of time during pregnancy when there is no risk from alcohol consumption cannot be defined based on the available evidence. The risk of harming the fetus is highest when frequent and large amounts of alcohol are consumed. The risk of harming the fetus is low when women have consumed only a small amount of alcohol before learning of their pregnancy.
Data are insufficient for quantifying amounts of caffeine that do not pose a risk to mother and child. A Cochrane meta-analysis based on only two studies showed no adverse effects on gestation length or birth weight from consumption of up to 3 cups of coffee per day during pregnancy. As a precaution, high caffeine consumption is discouraged. From this pregnant women are advised against the consumption of so-called energy drinks, which usually contain a high amount of caffeine.
- Werner Kübler (auth.), Prof. Dr. Wolfgang Künzel (eds.) – Gesunde Lebensweise während der Schwangerschaft_ Ratgeber für Ärzte-Springer-Verlag Berlin Heidelberg (1988)
- Deutsche Gesellschaft für Ernährung, Österreichische Gesellschaft für Ernährung, Schweizerische Gesellschaft für Ernährung: D-A-CH Referenzwerte für die Nährstoffzufuhr. Frankfurt, Umschau/Braus, 2012
- German National Consensus Recommendations on Nutrition and Lifestyle in Pregnancy by the ‘Healthy Start
- Conway, Rana – What to Eat When You’re Pregnant and Vegetarian_ The Complete Guide to Healthy Eating-Pearson (2013)