The document discusses important nutrition considerations during pregnancy. It recommends getting proper nutrition prior to conception to support fetal development during the first few weeks. Key nutrients discussed include folate, iron, calcium, vitamins D and A, omega-3 fatty acids, protein, and carbohydrates. Adequate intake of these nutrients is important for reducing health risks for both mother and baby during pregnancy and development.

1. BY- PROF. DR. MC BANSAL
DR. RIDHI KATHURIA

2. LET THY KITCHEN BE THY
APOTHECARY, AND LET
FOODS BE THY MEDICINE

3.  Good nutrition is an important component of a healthy lifestyle and a
healthy baby.
 The best time to review the nutritional status to make appropriate
changes is prior to conception.
 A very important time of fetal development is during the first several
weeks of pregnancy as all of the major fetal body systems are undergoing
formation and rapid development.
 Many women may not even realize they are pregnant at this time.
 Therefore it is prudent to make your lifestyle and nutritional changes
several months before conception occurs.

4. Pregnancy is the only time in life of women when weight gain is not only
desirable, but also encouraged.
Weight gain should not be confused with being obese.
There are multiple growth spurts of multiple organ systems that contribute
to the normal weight gain.

5. Placenta (avg) at term = 650gms *
Amniotic fluid = 800gms*
Breast enlargement = 405gms*
Uterine mass = 900gms*
Fat & fluid = 1200gms*
Maternal blood = 1800gms*
Average weighing baby = 2500 – 3000gms*
It is easy to see that the recommended weight gain of about 11,000gms
(11-14 kg) is very appropriate.
* Weights are shown as approx values

6. Extra 11-14kgs recommended translate into an additional 200-300
calories/day.
This increases the average daily caloric intake from 2200 calories per
day to approximately 2400-2700 calories per day.
Total extra energy cost of a pregnancy is 77,000kcal.
1st Trimester 85kcal/day
2nd Trimester 285kcal/day
3rd Trimester 475kcal/day

7. Pre pregnancy Weight for Height Recommended
BMI Category gain in body
weight (kg)
<18.5 Underweight 12.5 – 18
18.5 – 24.9 Normal Weight 11.5 – 16
25 – 29.9 Overweight 7.0 – 11.5

8. About 75% of pregnant females in India are underweight & anaemic.
Anaemia thus remains a major cause of maternal & fetal morbidity,
mortality and low birth weight.
Too early, Too close, Too many, Too late conception also adversely
affect the health status (nutritional status) of the females.
Another indirect important factor is Gastro-intestinal Infections,
Infestations, which are heralded further with under-nutrition, setting up
a vicious cycle.

9. IMPORTANT NUTRIENTS FOR
PREGNANCY
 Folate
 Iron
 Calcium
 Vitamin D
 Vitamin A

10.  Omega Fatty Acids
 Essential Amino Acids from protein sources
 Calorie providing Food
(Carbohydrate and Fats in proper ratios)

11. • Why is it important in pregnancy
– Needed to reduce risk of :- Neural tube defects
Congenital heart defects,
Cleft lips,
Limb defects
Urinary tract anomalies
Preterm delivery
Infant low birth weight
Fetal growth retardation

12.  400 micrograms of synthetic folic acid daily from fortified foods
and/or supplements has been suggested for all non-pregnant women, in
order to have adequate folic acid intake even in case of unplanned
pregnancies.
 Ideal to start before conception occurs.
It is hypothesized that the insulin-like growth factor 2 gene is
differentially methylated and these changes in IGF2 result in improved
intrauterine growth and development.

13. RICH SOURCES OF FOLATE
Certain foods are very high in folate:
 Leafy vegetables - spinach, asparagus, turnip greens, lettuce.
 Legumes - dried or fresh beans, peas and lentils
 Egg yolks
 Baker's yeast
 Fortified grain products (pasta, cereal, bread)
 Breakfast cereals (ready-to-eat and others)
 Sunflower seeds
 Liver and liver products
 Kidney

14. Moderate amounts:
 Fruit Juices (Orange Juice, Canned Pineapple Juice, Cantaloupe,
Melon, Grapefruit Juice, Banana, Raspberry, Grapefruit And Strawberry)
 Vegetables (Beets, Corn, Tomato Juice, Vegetable Juice, Broccoli,
Brussels Sprouts)

15. • Why is it important in pregnancy
– Pregnancy causes a surge in the volume of blood in the
body; the expanded volume may go up by 50%.
– To meet the demands of the increased blood volume,
iron requirements go up significantly.
– Iron is also required for the normal development of the
growing baby and the Placenta.

16. On an average, the iron requirement during pregnancy is as follows:-
Basal iron = 280 mg
Expansion of red cell mass = 570 mg
Fetal transfer = 200-350 mg
Placental development = 50-150 mg
Blood loss at delivery (normal) = 100-250 mg
After deducting iron conserved by amenorrhoea (240-480mg), additional
500-600 mg iron is required in pregnancy.
If the patient is chronically anaemic, then her iron stores
also stand to be depleted.
This necessitates an extra supplementation of
500 mg is needed.
Thus Total Iron Supplementation Stands At 1000 Mg.

17. • Iron requirements in pregnancy go up from 18 to 27-30 mg per day.
• Because iron is not easily absorbed from the diet, it is recommended to
take an iron supplement
• Risk profile of an anaemic mother includes-
a)Preterm birth.
b)Low birth weight.
c)Increased blood loss during and after labour.
d)Depleted stores.

18. RICH SOURCES OF IRON
oCooking In An Iron Skillet
o Fortified Bread & Breakfast Cereals
o Red Meat
o Soybean
o Poultry
o Spinach
o Lentils
o Beetroot
o Beans
o Jaggery
o Leafy Vegetables
o Pistachios
o Tofu

19. IRON ELEMENAL IRON
DOSE (mg)
PREPARATION CONTENT (mg%)
Ferrous
30 200
Fumerate
Ferrous
11 550
Gluconate
Ferrous
20 300
Sulphate
Ferrous Penta-Carbonyl Has Not Yet Been Approved By The FDA For Use
During Pregnancy And Lactation. However, If No Other Preparations Cant
Be Used And Benefits Out W eigh The Risks, Then It Can Be Used W ith
High Degree Of Vigilance.

20. • Why is it important during pregnancy?
1. Total calcium concentration falls because of physiologic
hypoalbuminemia
2. Free ionized calcium concentration does not change (9-11gm%)
3. The placental produces 1,25-dihydroxyvitamin D, which results
in increased intestinal absorption of calcium
4. Calcium is actively transported across the placenta to the
fetus, facilitated by parathyroid hormone-related peptide

21. This increased demand if not met in the diet – Will lead to excessive
calcium resorbtion from the maternal bones – Osteoporosis.
 Involved in mineralization of bones and teeth, energy and cell
production and electrolyte acid-base buffering.
 Fetal bone and teeth calcification primarily occurs in last 2-3 months.
(total fetal requirement=)
 2 cup full of milk daily or equivalent to supply 1200 mg
calcium/1200mg phosphorous daily
 Excess phosphorous can be a problem. Avoid snack foods, processed
meats and cola drinks.
Therapeutic calcium supplementation (1200mg/day) should
Be in the form of calcium citrate/ calcium gluconate
Supplemented with vit -d

22. RICH SOURCES OF
CALCIUM
 Dairy foods - Milk, yogurt, Cheese, Cottage Cheese, Rasgullas.
 Leafy & Green vegetables - Broccoli, Spinach, Okra,
Horseradish, Watercress
 Fruits - Oranges, Bananas.
 Beans and Peas – Red kidney beans, Soyabean,
Cabbage, Celery.
 Tofu, Peanuts, Peas, Black Beans, Baked Beans
 Fish - Salmon, Sardines
 Miscellaneous - Sesame Seeds, Blackstrap Molasses,
Corn, Almonds, Brown Sugar.
Fortified foods

23. Why is it important in pregnancy?
• It helps the body to use calcium that is consumed.
• Maintain blood calcium & phosphorous levels.
• Anti proliferative action.
RECENT
STUDIES
INDICATE
INCREASED RISK
OF AUTISM IN
INFANTS WITH
VIT. D
DEFICIENCY

24. ᴥ Sunlight exposure
ᴥ Fish - Salmon, Tuna, Flounder, Sole.
ᴥ Milk
ᴥ Cereal
ᴥ Pork
ᴥ Mushrooms
ᴥ Riccota Cheese
ᴥ cod liver oil

26. Why is it important in pregnancy?
 Need enough for healthy growth
 Too much can cause birth defects
 Formation of Rhodopsin, essential for normal vision
 Glycoprotein synthesis (epithelial cell function)
 Maintain normal skin health by switching on genes and
differentiating keratinocytes (immature skin cells)
into mature epidermal cells.
 Regulates gene transcription.
 Anti Oxidant action.

27. ToxiciTy
One of the rare entities which cause adverse effects if taken in
excessive amounts.
Since vitamin A is fat-soluble, disposing of any excesses taken in through
diet takes much longer than with water-soluble B vitamins and vitamin C.
This allows for toxic levels of vitamin A to accumulate.

28. Nausea Hair loss
Irritability Dry skin
Anorexia Drying of the mucous membranes
Vomiting Fever
Blurry vision Insomnia
Headaches Fatigue
Hair loss Weight loss
Muscle & Abdominal pain Bone fractures
Drowsiness Anemia
Altered mental status. Diarrhea

30.  Liver (Beef, Pork, Chicken,  Cheddar Cheese
Turkey, Fish)
 Melon
 Cod Liver Oil
 Egg
 Dandelion Greens
 Apricot
 Carrot
 Papaya
 Broccoli Leaf
 Mango
 Sweet Potato
 Pea
 Butter
 Broccoli
 Spinach
 Milk
 Pumpkin
 Tomatoes

31. Why are they important in pregnancy?
• They serve as building blocks of proteins.
• Used in production of DNA, Cell membrane, Haemoglobin,
Receptors, Enzymes, Neurotransmitters, Hormones, Antibodies &
other Bioactive molecules .
• Serve as body store of energy after fat stored in adipose tissue.

32. INDISPENSABLE DISPENSABLE CONDITIONALLY PRECURSORS OF
AMINO ACIDS AMINO ACIDS INDISPENSABLE CONDITIONALLY
INDISPENSABLE
HISTIDINE ALANINE ARGININE GLUTAMINE/
GLUTAMATE
ISOLEUCINE ASPARTIC CYSTEINE ASPARTATE
ACID
LEUCINE ASPARAGINE GLUTAMINE METHIONINE
LYSINE GLUTAMIC ACID GLYCINE SERINE
METHIONINE SERINE PROLINE GLUTAMIC ACID/
AMMONIA
PHENYLALANIME TYROSINE SERINE
THREONINE CHOLINE
TRYPTOPHAN GLUTAMATE
VALINE PHENYLALANINE

33. According to the American College of Nurse-Midwives, pregnant women
require 71 grams of complete protein each day.
Some types of amino acid protein supplements contain only certain essential
amino acids required by the body.
If consuming amino acid protein supplements during pregnancy, choose those
that contain all nine essential amino acids.

34. Many types of amino acid protein supplements contain added ingredients such
as Creatine, Herbs, Caffeine, Artificial Sweeteners and Preservatives.
A pregnancy diet has more restrictions than a non-pregnant person. Not all
herbs and artificial sweeteners are safe for pregnant women.
In fact, according to the American Pregnancy Association, the FDA
encourages pregnant women to consult with their healthcare provider before
taking any types of herbal products. This includes amino acid protein
supplements that contain herbs.

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37. Deposition Of Protein In The
Fetus & Maternal Tissues During
SITE OF PROTEIN
DEPOSITION Pregnancy
DEPOSITION (g) BY WEEKS OF GESTATION
10 20 30 40
Fetus 0.3 27 160 440
Placenta 2 16 60 100
Amniotic Fluid 0 0.5 2 3
Uterus 24 55 102 166
Breasts 9 36 72 81
Blood 0 30 102 135
TOTAL 35 165 498 925

38. Omega-3 fatty acids are fats commonly found in marine and plant oils.
They are considered essential fatty acids, meaning that they cannot be
synthesized by the human body but are vital for normal metabolism.
Though mammals cannot synthesize omega−3 fatty acids, they have a
limited ability to form the long-chain omega−3 fatty acids including
Eicosapentaenoic Acid
Acid
Docosahexaenoic Acid
Acid
α-Linolenic Acid

40. DHA is important for development of the central nervous system in all
mammals.
There is an enormous growth spurt in the human brain during the last
trimester of pregnancy and the first postnatal months, with a large increase
in the cerebral content of Arachidonic Acid (AA) and DHA.
The fetus and the newborn infant depend on a continual maternal supply of
DHA and AA.

41. CARBOHYDRATES
Principle energy yielding food.
‘Digestible Carbs’ – Sugars & Starches.
Carbs
‘Indigestible Carbs’ – Cellulose, Hemicellulose,
Carbs
Gum, Pectin, Lignin.
Foods with carbohydrates in them have a wide range of
effect on the blood glucose levels, during digestion.
This is known as the ‘Glycaemic Response’
‘Glycaemic Index’ is the effect of carbs on the blood glucose
levels.
Rapidly breaking down carbs have high GI, and vice versa.

42. BASED ON NUMBER OF SUGAR UNITS
NUMBER OF SUGAR
NAME EXAMPLES
UNITS
Monosaccharides 1 Glucose, Fructose
Sucrose, Lactose,
Disaccharides 2
Maltose
Oligosaccharides 3-10 Raffinose, Stachyose
Starch (plant food),
Polysaccharides >10 Glycogen (animal
food)

43. Should Pregnant Women Go on
Low-Carb Diets?
Pregnant women should not go on low-carb diets, let alone carb-free
diets.
In fact, it is recommended that at least half of the calories that
pregnant women consume should be carbohydrates.
The main reason is because carbs are known to turn to glucose, which is
necessary for the unborn baby.
Carbs are known to provide the baby with nutrients, protein and healthy
fats. All of these are quite essential to the proper development of the
baby.

44. Can a Carb-Free Diet Harm an Unborn
Baby?
What many people do not realize is that a carb-free diet can actually harm
an unborn baby.
It is highly likely that the baby will not get the nutrients that he or she
needs for healthy development when one puts oneself on a carb-free, high-
protein diet.
When women choose to go on a diet that is high in protein when they are
pregnant, their cortisol levels are known to increase.
When an unborn baby is exposed to higher cortisol levels, the chances that
he or she will have high blood pressure later on in childhood or adulthood
increases.
Although a low-carb diet may not be as bad, it is important to keep in mind
that these same side effects may also affect your unborn baby when you

45. Are There Any Types of Carbs
Pregnant Women Should Eat?
There are various types of carbs that pregnant women should eat while
they are pregnant in order to ensure the ultimate health and development
of their baby.
Some of these carbs include fruits, vegetables and whole grains.
These are what most people refer to as "GOOD CARBS" and ultimately,
CARBS
are what will provide the baby with the nutrients needed for healthy
development.

47. What Types of Carbs Should
Pregnant Women Avoid?
There are many carbs that pregnant women should avoid, or only eat in
moderation.
These are what most people call "BAD CARBS." Some of these types of
CARBS
carbs include donuts, candy, fast food etc.
These carbs and known to cause weight gain and gestational diabetes among
pregnant women.
Although eating bad carbs will not necessarily cause any harm to the baby,
they will not provide any health benefits.
Eating bad carbs in moderation may not be harmful, but when it comes
down to it, one should not eat them too frequently during pregnancy.

49. WHY THE DEVELOPING BABY NEEDS FATS
 Babies need a diet high in beneficial fats, as these are
their main source of energy.
 A baby’s brain, which is around 60% fat, uses nearly three quarters
of total dietary energy for growth, whereas an adult's uses only a fifth.
 Once born, they’ll get a lot of essential fats from breastmilk, which
contains over 50% of its calories as fat.
 But while still in the womb, they rely on maternal
fat supply.

50. FAT IS ESSENTIAL FOR VITAMIN
ABSORPTION
Fats act as carriers for fat-soluble
Vitamins such as A, D, E and K.
Vitamin D Helps Keep Bones And Teeth
Healthy.
Vitamin E Protects Cell Membranes By
Acting As An Antioxidant
Vitamin K Helps Wounds Heal Properly As
It Helps With Blood Clotting And Also
Helps Build Strong Bones

51. BUTTER & OTHER COOKING MEDIA FAT (g/unit)
Butter 100 g 81
Ghee 100 g 100
Vegetable Oil 100 g 100
Vegetable Hydrogenated Oil 100 g 100

52. BREADS AND CEREALS FAT (g/unit)
Chapati (one) 0.4
Puri (one) 2.8
Paratha (one) 4.1
Aloo ka Paratha (one) 3.5
Cooked Rice (3/4 th katori) 0.1
Khicheri (1 katori) 7.3
Dosa 3.5
Bread large sized (1 slice) 0.7
Dry Cereal (3/4 th katori) 0.3

53. LEGUMES (1 katori cooked dal including veg oil used) FAT (g/unit)
Bengal Gram (Channe ki dal) 4.1
Black Gram (Urad ki dal) 4.5
Green Gram (Moong ki dal) 5.6
Lentil (Masoor ki dal) 4.1
Red Gram (Arhar ki dal) 2.0
Sambar 2.1
Chickpea (Kabuli Channa) 6.6
Green Gram (Saboot Moong ki dal) 3.3
Lentil whole (Saboot Masoor ki dal) 2.5
Rajma 5.7

54. VEGETABLE PREPARATIONS (1 katori incld oil used) FAT (g/unit)
Matar Paneer (Cottage Cheese with Peas) 10.4
Aloo Matar (Potatoes with Peas) 6.4
Potato curry 6.2
Veg Kofta 13.7
Veg Korma 7.9
Aloo Baingan (Potatoes with Brinjal) 6.7
Carrots 6.0
Pumpkin 6.3
Cabbage 10.3
Ridge Gourd 7.3
Okra 15.0
Bhurtha 8.2
Stuffed Tomatoe 3.4

55. RAW VEGETABLES & FRUITS FAT (g/unit)
Green Peas 100 g 0.1
Brinjal 100 g 0.3
Sweet Potatoes 100 g 0.3
Beams 100 g 1.0
All other Vegetables 100 g < 0.3
Apple 100 g 0.5
Pear 100 g 0.2
Most other 100 g 0.3

56. SNACKS FAT (g/unit)
1 Samosa 12.6
1 -1/4 th Upma 11.3
French Fries 90 g 11.3
Palora (4 pieces) 11.0
Besan ka Pura 11.7
Dahi Vada (1) 9.6
Masala Vada (2) 4.6
Poha 1-1/2 katori 13.1
Potato cutlet (1) 5.4
Chaat 10.0

57. MILK PRODUCTS FAT (g/unit)
Milk (1 cup) 8.6
2% Milk (1 cup) 4.9
Skimmed Milk (1 cup) 0.2
Buttermilk (1 cup) 2.4
Ice Cream regular (1 cup) 14.1
Yoghurt (1 cup) 9.8
Cottage Cheese (30 g) 1.2
Swiss Cheese (30 g) 7.9
Cheddar Cheese (30 g) 9.1

58. MEAT, FISH & POULTRY FAT (g/unit)
Lamb Leg (90 g) 9.4
Lamb Chop (90 g) 15.8
Chicken, white, no skin (90 g) 2.9
Fried Chicken (90 g) 7.9
Fried Liver (90 g) 9.8
Fried Fish (90 g) 12.5
Fish Jhol (1 katori) 2.5
Mutton ball curry (1 katori) 17.6
Prawn curry (1 katori) 6.5
Boiled Egg (1) 5-6
Fried Egg (1) 7-9

59. DESSERTS FAT (g/unit)
Halwa (100 g) 15.9
Jelly & Custards (100 g) 1.2
Kheer (150 g) 13.4
Sevian (100 g) 10.0
Suji Kheer (150 g) 14.2
Sriikhand (100 g) 19.7
Sandesh (2 pieces) 9.0
Besan ki Barfi (60 g) 25.4
Chikki (60 g) 12.0
Fruit Cake (50 g – 1 piece) 15.1
Jam Tart (35 g – 1 piece) 9.1
Lemon Tart (55 g – 1 piece) 9.2
Nutty Biscuits (40 g – 2 pieces) 13.8

61. MINERAL DIEARY RDA’S CLINICAL
SOURCES MANIFESTATION
SODIUM Table salt, Dairy Adults = 1.5 g/dl Only excess loss can
products produce deficiency –
Muscular cramps,
Weakness, Hypovolemia
POTASSIUM Bananas, Adults = 4.7 g/dl Weakness, Paraesthesia,
Muskmelon, Bael Preg = 4.7 g/dl Arrhythmias.
fruit, Citrus fruit, Lactation = 5.1 g/dl
Leafy veg, Milk, Meat
MAGNESIUM Whole grains, Leafy Men = 400 mg/dl Muscle weakness,
veg Women = 310 mg/dl Twitching, Tremors,
Preg = 350 mg/dl Numbness, Apathy.
Lactation = 310 mg/dl
PHOSPHORU Milk, Cheese, Adults = 700 mg/dl Weakness, Fatigue,
S Yoghurt, Fish, Preg & Lactation = 700 Leukocyte & Platelet
Poultry, Meat, Grains. mg/dl dysfunction, Heart
failure, Haemolysis

62. IODINE Seaweeds, Salt water Preg = 220 micro g/dl Thyroid enlargement
fish, Shell fish, Lactation = 290 micro
Iodised salt g/dl
Women = 150 micro
g/dl
Manganese Nuts, Dry fruits, Women = 1.8 mg/dl Impaired growth &
Cereals, Unrefined Preg = 2.0 mg/dl skeletal development,
grains, Tea Lactation = 2.6 mg/dl Decline in
reproductive function
Selenium Seafood, Muscle Women = 55 micro Cardiomyopathy,
meat, Cereals g/dl CHF, Striated muscle
Preg = 60 micro g/dl degeneration
Lactation = 65 micro
g/dl
Zinc Nuts, Legumes, Women = 8 mg/dl Growth retardation,
Meats, Shellfish Preg = 11 mg/dl Poor wound healing,
Lactation = 12 mg/dl Hypogonadism

63. TRIMESTER EXTRA ENERGY EXAMPLES OF FOODS
NEEDS
1st trimester 100 extra •A large apple OR
calories each day •A slice of cheese OR
•A glass of milk OR
•A piece of bannock
2nd and 3rd 300 extra •A piece of toast with peanut
trimester calories each day butter and a glass of milk OR
•A small piece of meat or fish
with bannock OR
•A bowl of vegetable soup with
crackers and cheese

64. NOT ENOUGH WEIGHT GAIN TOO MUCH WEIGHT GAIN
• Low birth weight baby
• High birth weight baby
• Early birth
• Difficult birth (Feto pelvic
disproportion)
• Baby may not develop
properly
• Higher perinatal mortality
• Baby may have life-long
health problems • Mother may develop
gestational diabetes
• Higher perinatal mortality
• Baby may develop diabetes &
cardiac problems in later life
•Baby may have mental and
behavioural problems

65. • Too much caffeine is not good during pregnancy
• Coffee, tea and some pop has caffeine
• 3 small cups of coffee per day (400-450 mg of caffeine) is
safe.
• Switch to decaf or try half decaf, half regular

66. • Smoking is harmful to the baby
• Passive smoking is dangerous
• Nicotine causes vasospasm leading to
Placental insufficiency.
• IUGR
• Preterm Birth.