Kitabı oku: «Need to Know Fertility, Conception and Pregnancy», sayfa 2

2. A healthy pregnancy

Every woman knows that it is really important to take good care of her health when she is pregnant. But many women are not aware that their health before pregnancy is critical to producing a healthy baby. This means that you need to think about your health and, in particular your diet, not just after that positive pregnancy test, but for several months before.

Your pre-pregnancy health

Doctors have known for a long time that pre-pregnancy care is important. Although women are becoming increasingly health conscious and some now seek specific pre-pregnancy advice, there are many women who don’t understand its importance.

Take care of yourself

We all lead hectic lives and all too often missing your first period is the catalyst for thinking about your pregnancy, but you are already two weeks pregnant at this point and it may take a further few weeks before you see your obstetrician. By this time, your baby is developing rapidly and you may have missed opportunities to influence the pregnancy positively.

• The first twelve weeks of pregnancy is the time when all of the major organs are developing in the baby’s body.

• The heart, lungs, liver, kidneys, brain and nervous system are all formed at a time when many women do not even realize that they are pregnant.

This is why pre-pregnancy care is so important. It is important not just for women with a health condition, but for every woman contemplating pregnancy.

Your diet

If you are thinking about becoming pregnant, diet is important. It has been said that you are what you eat and, of course, your baby will be too. Indeed, eating a well-balanced diet before you conceive is one of the most important things you can do for your baby.

Your weight

In addition, if you are overweight, it is best to reduce your weight before trying to conceive. This is because not only does being overweight reduce your chances of conceiving, but it also puts you and your baby at greater risk of many complications.

Smoking
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Conception and stress

If you have been trying desperately for a baby and you have not conceived, you can end up feeling stressed and anxious, which can have an adverse effect on conception. Having a balanced diet, getting enough sleep and taking regular exercise should help. If you have a very stressful occupation, you might want to consider ways of limiting or avoiding stress at work.

If you are a smoker, you should know that smoking can not only reduce your fertility, but also make you more prone to miscarriage and restrict your baby’s growth in the womb. Stopping smoking is easier said than done and it may take you some time to give up smoking completely. Ideally, you and your partner should try to stop several months before attempting to conceive. You should also know that it is never too late to stop. Stopping smoking even after you are pregnant can make a difference for your baby.

Be aware of your surroundings

If you work with certain chemicals, lead, anaesthetics or X-rays, this may involve a risk to your unborn baby. Talk to your doctor about it. It has been suggested that computers, visual display units (VDUs) and copying machines give off harmful rays encouraging miscarriage, but despite several large studies there is no scientific evidence to suggest that they present any risk to pregnant women or their babies. Other studies on women who delivered small babies have likewise identified no link between VDU exposure and low birth weight. So if you work with a VDU, there is no need to be concerned or to take any special precautions when you are pregnant.

Your diet

Diet is fundamental to good health, and no more so than when you are preparing for pregnancy or in early pregnancy. All the ‘building blocks’ of your baby’s body are derived from your food.

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Meal times

Eat regular meals with a wide variety of healthy foods that you enjoy. If you get your diet right before conception, you will have established an ideal pattern for your pregnancy.

A balanced diet

A balanced diet provides you with:

• protein for muscles and other structures

• calcium for bones

• carbohydrates for energy

• fats for cell growth

• vitamins for key body functions

An optimal nutritional balance is the first step to giving your baby the best start in life. The requirements for protein, iron, calcium and vitamins B, C, D and E increase in pregnancy, but a well-balanced diet usually provides you with enough protein, vitamins and minerals to meet these extra demands.

Your baby’s health depends to a great extent on the health of not only you but also your partner at the moment of conception. You increase your chances of conceiving a healthy baby if you both eat a healthy, varied diet. Ideally, you should keep your intake of foods rich in fat and sugar to a minimum and your diet should include:

• a good selection of fresh vegetables and raw fruit (taking care to wash them thoroughly) to provide vitamins and fibre

• foods rich in protein, such as lean meat, fish, poultry, eggs and beans

• foods rich in calcium, such as milk, cheese and yoghurt

• cereals, bread, pasta and potatoes to provide carbohydrates and additional fibre

It is also sensible to combine this diet with an adequate fluid intake. Water is better than coffee, tea or sugar-rich drinks, such as cola.

Fruit and vegetables

Try eating more salads using a wide range of fresh vegetables, and try to take two portions of vegetables or fruit with each meal. Avoid over-cooking vegetables as this breaks down many of the vitamins they contain; try steaming them instead. Have fresh (not canned) fruit for dessert and drink fruit juices.

Protein

You can get most of your protein from meat like chicken, beef and lamb as well as nuts and pulses, but fish is an excellent source of protein, and oily fish like salmon and herring are rich in essential fatty acids (so-called omega 3 essential fatty acids), which are important for the development of the baby’s brain and nervous system. Moreover, a high fish intake is associated with a reduced risk of pregnancy complications such as premature labour or a low-birth weight baby. That said, there are some fish that should be avoided if you are trying to conceive or if you are pregnant.

Calcium

Foods rich in calcium such as milk, cheese and yoghurt are important to eat to ensure you have good calcium stores for the developing baby. When you are pregnant, drinking 500 ml (18 fl oz) of milk per day or 250 ml (9 fl oz) of milk and eating a yoghurt or portion of cheese is enough to ensure that you have sufficient amounts of calcium in your diet.

Carbohydrates

These are essential for energy. Many women worry about carbohydrates being related to weight gain and thus cut down on all forms of carbohydrate when trying to become pregnant. There are ‘good’ and ‘bad’ types of carbohydrate, however. Starchy foods such as pasta, wholemeal bread and potatoes are ‘good’. ’Bad’ carbohydrates are sugar-laden foods, such as cakes, biscuits and sweets. Cut down on these and think about increasing your intake of starchy carbohydrates. You should try to eat wholemeal bread, and take a portion of potatoes, pasta or wholegrain rice with each main meal. For breakfast think about having porridge or a high-fibre or wholegrain breakfast cereal, and avoiding cereals with a high sugar content.

Fibre

Otherwise known as ‘roughage’, fibre is found in foods derived from plants. It cannot be easily digested and absorbed by our bodies and so it stays in the bowel, providing roughage. It can be broken down to some extent by bacteria in the large bowel and some of these breakdown products can be absorbed and used as a source of energy. Because it provides roughage for the bowel – aiding the process of peristalsis (contractions in the bowel) by which the food is pushed through the gut. Fibre is important in ensuring that bowel function is normal and in preventing constipation. This is especially important in pregnancy when your bowel function often slows down. Many women thus find constipation a problem during pregnancy, and eating a fibrerich diet is very good at preventing this.

You should therefore eat foods with a high-fibre content, such as wholemeal bread, pasta and fruit. However, if you increase your fibre intake suddenly, you may find that you feel bloated and have excess wind, so it is better to increase your intake gradually. You should also ‘match’ the increase in fibre with an increase in fluid intake, preferably water.

Fluid

It is all too easy to get slightly dehydrated. We have busy lives and often drink too much caffeine in tea and coffee that can add to the dehydration. It is a good idea to increase your fluid intake. You should aim to drink around six glasses of water a day. In pregnancy you will be prone to constipation as the bowel tends to become more sluggish because of the effect of pregnancy hormones, so along with an increase in fibre in your diet, drinking water helps to prevent constipation.

Reducing fat intake

It is best to avoid fried food and foods with a high fat content such as meat pies, sausages and pastries. If you want to fry food, then cook it in unsaturated vegetable oil, such as olive oil, or try grilling it instead. You should choose lean meat and trim off any excess fat before you cook it.

Reducing sugar intake

When pregnant, you should avoid high levels of sugar in your diet. Try to avoid or at least minimize your consumption of sweets and chocolate and also sugar-rich soft drinks. It is, of course, easier said than done, but try to eat fruit for a snack instead, and drink mineral water.

Reducing salt intake

You do not want or need to eliminate all salt from your diet. Moderation is the key: try not to put extra salt on the foods you eat and minimize the salt you add during cooking, as well as eating fresh foods rather than processed or tinned products, which are often high in salt. Meat extracts and soy sauce are high in salt, too, so keep intake of these to a minimum.

Vitamins and minerals

A regular intake of vitamins C and D are important both before and during pregnancy. In a well-balanced diet, it should be possible to obtain the necessary quantities without resorting to vitamin supplements. In fact, the only vitamin supplement that is usually needed before and during pregnancy is folic acid. Specific supplements of vitamins C and D are not usually required prior to pregnancy unless you have particular medical or nutritional problems, in which case you need to seek advice from your doctor. If you are vegetarian or vegan, you may need specific supplements of vitamins and minerals. These, too, require individual advice from your doctor.

Vitamin C

Available from fresh fruit and vegetables, vitamin C is important as it helps you absorb iron and also because it is needed for the production of the red blood cells that carry oxygen around the body. In pregnancy, there is a significant increase in the number of red blood cells in a woman’s body – around 25 per cent on average by 32 weeks of pregnancy. So there is an extra demand for vitamin C, iron and folic acid, not just for the baby but also for the mother as all these vitamins and minerals are essential for red blood cell production.

Vitamin D

Vitamin D is essential for the good development of bones. It is available from dairy products.

Vitamin A

Too much of certain dietary component can sometimes cause potential harm. When it comes to vitamins in pregnancy, vitamin A is one to know about. Vitamin A is a fat-soluble vitamin that is stored in your liver and it is vital for the maintenance of good eyesight, and healthy skin, hair and nails. In the developing baby, vitamin A is essential for tissue growth.

must know

Foods containing vitamin A

• liver

• liver pâté

• carrot

• full fat milk

• egg

Vitamin A occurs in two main forms in our diet: the first form is ‘retinol’ – the ‘real’ vitamin A; the second is the ‘carotenoids’, which your body converts into retinol. Beta-carotene is a carotenoid and is converted into retinol only when it is required. It acts as an antioxidant in the body (helping to prevent damage to blood vessels caused by free radical molecules) and is the pigment that gives the green, yellow or orange colour to vegetables and fruit. The brighter the vegetable, in fact, the more beta-carotene it contains. Fresh liver is a particularly rich natural source of vitamin A, as animals, like humans, store vitamin A in their livers.

Very high intakes of ‘true’ vitamin A – ‘retinol’ – have been linked with an increased risk of fetal abnormalities during pregnancy. Such high levels are likely to be far in excess of those you would find in your normal diet, however. The amount of retinol linked with fetal abnormalities is in excess of 3,300 mcg per day. This level is very high: you would need to eat 30 eggs in one day, for example, to get that much vitamin A. At the same time, you should not take supplements containing vitamin A in the retinol form or eat foods that are very rich in retinol, such as liver or liver products like pâté, when you are planning to become pregnant or are pregnant. Similarly, fish liver oils (e.g. cod liver oil) should also be avoided.

must know

Women who are likely to have low iron stores

• vegans /vegetarians

• those who have had two or more pregnancies close together

• those who have suffered from anaemia

• those with heavy periods

• those who are expecting twins, triplets or more

Iron

Iron is a mineral that is stored in your liver, spleen and in the centre of certain bones. Maintaining an adequate iron intake is important both before and during your pregnancy. Your developing baby needs iron for the formation of several important proteins. In particular, iron is required for the formation in the red blood cells of haemoglobin, the substance that transports oxygen around your body.

If you have an adequate intake of iron in your diet before and during your pregnancy, you are usually able to meet your own and your developing baby’s needs. Iron supplements are not routinely required when planning a pregnancy. However, there are some women who are more likely to have low iron stores and therefore need to take supplements. These include women who had low iron stores or a diet poor in iron before pregnancy and women expecting twins or triplets. Your doctor is able to advise you about this.

must know

Foods containing iron

• breakfast cereal

• red meat

• baked beans

• green leafy vegetables

• eggs

• wholemeal bread

You find iron in foods such as baked beans, bread (fortified white, as well as brown and wholemeal), breakfast cereals, pulses (such as lentils and red kidney beans) and red meat (but avoid liver because of its high vitamin A content).

If you require iron supplements, you can maximize the absorption of iron by taking the iron tablet with a citrus drink such as fresh orange juice, which is rich in vitamin C (also important for treating anaemia).

If you suffer from heartburn or indigestion, do not take the iron supplements at the same time as antacid medicine as this reduces the absorption of iron. In pregnancy, iron supplements are often combined with folic acid, frequently in the same tablet.

Folic acid

Folic acid is an important member of the B vitamin family and, as such, is essential in small quantities for maintaining normal body metabolism. Because folic acid does not occur naturally in your body you need to obtain it from other sources such as your food or by means of vitamin supplements.

watch out!

There is one relatively uncommon form of anaemia due to deficiency of vitamin B12. Folic acid supplements could make it difficult for routine blood tests to pick up this condition. If you have a history of anaemia due to vitamin B12 deficiency, check with your doctor before taking folic acid.

The importance of folic acid

Folic acid is essential for the production of healthy red blood cells, which carry oxygen around the body. We are constantly making and replacing our red blood cells: it has been estimated that, on average, an adult makes more than 120 million new red blood cells every minute throughout their lives. Hence deficiency of folic acid means that an insufficient number of red blood cells are produced, leading to problems such as anaemia.

Folic acid is also known to reduce the risk of certain abnormalities in the baby known as neural tube defects, of which spina bifida (which in its severe form can be seriously dangerous for the baby), is perhaps the best known. All babies are potentially at risk of spina bifida, or other neural tube defects such as hydrocephalus, whatever the mother’s age and whether or not this is a first or a subsequent pregnancy.

The neural tube is the part of the developing baby that eventually becomes the brain and the spinal cord. It forms at about four weeks after conception or about two weeks from the time of a missed period. Research has shown that sufficient folic acid in the mother’s blood is essential for normal formation of the neural tube. Interestingly, in the USA, folic acid has been added to all flour for bread and pasta from 1998. Since that time, the number of babies with neural tube defects has fallen by almost 20 per cent. There is also some evidence that suggests that adequate folic acid intake might help prevent problems such as small-for-dates babies.