is a clinical dietitian holding a master’s degree in clinical nutrition from the University of Nottingham (UK) and currently pursuing her PhD in Health Promotion
Improving women’s health status before pregnancy is as important as during pregnancy. Unfortunately, this is often a missed opportunity. According to the World Health Organization (WHO), 4 out of 10 women reported that their pregnancies were unplanned. Consequently, this poses challenges to early essential health interventions in 40% of pregnancies.
Optimal nutrition is a crucial component of preconception care, which focuses on improving fertility, ensuring primary prevention of poor pregnancy outcomes and supporting proper fetal development. Accordingly, each woman of childbearing age is advised to adopt healthy eating practices and positive lifestyle habits before pregnancy planning. Below are recommendations on nutrition-related modifiable factors for a healthier preconception period.
Pre-pregnancy body weight is an independent predictor of many adverse pregnancy outcomes. Maternal excessive body fat (BMI > 30kg/m2) was shown to be significantly associated with decreased fertility, increased risk of gestational diabetes, preeclampsia (increased blood pressure during pregnancy), preterm delivery, and pregnancy loss.
This is in addition to fetal complications such as congenital heart defects, macrosomia (high infant’s birth weight), and other metabolic and developmental abnormalities.
Similarly, being underweight (BMI < 18.5kg/m2) increases the risk of infertility, pregnancy and fetal growth complications problems such as low birth weight and premature birth. Therefore, achieving a healthy weight with a BMI between 18.5 and 24.9 kg/m2 before pregnancy is highly advised. This is achieved by following a well-balanced nutrient-dense diet high in whole grains, fibre-rich food, a wide variety of fruits and vegetables, and low in fried, processed, and high-sugar food choices. Additionally, engaging in regular physical activity by aiming for at least 30 minutes of moderate-intensity exercises daily is recommended.
Vitamins and minerals
1. Iron: Preconception iron deficiency increases the risk of maternal anemia during pregnancy, low stores of iron in newborn, low birth weight and preterm delivery. The recommended daily intake of iron to meet the needs of healthy women is 18mg per day. This can be sufficiently met through the consumption of iron-rich food sources such as lean meat, poultry and fish, enriched grain products and fortified cereals, beans, peas, lentils, and green leafy vegetables. For better iron absorption, combine animal and plant sources together, or add sources of vitamin C like citrus fruits, dried cranberries or kiwi to the plant-based options. Also, avoid drinking coffee and tea with your meal as they decrease iron absorption.
2. Folate: Women of childbearing age are recommended to consume 400 micrograms of folate daily. This B vitamin helps reduce the risk of baby’s spinal malformation – neural tube defects such as spina bifida, which usually occurs in the first few weeks of pregnancy when the fetus rapidly develops spine and nerve cells. Folic acid can be obtained from natural sources such as spinach, kale, beans and legumes, citrus fruits, and whole grains. If not, supplementation would be required.
3. Calcium: Women planning to get pregnant are recommended to consume at least 1,000mg per day which is equivalent to three eight ounces of skim milk. Calcium-rich food sources include dairy products, calcium enriched milk alternatives (e.g. soy/ coconut/nut milk), sardines, fortified cereals, and green leafy vegetables.
Research has shown that high intake of caffeine is significantly associated with reduced fertility. Therefore, women should limit their caffeine consumption to 200-300mg per day (2-3 cups per day), this includes not just coffee, but other sources such as energy drinks, soft drinks, tea and chocolate. Caffeine also affects the body’s ability to absorb iron and calcium.
A woman who is trying to conceive should not consume alcohol. Even a moderate drinking of alcohol defined as one drink per day (=12 ounces of regular beer, five ounces of wine, or one-and-a-half ounces of 80-proof distilled spirits) could lengthen the time to conception. Also, since a high percentage of women may not be aware when they are pregnant, especially in the first trimester, alcohol could result in behavioural or neurological defects in the offspring.
A great importance lies in healthy nutrition during pregnancy given its long-lasting impact on the health of the offspring. Not only does it influence fetal growth and development but also the infant’s risk of chronic diseases, food preferences, and eating behaviours later in life during puberty and adulthood.
It is important to gain weight within the advisable range during pregnancy for desirable pregnancy outcomes. The recommended weight gain for a pregnant woman depends on her BMI prior to conceiving. The following is the suggested weight gain range (for women carrying a single fetus) during the entire pregnancy: for underweight women (BMI < 18.5kg/m2): 12.5 – 18kg; for women having a normal weight (18.5 ≤ BMI < 24.9): 11.5 – 16kg; for overweight women (25 ≤ BMI < 29.9): 7 – 11.5kg; for obese women (BMI > 30): 5-9kg. A poor weight gain during pregnancy increases the risk of infant death, low birth weight, and heart disease and HTN later in the infant’s life. Women with an excess weight gain during pregnancy have a higher chance of cesarean section, a large for gestational age baby, excess weight retention at one year postpartum, and increased infant’s risk of obesity, diabetes, and other cardiometabolic diseases later in life. Therefore, for a healthy weight gain, pregnant women should regularly eat small frequent meals throughout the day – main meals and snacks and each meal must be nutrient-dense, combining the three macronutrients (complex carbohydrates, lean protein, and healthy fats).
1. Carbohydrates: Priority should be always given to complex (high-fibre) carbohydrates from wholegrains, whole fruits, and vegetables rather than simple sugars, including sugary beverages, whether natural (juices) or industrially produced (soda). This will also manage the constipation that often occurs during pregnancy.
2. Protein: Protein is essential to support the growth of maternal and fetal tissue, as well as the fetal brain. Pregnant women should consume 2-3 portions of protein a day and not more than 2 portions of oily fish per week. Rich sources of protein include meat, fish, poultry, eggs, beans and pulses, and dairy products such as milk, cheese and yoghurt (one portion = 1 egg = ¼ cup of pulses = palm size of meat/poultry/fish). Vegetarians are recommended to combine plant-based protein sources like legumes with whole grains (e.g. wheat, bulgur, quinoa, brown rice) to ensure proper intake of important micronutrients.
3. Fat: During pregnancy, dietary fat is an important source of energy which also supports the absorption of fat-soluble vitamins (A, D, E, K). However, caution should be taken with high-fat diets to avoid excessive body fat during pregnancy. Thus, foods containing saturated fats (e.g. butter, red meat) and trans (e.g. wafer biscuits, ready-made food, pastry) should be avoided. Omega-3, a healthy fat, is key during pregnancy. It reduces the risk of preterm birth and low birth weight. Pregnant women are encouraged to eat fatty fish (e.g. salmon and sardines – which generally have low toxin levels) or to take omega-3 supplements.
Vitamins and minerals
During pregnancy, folate, vitamin D and iron supplements are recommended in addition to natural sources. As previously mentioned, folate protects the baby from developing neural tube defects. In addition, vitamin D supports the baby’s immunity, bones and teeth growth, while iron supplementation help prevent maternal anemia and fetal negative outcomes. It is also advised that pregnant women do not take supplements with vitamin A as excess could lead to fetal abnormalities. The needs of all other vitamins and minerals should as well be adequately met for a healthy pregnancy.
For adequate hydration and delivery of essential nutrients to the fetus, women should drink a total of 2.3 litres per day (~10 cups) of fluids including water, high moisture foods (e.g. cucumber and watermelon), and other beverages. It is advisable to avoid sugary drinks, energy drinks, and even fruit juices.
Caffine and alcohol
Pregnant women should consume decaffeinated beverages, as caffeine’s half-life increases during pregnancy from three hours in the 1st trimester to 80-100 hours in late pregnancy. A maximum consumption of one cup a day appears to be safe. In respect to alcohol, no safe level has been established and thus, women should not drink alcohol during pregnancy.
Exercising during pregnancy has many benefits. It supports the cardiorespiratory fitness, reduces the weight retention at two months postpartum in women of normal pre-pregnancy BMI, and decreases the risk of high blood glucose. For women who were regularly active before pregnancy, they are encouraged to engage in 150 minutes of moderate-intensity aerobic activity spread throughout the week which is equivalent to 30 minutes of moderate intensity exercise on most days of the week. Women beginning physical activity during pregnancy are advised to gradually increase the intensity and frequency of training.
Pregnant women are at increased risk of developing foodborne illnesses due to hormonal changes that lead to decreased immune function. Therefore, special caution is recommended in handling and preparing food. Pregnant women should avoid unpasteurized milk and milk products like soft cheeses (e.g. camembert, brie, soft goats’ cheese), raw or undercooked food like eggs, meat, shellfish, and poultry or any products that may contain them (e.g. mayonnaise).