Focus on 5 aspects to teach you how to easily achieve individualized nutrition management during pregnancy and childbirth

Author: Liu Yanping, deputy chief physician of Peking Union Medical College Hospital

Reviewer: Ma Liangkun, Chief Physician, Peking Union Medical College Hospital

Pregnancy is a very special stage in a woman's life. It is not only related to the mother's health, but also directly affects the development and future health of the fetus. It is particularly important to do a good job of individualized nutrition management during pregnancy and childbirth, which is an important means to ensure the health of mother and baby. Here are 5 ways to start from and easily achieve individualized nutrition management during pregnancy and childbirth.

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1. Is it only necessary to supplement folic acid during the pregnancy preparation period?

The "Dietary Guidelines for Chinese Residents (2022)" issued by the Chinese Nutrition Society mentioned that folic acid supplementation for women preparing for pregnancy from 3 months before pregnancy is beneficial to improve the success rate of pregnancy. Folic acid is a key coenzyme involved in the synthesis of genetic material and cell division, and plays an important role in germ cell generation, embryo formation, fetal development and even the entire life cycle. In addition to folic acid, vitamin B2, vitamin B6, vitamin B12, etc., which work together with it to exert physiological effects, are all water-soluble B vitamins that are easily deficient due to insufficient dietary intake. When one or more of these synergistic nutrients are in a state of deficiency, serum homocysteine ​​levels will increase, which is easy to cause atherosclerosis, hypertension, and stroke. It is also a cause of diseases such as gestational hypertension, preeclampsia, and premature birth. In addition, there are more prominent micronutrient deficiencies in the female population of childbearing age in my country, such as vitamin D deficiency (50% to 90%), iron deficiency (about 30%), iodine deficiency, vitamin A deficiency, selenium deficiency, etc. In clinical practice, it is very common for "healthy" women preparing for pregnancy to have abnormal levels of several nutrients.

From this point of view, the preparation for pregnancy period is not just about folic acid supplementation. If you are not confident about your diet quality and nutritional status, if you have experienced a large fluctuation in weight recently (more than 5%), if you have excessive menstrual flow or other blood loss, or if you have underlying diseases that affect nutrient absorption and metabolism (such as thyroid disease, diabetes, digestive tract disease, etc.), then it is necessary to go to the pregnancy nutrition clinic for individualized nutritional evaluation, early detection, and early treatment. This is the first step in nutrition management during pregnancy.

2. Weight management is the core of healthy pregnancy

If you are overweight, have too much energy intake, and have excessive fat accumulation, it will affect the female reproductive and endocrine systems, leading to ovulation disorders, endometrial abnormalities, and difficulty in embryo implantation, directly affecting pregnancy; if you are underweight, have insufficient energy intake, and have too little adipose tissue, it will cause a lack of lipid nutrients, the raw material for the synthesis of estrogen and progesterone, and in severe cases it can lead to amenorrhea. Maintaining an appropriate weight level, that is, a body mass index (BMI) of 18.5 to 23.9 kg/m2, as well as moderate exercise + a reasonable diet, so that the normal body fat rate and muscle mass are achieved, is the main goal of self-adjustment of weight during the preparation for pregnancy.

Excessive weight gain during pregnancy will increase the risk of gestational diabetes, gestational hypertension, premature birth and other diseases; excessive pursuit of "growth without weight" during pregnancy will result in too little weight gain, which will also limit fetal development and make it impossible for the body to reserve the necessary nutrients for breastfeeding. It should be noted that rapid weight gain in the late pregnancy does not necessarily mean that you eat too much. On the contrary, it may be due to insufficient protein intake (vegetarianism) or excessive sodium intake (salty food) causing water and sodium retention and edema. At this time, you need to actively supplement protein and eat a light diet with less salt, rather than strictly restricting the amount of food.

It can be seen that developing a good habit of monitoring weight during pregnancy and promptly detecting energy and nutritional imbalances are key links in a healthy pregnancy.

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3. Eating well can meet the surging nutritional needs during pregnancy

The accelerated pace of life and increased work pressure have led to an increasing rate of eating takeout and fast food that is high in oil, fat, and carbohydrates. This unhealthy diet often lacks dietary fiber, vitamins, or minerals, and will cause further loss of nutrients due to overcooking. This diet pattern will also lead to increasingly serious deficiencies in protein (from lean meat, fish, poultry, soy products, milk, eggs, etc.), folic acid (from lean meat, liver, beans, green vegetables, etc.), iron (from liver, blood, etc.), and other nutrients, affecting fetal development and harming maternal health.

So what does it mean to eat well? Eat foods rich in iron, choose iodized salt, and reasonably supplement with fresh green leafy vegetables rich in folic acid. In the middle and late stages of pregnancy, you should increase the intake of fish, poultry, eggs, lean meat and milk in moderation. Eat a light diet, cook simply, and use less high-temperature cooking methods such as baking, baking, deep-frying, and pan-frying. Eat freshly cooked food and eat less processed meat. At the same time, no longer adhere to the unreasonable "low-carbon" or "light fasting" diet structure or meal arrangement strategy, advocate separate meals, supplement nutrition in small amounts and multiple times, and avoid fasting for too long. These measures are very important to avoid large fluctuations in nutrient levels in the body and maintain fetal development during pregnancy.

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4. What is the key to dietary adjustment when becoming a diabetic mother?

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The treatment of gestational diabetes mainly relies on dietary management. Even with the use of insulin, a proper diet is still the top priority. Among the food ingredients, the staple food rich in carbohydrates directly affects blood sugar. Therefore, the key to the dietary adjustment of diabetic mothers is the choice of staple food.

When fasting blood sugar is high in the morning, the amount of staple food for breakfast can be controlled at 25-35 g dry weight (the weight of organic matter without water), and about 20 g can be added in the morning snack; the amount of staple food for each lunch and dinner meal is 50-75 g dry weight, which is equivalent to the cooked weight of grain rice (the weight of food after cooking) of 130-200 g. In addition, it is necessary to arrange grain food appropriately for afternoon snacks and snacks before bed, 15-25 g each time. The above staple food amount and meal distribution are roughly suitable for single mothers with medium build and light to moderate physical activity level, and can be adjusted individually according to weight changes and blood sugar spectrum (blood sugar monitoring records at different time points every day).

It is recommended that pregnant mothers with gestational diabetes eat multi-grain rice. This is a kind of rice that is steamed under pressure with whole grains and beans (accounting for 30% to 50%) and white rice (accounting for 50% to 70%). It is the preferred staple food for pregnant women with diabetes. It is easy to make and has a better effect on controlling postprandial blood sugar than white rice, various noodles, cakes, buns, dumplings or bread, and is also better than purple sweet potatoes, corn and various kinds of miscellaneous wheat noodles. Its benefits are that it can continuously and stably transport glucose into the blood, and it can also bring rich dietary fiber and plant sterols, regulate intestinal flora, and regulate sugar and lipid metabolism and nutrient absorption. If the diabetic mother has a weak digestive ability and may not be able to tolerate the coarser multi-grain rice, the formula can be adjusted or the proportion of multi-grains can be reduced.

5. Recharge in time after overdraft after childbirth and restore nutrition!

During childbirth, the repeated contraction of the core muscles and uterine smooth muscles, blood loss, excessive sweating, and fluid loss are all very detrimental to the mother. Therefore, during the confinement period, the intake of various nutrients should be strengthened and a balanced diet should be taken to promote postpartum recovery and breastfeeding.

The nutrient that is particularly easy to be deficient in the short term after delivery is iron (which can correct childbirth blood loss and postpartum anemia). You can eat more iron-rich foods, such as lean meat, various blood products, animal liver, etc. Calcium and vitamin D should be supplemented during the postpartum and lactation stages. If the mother cannot drink enough milk (500 ml per day) and cannot go out to receive effective sunlight (exposing the head, neck, and forearms for 20 to 30 minutes at noon every day), she should use preparations to supplement calcium and vitamin D. This can protect the mother from abnormal bone metabolism and provide the child with sufficient calcium. The need for iodine and folic acid increases significantly during pregnancy and lactation. You should continue to use iodized salt, pay attention to the intake of foods rich in folic acid, and continue to supplement multivitamins containing folic acid when necessary. The intake of DHA (docosahexaenoic acid) by postpartum mothers can improve the composition of fatty acids in breast milk and continuously promote the early brain development of newborns. The food source of DHA is various high-fat fish. Compared with the late pregnancy, the nutrients required during lactation include vitamin A and choline, which are easily deficient after delivery. They are also two key substances that interfere with breast milk quality and should be supplemented.

To sum up, mothers should expand their food choices after delivery, try to make the food diverse but not excessive, pay attention to the intake of various animal foods, insist on balanced nutrition throughout the lactation period, and if necessary, ensure nutritional intake by fortifying specific nutrients through preparations.