Nutrition for pregnancy
DR. McDougal
Biologically speaking, pregnancy is the time when women are the most important to their species, therefore they should be at their healthiest. Unfortunately, for the most part, in our modern society pregnant women tend to be sick women. They are often fat, swollen, constipated, uncomfortable, and lethargic. Many are on medications for diabetes and high blood pressure. For one-fourth of these pregnant women, the grand finale of this life giving orchestration ends in surgical removal of the baby. Often at the source of all this trouble are doctors, dietitians, mothers, and mother-in-laws telling the mother-to-be to drink at least four glasses of milk a day for calcium, and to eat plenty of meat for protein every day.
Most of us will try any kind of diet for ourselves, but when it comes to our unborn children we become ultraconservative. I know: it happened to us. Mary and I made the final adjustments to installing our strict vegetarian diet shortly after the birth of our second child in 1975. Five years later Mary became pregnant with our third. In no time she began buying cheese, fish, and eggs, reverting to old reasoning that this high-protein, high-calcium food was essential for a healthy pregnancy--even though I suspected she knew better. At three months she had a miscarriage. This traumatic event caused her to rethink her decisions. Two years later she was pregnant again. I waited for the return of cheese, or at least some fish, into our household--it never happened. Her experience of losing the last baby had cured her of fear-driven action. During the entire nine months of pregnancy she had no meat, foul, fish or dairy products--please note: not that these foods had necessarily caused her previous miscarriage, but that the introduction of these foods last time had not actually guaranteed a successful pregnancy.
Mary reports that she has pleasant memories of this last pregnancy--says she felt energetic every day and that her rings always fit her fingers without the slightest swelling. At the time of Craig's birth she had gained only 20 pounds, and after delivery she was only 5 pounds heavier than her prepregnancy weight. In a week she'd lost that extra 5 pounds, and over the next three years, with the help of nursing and by eating a starch-based diet, she kept her weight at 5 pounds less than her prepregnancy weight. She feels this was one of the happiest, and healthiest periods of her life.
HISTORICAL PERSPECTIVE
Different cultures have offered a wide variety of recommendations for the diet of pregnant women. Sometimes special foods are recommended; and at other times foods are restricted. In ancient China, women were discouraged from consuming foods that were believed to influence the appearance of their children. For example, turtle meat was believed to produce a short-necked infant and goat meat a child with a stubborn disposition. In 1889, a Dr. Prowchownick of New England prescribed a particular diet for his pregnant patients. As a result of insufficient sunlight exposure, women who worked in sweatshops were developing rickets that resulted in a contracted pelvis, causing difficult deliveries. Believe it or not, his diet was designed to stunt the growth of the fetus during the last months of pregnancy! To obtain these results the women ate a high protein diet, restricted in fluids and calories. This approach was also popular in the US until after World War I, when it was observed that the low level of preeclampsia seen in Germany during the war, appeared due to a decrease in meat intake. (Preeclampsia is the development of hypertension with protein in the urine or edema, or both, during pregnancy.)
Thirty years ago a Joint Expert Group of the Food and Agriculture Organization of the World Health Organization pronounced that nutrition was of no great importance in pregnancy. Today experts disagree on issues as important as proper weight gain, basic physiological adaptations of pregnancy, and the requirements for energy, protein, and micronutrients. During the early 1940s, in an attempt to reduce the risk of preeclampsia, women were put on calorie- and sodium-restricted diets, and were sometimes prescribed appetite suppressants and diuretics to limit weight gain to 15 to 20 pounds. Unfortunately, one unwanted side effect of this regime was small babies who bore an increased risk of death.
Avoidance of excess weight gain remained the doctrine of practice until the 1960s, when it was observed that this restriction was often resulting in small babies bearing a higher death risk. Most doctors since that time have encouraged their patients to eat, and not to worry about extra weight gain. Now both mother and baby too often become too big, carrying an increased risk of death and of need for cesarean sections.
The female birth canal was designed to allow a baby weighing 5 to 8 pounds to fit through--the size they tend to grow when mothers eat a healthy, plant-based diet. With unrestricted weight gains for the mothers, babies these days are weighing in at 10 to 12 pounds--a size often too big to comfortably fit through the mother's pelvis. Big babies are harder to deliver and as a result, injury and death more likely. Harm to the mother and the possibility of cesarean section birth is increased by about 50% (Obstet Gynecol 79:664, 1992). What a predicament! If you feed too little food to mom then baby's too small; too much food and baby's too big. Just proves you can't make something so wrong as the rich Western diet right by simply changing portion size.
ENERGY IS REQUIRED TO GROW A BABY!
To grow a baby, 60,000 to 80,000 extra calories are required. That's an extra 250 to 300 calories a day during the second and third trimesters. The simple carbohydrate glucose, derived originally from plant sources, is the primary metabolic fuel for the growing embryo, fetus and newborn immediately after delivery. Pregnant women become hungrier, especially during the last two trimesters of pregnancy. As a result they eat more food, taking in more calories and more of all the essential nutrients these foods should supply. Calorie intake is estimated to increase from 2200 kcal to 2500 kcal a day. However, in many parts of the world women do not eat more food. Instead, they gain the extra calories by increased body efficiency. Physically hard-working pregnant women from the Philippines and rural Africa take in no more, and often fewer calories, than before pregnancy (Lancet 2:363, 1984 & 2:1129, 1987). Fortunately, their foods are primarily nutrient-dense vegetable foods which will easily provide the raw materials to grow a healthy baby.
HOW MUCH PROTEIN IS ENOUGH?
Protein is, of course, an essential nutrient, but most of us have been taught to regard it as an almost magical determinant of health and the outcome of pregnancy. A study of dietary intervention with pregnant Guatemalan women who ate sparsely showed the effects of the composition of the diet. In two villages a high protein-calorie supplement was made available; in the other two villages a drink provided calories without protein. The study found birth weights were influenced by the number of calories consumed, rather than by the protein content of the supplements. (Stein Z, The Journal of Reproductive Medicine 21:287, 1978). Those receiving the extra protein actually had worse outcomes; the supplementation of protein during pregnancy resulted in more underweight infants, an increase in premature deliveries, and an excess death rate of the newborns. (Stein Z, The Journal of Reproductive Medicine 21:287, 1978). Despite claims that pregnancy-induced hypertension can be prevented with a high protein diet, there is no evidence that a high protein intake per se during pregnancy is beneficial--and that in some instances it actually may prove harmful (Am J Obstet Gynecol 147:354, 1983; Pediatrics 65:683, 1980).
During the last six months of pregnancy, only 2 pounds of protein (5-6 grams a day) are deposited in mother and infant. A starch-based diet provides between 44 and 130 grams of protein for the woman consuming 2200 kcal daily. The World Health Organization recommends 6 % of the calories from protein for a pregnant woman and 7% for lactating women. This amount is easily supplied by plant sources:
Check the accuracy of this information with your doctor before applying
information in this newsletter to your health care. Don't change your diet or
medication without your doctor's advice.
Thank you!
John McDougall, M.D.
If you would like to read more about Nutrition For Pregnancy or the other articles in this issue:
Put a large pot of water on to boil. When boiling, drop in pasta and cook according to package directions. Place the 1/3 cup water in a sauce pot with the green onions. Cook for 2 minutes, then add the remaining ingredients. Cook stirring frequently for 5 minutes. Drain pasta and place in a bowl. Pour sauce over and mix well. Serve at once.