Source: The Swiss Association for Nutrition (SAN)
September 25, 2003

A pregnant woman's nutrition directly influences the course of the pregnancy and normal fetal development, and also the long-term health of the mother and child. In the first half of pregnancy, nutrition requirements mainly concern quality, while in the second half, quantity is also an issue, to ensure fetal growth. Proper nutritional habits should already be established at the start of this second life - if possible even before conception.

Energy and nutritional requirements

The pregnant mother's body is subject to greater demands to ensure fetal development as well as the growth, health and functioning of the uterus, placenta and amniotic fluid. A daily increase of 150 calories in food consumption is recommended at the start of pregnancy, which will eventually reach an extra 250 calories a day by the end of pregnancy. This entails a "double-shot" in the form of a daily glass of milk during the first trimester and an additional piece of fruit or slice of bread during the final six months. While weight gain is normal, the mother-to-be should not let herself starting "eating for two" (or more). The average weight gained is between 9 and 12 kg (20 to 26 lbs), although there is a natural variation between individuals. With overweight women, it may be less, while thinner women may gain more.

An additional intake of 10 g (1/3 ounce) of protein a day during the entire pregnancy is recommended to build up, maintain, and regenerate body tissue in both the fetus and mother. This daily ration of 70 g (2½ oz) of protein is guaranteed with our current nutritional recommendations. Glucose, the basic stuff of carbohydrates, is the main source of energy drawn on by the fetus. A daily intake of carbohydrates in the form of bread, pasta, or fruit is needed for a problem-free pregnancy. Fats with essential fatty acids are critical for the development and functioning of the baby's nervous system.

Minerals and vitamins
The increased demand for minerals and vitamins during pregnancy can be satisfied by an adequate, varied, and balanced diet. Attention should be paid to folic acid, calcium, and iron in particular, since these are often deficient.

More Calcium
A substantial transfer of calcium occurs between the mother and the fetus throughout pregnancy, allowing the baby's bone and teeth formation. In the first six months, the mother stores up calcium in her own bones. When its skeletal growth reaches its peak in the last three months, the fetus draws on the mother's store. This is when the consumption of high calcium-containing foods such as milk and milk products must be increased, since a calcium deficiency will damage the mother's teeth and make her bones brittle.

More Iron
The demand for iron, essential for blood formation, is also increased during pregnancy because the mother's blood volume increases, and the fetal red blood cells have to be developed. Iron is available in meat, fish, egg yolk, whole-grain products, and vegetables. Iron of plant origin is not as well assimilated as iron of animal origin. However, if you ingest vitamin C from raw food during the same meal, iron is more easily absorbed.

More folic acid
This vitamin promotes the development of the fetal central nervous system and prevents developmental defects of the neural tube (spina bifida). Folic acid is contained in vegetables, wheat germ, tropical fruits, and in eggs. However, routine nutrition does not always supply enough folic acid (vitamin B9) to meet the requirements of a pregnant woman. Additional folic acid intake is necessary in the months before pregnancy and during the first trimester.

Tips for relief of pregnancy-related discomfort

Nausea and vomiting
These symptoms are common, especially at the beginning of pregnancy.

• Plan light and more frequent meals.
• Do not eat solid and liquid foods at the same time. Drinks should be taken a half-hour before or after the meal.
• Avoid fatty foods, fried foods, sauces, and hot spices.
• Have breakfast 15 minutes before getting up to offset morning sickness.

Heartburn
This symptom often occurs toward the end of pregnancy. It is caused by the pressure of the baby against the mother's stomach.

• Eat light and more frequent meals.
• Eat in the evening, at least 2 hours before going to bed.
• Avoid fatty foods, coffee and cola drinks.

Flatulence

• Avoid foods with a fermentative effect, such as cabbage, leeks, garlic, onions, and legumes.
• Drink tap water or non-carbonated mineral water.
• Eat slowly and in peace and quiet.

Constipation
Intestinal movement is slowed during pregnancy, and this may result in, or worsen, digestive disorders.

• Drink at least 1.5 liters (3¼ pints) of fluids per day (water, herbal tea, fruit juice, milk).
• Eat fiber-rich food: whole-grain bread, vegetables, fruit, legumes.
• Drink a glass of cold water when you get up in the morning, and eat dried fruits (prunes).

Edema
This swelling of the legs, arms, and sometimes the face are due to water retention.
Do not go without salt except in special cases.

• Drink 1.5 liters (3¼ pints) daily

Food cravings

• Maintain a regular schedule of meals.
• Take small snacks between meals consisting of fruit, milk, yogurt, bread with cottage cheese, or whey.

Food Poisoning/g-i infections: toxoplasmosis, listeriosis
Some infections have serious effects on the embryo, but they can be prevented by observing the rules of hygiene.

• Always carefully peel and wash raw vegetables, fruit, and herbs (parsley, basil).
• Always wash your hands carefully before cooking, eating, after you have handled raw meat, or have touched sand or soil.
• Eat only well-cooked meat. Avoid tartar steak, fried sausage, meat fondue, rare steak, carpaccio.
• Avoid cats and their litter, as toxoplasmosis pathogens propagate in the cats' intestines.
• Do not eat uncooked fish, meat, milk, and eggs.
• Do not eat cheese rind.

Alcohol
Consumption of alcohol during pregnancy should be avoided if possible, as it affects the physical and mental development of the fetus. The risk of injury is particularly high in the early months.

Caffeine
Caffeine is found in coffee, black tea, cola drinks, energy drinks, and cocoa (chocolate) as well as other foods. It has a stimulating effect and therefore speeds up the heart rate. Caffeine in the blood of a pregnant woman affects the heartbeat of the baby, which almost doubles. Pregnant women may take two cups of coffee or four cups of tea a day without endangering the fetus.

Tobacco
With each inhalation from a cigarette, nicotine enters the mother's circulatory system and also that of the fetus through the placenta. The blood vessels contract and the oxygen supply of the fetus is compromised. For this reason, tobacco is contraindicated during pregnancy (and this includes secondhand smoke).

Recommendations
Eat three meals daily plus small snacks. Don't skip breakfast.
Consume 3 or 4 portions of milk products daily.
Avoid weight-loss diets.
Avoid alcohol and tobacco, take coffee in moderation.

Nutritional recommendations for pregnant women

Many factors affect our eating behavior: individual needs and wants, health status, social environment, selection of available foods, advertising, etc. The following recommendations ensure (in the form of a balanced diet) an adequate supply of energy, and nutritional and protective elements, and therefore represent healthy nutrition. The listed amounts and portions are averages; it is no possible to follow them exactly day by day.
Words in italics are especially important for the mother-to-be.

Oils and Fats
Daily consumption: 2 teaspoons (10 g) nutritious vegetable oil such as sunflower oil, thistle oil, corn oil, unprocessed olive or canola oil, e.g., for salad dressings.
Daily consumption: at most 2 teaspoons (10 g) grease or cooking oil, such as peanut oil, or olive oil for hot meal preparation.
Daily consumption: at most 2 teaspoons (10 g) spread, i.e., butter or margarine.
Daily maximum: one meal heavy in fat such as deep fried or breaded foods, cheese dishes, fried potato cakes, bratwurst or hot dogs, cold cuts, dishes with sauces, shortcake or pastry dough, cake, pies, chocolate, etc.

Pastries/Snacks
Use them in moderation - most sweets contain hidden fat. At most eat 1 small portion of sweet snacks daily (e.g. 1 chocolate bar, 1 piece of cake or a pastry, an ice cream).

Meat, Fish, Eggs, Legumes
2 - 4 times per week: 1 portion meat (1 portion = 80-120 g, or 3-4 oz). More is unnecessary, less is permitted. At most, one meal of cured meats such as ham, sausage or bacon in place of meat.
At most, one meal per month of offal, such as kidney, tripe... (1 portion = 80-120 g, or 3-4 oz).
Avoid liver.
1-2 portions fish per week (1 portion = 100-120 g, or 3½ -4 oz).
2-3 eggs per week, including those used in baked goods, soufflés, or cream sauces.
They should be cooked to avoid food poisoning.
Per week: 1-2 portions legumes and derivates e.g., lentils, chickpeas, beans (1 portion = 40-60 g, or 1½ -2 oz, dry weight), tofu (1 portion = 100-120 g, or 3½ -4 oz)

Milk and Milk products
Per day: 3-4 portions of milk products (1 portion = 0.2 liter or ½ pint of milk, or 1 cup of yogurt, or 30 g= 1 oz hard cheese or 60 g = 2 oz soft cheese).

Grain Products and Potatoes
Daily consumption: eat 3-4 portions of starchy foods such as bread, potatoes, rice, cereals or pastas, preferably whole-grain products. The portion size depends on the frequency and amount of physical activity practiced.

Fruits
Per day: 2-3 portions of fruit, raw if at all possible (1 portion = 1 apple, 1 banana, 3 plums or a bowl of berries).

Vegetables
Per day: 2-3 portions of vegetables, one of which should be raw, e.g., as a dip vegetable or a mixed salad (1 portion = 100 g = 3½ oz raw vegetables, or 150-200 g = 5-7 oz cooked vegetables, 50 g = 1¾ oz green salad or 100 g = 3½ oz mixed salad).

Alcoholic and Nonalcoholic Drinks
Drink at least 1.5 liters (3¼ pints) of liquid per day, preferably unsweetened nonalcoholic drinks.
Replace fluids in the case of vomiting, diarrhea, or heavy perspiration.
Alcohol: for her own benefit and that of her unborn child, the pregnant mother should avoid alcohol consumption, as it is assimilated by the fetus.