Malnourished Infants-Victim of Unbalanced Maternal Diet (Pregnancy Diet) by Dr. Sangita Gaur (Nutritionist)

 


Malnutrition is widely recognized as a major health problem in the developing countries of the world. It is an important battle, which is to be fought and won. Recently, malnutrition in early life has been cited as a possible cause for development of chronic degenerative diseases in adulthood. It has been observed that the prevalence of coronary heart disease and diabetes is three times higher in those adults who weighed 2.5 Kg. or less at birth than in those who weighed 3.4 Kg. or more. People of developing countries like India have higher mortality rate from coronary artery disease than the people of developed countries and this may be programmed by change in maternal nutrition. This study has considerable relevance in the context of Indians as one-third babies in India.

           weigh less than 2.5 kg at birth (LBW) and have intrauterine growth retardation. Since, infants  are  the  prime  victim  of  unbalanced   maternal  diet  as  exhibited   by  low  birth weight and very high infant mortality, therefore our study makes a special focus on the most vulnerable segments of the population, such as infants and pregnant women, to malnutrition.

      The expectant mothers have not only to nourish herself but also the growing fetus as all the nutrients are supplied either from the mother's diet or her tissues and if her diet does not supply the nutrients essential for her needs and those of the fetus, the fetal requirement is met by withdrawing the nutrients from the tissues of her own body. This tissue depletion weakens her and increases the risk of serious complications like miscarriage, still birth, LBW babies and maternal deaths. Thus, proper antenatal care throughout pregnancy is essential.

 Unborn baby's needs as well as your own requirements. The first three months of pregnancy is important as most of the physical and mental growth of the baby takes place during this time. The principal organs both external and internal and the nervous system of the baby form within this period. So it is important to eat well from the beginning itself even if you have discomforts like nausea etc. Like wise babies growth is rapid during the last three months of pregnancy. A nutritious diet during this period is essential for normal birth weight of the baby.

 A proper diet while you are pregnant is relatively easy to maintain. For the most part, you should be eating the same nutritious foods you should be eating when you are not pregnant. The primary differences are the amount of protein you will need and a calorie increase. You will be surprised to know that you only need to increase your calories by about 300 calories per day. This is the equivalent of a ham and cheese sandwich and a glass of milk. While the calories are important, they are not a license to binge on unhealthy, fatty snacks.

 A nutritious diet with enough proteins, fats, carbohydrates, minerals and vitamins are essential during pregnancy. Your diet should consist of a variety of foods selected from the five basic food groups.  Fresh fruits and vegetables, whole grain products like breads or cereals, meat, fish or other protein alternatives, milk and other diary products etc provide a nutritious diet. Keep off canned and processed foods, spicy foods, coffee, tea, hot chocolate, sugary foods such as cakes, cookies, candies, sodas and colas and reduce your salt intake as far as possible. 

Eat as wide a variety of food as possible but in moderation. Too much of any one food can even be harmful if it leads to excessive gain in weight.  Try to have three meals every day or six smaller meals if you have problems with nausea or heartburn.  A total up to a total of 2,200 or 2,800 calories is essential for a healthy pregnancy. Besides the natural diet, prenatal vitamins especially iron, calcium, folic acid are often prescribed routinely through out the pregnancy by the doctor

Some of the essential nutrients 

 Folic acid: Folic acid is the most vital nutrient pregnant women need. This is needed for the development of baby's nervous system, especially in the first few weeks. Folic acid is a B vitamin that helps prevent neural tube defects (defects of the spine, brain, or their coverings) and other birth defects like cleft lip and congenital heart disease. By consuming at least 4 milligrams (mg) of folic acid every day before getting pregnant and during the first three months of pregnancy, you can help reduce the risk of these defects. Folic acid is found in dark-green leafy vegetables (like spinach or kale), liver, yeast, beans and citrus fruits, and in fortified cereals and bread. Folic acid is easily lost while cooking, so steam green vegetables or eat them raw.

 Iron: Iron is one of the most important minerals for a pregnant mother. Red blood cells each contain over 200 million molecules of hemoglobin, which is primarily iron. This hemoglobin is the molecule that carries oxygen through the body. Because you will produce more blood during pregnancy, it is important to have plenty of iron for hemoglobin production. Good sources of iron include spinach, broccoli, strawberries, red meat (especially liver, if you can eat it!), prune juice, legumes, such as peanuts, and whole grains. Iron is needed to fuel hemoglobin production for you and your baby. Iron also helps build bones and teeth. A shortage of iron can cause a condition called anemia.  If you have anemia, your doctor will give you iron supplements to take once or twice a day. You can help prevent anemia by eating more iron-rich foods like potatoes, raisins, dates, broccoli, leafy green vegetables, whole-grain breads and iron-fortified cereals.

 

Calcium : The fetus’ bone formation is linked to proper calcium intake. Calcium is important for you as well since strong bones will be needed to carry the added weight and maintain your strength during pregnancy. If you do not get enough calcium, the fetus will draw this nutrient from your body, taking what it needs first, thus sapping it away from your own supply.This is vital for the healthy development of your baby's bones and teeth, which start to form at about week eight. You will need about double the quantity of calcium than is normal. At least three servings of milk, yogurt, or cheese is essential to meet expectant mother's calcium needs. Apart from diary products, good sources include leafy, green vegetables. Diary products are also high in fat, so if possible choose low fat varieties such as skim milk.  The recommended daily amount of calcium during pregnancy and breast feeding increases significantly  from 800-1200mg.  

To ensure the proper absorption of calcium, Vitamin D works wonders and is easily obtained from Vitamin D fortified milk. Sunlight also supplies vitamin D although you want to limit the amount of sunlight you take in each day

 Protein For proper fetal growth, protein is needed. This contributes to the developing placenta and blood cells. Three healthy servings of protein a day is a good rule of thumb. You can get these from beans, chicken, meat, fish, eggs, and tofu. Make sure you that you cook meats and eggs thoroughly to kill any lingering bacteriaTry to eat a variety of protein rich foods, because your needs increase during pregnancy. Vitamin B6 is needed for the proper utilization of protein. Fish, meat, nuts, peas, beans and diary foods such as milk and eggs all supply protein, but animal sources can also be high in fat, so limit your intake of these and choose lean cuts of meat whenever possible. 

Vitamin C : This will help to build a strong placenta, enable your body to resist infection and aid the absorption of iron. It is found in fresh fruit and vegetables and supplies of the vitamin are needed daily because it cannot be restored in the body. A lot of vitamin C is lost by prolonged storage and cooking, so eat fresh produce and steam green vegetables or eat them raw.

 Fiber : This should form a large part of your daily diet, since constipation and piles are common in pregnancy and fiber will help prevent it. Besides rich sources like fruits and vegetables, brown rice, nuts, cereals including oats, beans, peas and pulses etc are good sources of fiber.

 Water: Water plays a key role in your diet during pregnancy. It carries the nutrients from the foods you eat to your baby, and also helps prevent constipation, hemorrhoids, excessive swelling, and urinary tract or bladder infections. Most importantly, drinking enough water, especially in your last trimester, prevents you from becoming dehydrated which can then lead you to have contractions and premature or early labor. Pregnant women should drink at least six to eight glasses of water per day. You can drink juices for fluid, but they also have a lot of calories and can cause you to gain extra weight. Coffee, soft drinks, and teas cannot count towards the total amount of fluid you need as they have caffeine which actually reduce the amount of fluid in your body.

 A healthy pregnancy depends heavily on the type of nutrition during pregnancy you have. What you eat determines how healthy the baby will be. A proper diet also helps you cope with pregnancy related problems. Good nutrition during pregnancy is essential if you want to prevent problems like anemia, hemorrhage, dizziness, nausea, low blood pressure, fatigue etc. It also ensures that your baby is getting the nutrients she needs to grow inside the womb. Healthy nutrition during pregnancy is the key to good health.

 Eating Right

 Good pregnancy nutrition consists of the following.

 Cereals - Have plenty of cereals for breakfast, dinner and snacks. Cereals provide carbohydrates, proteins, minerals, vitamins and fiber for the body. They fill you without fattening.

 Dairy foods - Dairy products are one of the best sources of calcium, and your body needs a lot of it during pregnancy. Eat low fat dairy products if you are worried about too much weight gain in pregnancy. Cheese, milk, yogurt are excellent foods for pregnancy.

 Fruits And Vegetables - Fruits and vegetables have minerals and vitamins needed for the proper growth of the baby. They also add fiber to the meal, preventing problems like constipation and gas. Wash fruits and vegetables thoroughly before eating.

 Nuts and lentils - Nuts and lentils are good sources of protein. In addition, nuts supply good cholesterol for the body. Soy is a very good source of protein

 Meat - Eat lean meats like fish and chicken if you are weight conscious. Red meats are unhealthy for most people, so you can safely cut down on them.

Nutrition during pregnancy need not be elaborate. You can eat the simple cereals and seasonal fruits and veggies you always do. However, you need to ensure that you eat a variety of foods. You should avoid dieting when you are pregnant to ensure you get proper Nutrition during pregnancy. While you need not eat for two literally, the quantity of food you eat and the kind of meals you have may change.

 


Supplements

During pregnancy, your doctor may prescribe nutritional supplements if he feels you are not getting enough nutrition during pregnancy. Folic acid plays a crucial role in the development of the baby. Lack of folic acid can impair the growth of the baby, so the doctor will prescribe folate pills from the first trimester itself. You may also need to take iron supplements to prevent anemia.

By getting proper Nutrition during pregnancy, you will increase your chances of a healthy, trouble free pregnancy and labor.

 In many cases, you may have a multi-vitamin and mineral supplement prescribed for you during your pregnancy. It is vitally important that you take the prescribed dosage and discuss any supplements with your doctor. Do not take standard multi-vitamins because the amount, type and quantity may not meet your needs during pregnancy.

 Of course, there are also foods that should be avoided during pregnancy. First, avoid empty calories found in prepackaged junk food, and foods that are highly salty or greasy. While salted foods can be consumed without any problem, excessive salt consumption will lead to bloating, water retention, and may raise your blood pressure. Greasy foods will tend to aggravate the nausea of morning sickness and give rise to heartburn. Since greasy foods are full of calories but very little nutrition, they may cause extra weight gain with little or no benefit.

 You should also avoid all uncooked or undercooked meats and fishes. This includes sushi and raw oysters. Raw fish and shellfish may contain parasites such as tapeworm that will rob your body of the nutrients your fetus will need to grow and develop normally. PCBs and other chemical contaminants are also a concern with fresh, raw fish. Amounts that would have little or no affect on an adult may cause complications to a developing fetus.

 The best way to ensure proper nutrition for you and your fetus during pregnancy is to follow the government’s food pyramid guidelines, taking care to add additional proteins and calcium. Your doctor or a nutritionist can guide you in choosing a healthy variety of foods that will satisfy your cravings and help you bring a healthy, happy baby into the world. Remember that “eating for two,” means eating twice as healthy, not eating twice as much!

Dr Sangita Gaur
Former Nutritionist Indraprastha Apollo Hospital


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