Pregnancy : The Complete Guide

Introduction

Pregnancy, women’s most important phase in life where offspring develops inside her body. It is also called ‘Gestation’. It will be an exciting phase, but also overwhelming as a woman goes through many changes in her body. During the ovulation phase of the menstrual cycle, which is around 14th day after menstruation cycle, the sperm fertilizes with the egg that is released from the ovary. This fertilized egg travels down to the uterus and the implantation occurs. And then a woman becomes pregnant.

During pregnancy, a woman faces many challenges to overcome the various factors that might affect the pregnancy. A full-term pregnancy usually lasts 40 weeks. A woman can choose to start with pre-natal care and continue till the end of pregnancy to experience a healthy status and give birth to a healthy baby.

Symptoms before and during Pregnancy

Few symptoms will appear before and after confirmation of pregnancy,

• Missed period
• Headache
• Spotting
• Vomiting
• Back pain
• Acne
• Constipation and so on.

Stages of Pregnancy

The pregnancy phase has three stages, each called a ‘Trimester’.

First Trimester — Week 1–12 are from first trimester. During this stage, the fetus begins to develop the organs and the heart of the fetus will also start to beat. According to ACOG, the chances of miscarriage is high during this stage.

Second Trimester — Week 13-27 are from second trimester. During this stage, one can feel the baby and the movements. An ultrasound, to check for the abnormalities, is performed.

Third Trimester — Week 28-40 are from third trimester. The weight of the baby and the mother will gain. The baby, grown fully along with the bones, can sense the light while in the womb. As the labor time approaches, the woman will have pelvic discomfort and also see foot swelling.

Nutrition and Fitness before Pregnancy

It is of supreme importance what one does before as much as what she is doing during and after pregnancy.  When someone is in the conception stage of pregnancy or the goal is to conceive, the strategy should be to imbibe small daily habits, nutrition, and exercise that encourage you to take a holistic approach towards caring for the body. 

A lady who is trying to get pregnant, is currently pregnant, or is recovering from childbirth will experience hormonal fluctuations and one of the most significant developmental changes of your life lies between these transitional phases. But it can also be a very stressful time. Practicing mindfulness, exercise, and meditation will from time to time help you gather your equilibrium.

Nutrition

Thinking that the “off-limits food and drinks” rule begins the day she sees those two pink lines is a myth that the folklore will tell. It’s much more involved than that. The day she decides to get pregnant is when she starts changing her habits for good. Researchers support the amalgamation between fertility and health. If a woman is already into quantified eating then good, if not, then the following guidelines will set a good foundation to begin with:

1. Keep a portion of protein in all the meals. Foods rich in protein are eggs, chicken, fish for the non-vegetarians and tofu, paneer, soy, whey, dal, and rice for the vegetarians.
2. Include healthy fats rich in Omega-3: These healthy fats help with embryo development and baseline estrogen levels. Some options for this are in the form of fish like salmon or fish oil capsules, flax seeds or flaxseed oil capsules, sunflower seeds and walnuts.
3. Restrict on processed and junk foods.
4. Restrict alcohol and smoking.
5. Losing fat before conception should be the aim.  The only reason is that as one progresses through the weeks, she will gain weight, and also it will take her a couple of months to get on the road of recovery and begin her fitness regime.

Ideal Weight Gain during Pregnancy- Range and Rate

 

Optimal weight gain
BMI before pregnancy	Ideal weight gain	Rate of weight gain after 1st trimester
Underweight (BMI <18.5)	12.5 – 18 kg	~0.5 kg/week
Normal (BMI 18.5 – 24.9)	11.5 – 16 kg	~0.4 kg/week
High BMI (BMI > 25)	7 – 11.5 kg	~0.3 kg/week
Very High BMI	<7.0 kg	~0.3 kg/week

Source: ACOG guidelines

Gynaecologists ensure that the woman is gaining an “ideal” amount of weight during 40 weeks or till the day she delivers. Health practitioners focus on “ideal” weight gain.

 Along with a functioning placenta, amniotic fluid, extra blood volume and fluids, the body also stores fat and protein to serve the mom and the baby. During the pregnancy, no two women will have similar weight gain or rate of weight gain. Some might gain steadily and gradually week on week, while others go through growth spurts in intervals. One should remove the fear of gaining weight and instead shift focus on how you can work towards being and feeling as healthy as possible during your 40 weeks.

What is ideal for a woman is highly based on that individual’s pre-pregnancy weight. Women who gain little weight or below recommendations are at higher risk of having a child that is small for gestational age. On the other hand, if a woman gains more than the recommended amount might have a higher risk of gestational diabetes, blood pressure or a larger baby (more than the average weight of 2 to 3.5 kg birth weight).

Your birth plan might also depend on the outcomes of the above weight gain.  Pregnancy is an opportunity to understand that we cannot control the outcomes, but we can control behaviors that make those outcomes more likely. One has to determine what nutrition habits and lifestyle skills have to be inculcated practically to help effective management.

Energy Requirements in Pregnancy

During pregnancy, we mainly look for food that we “must” totally avoid. Sooner or later, you will come across unsolicited advice on “eating for two”, or x number of calories. 

It is important to understand the nutritional landscape for both quantified eating and beyond,

1. During the first trimester, one does not need an exponential number of extra calories. One is good to go within maintenance or 90-100 calories over it. While it is true, that with pregnancy comes a higher demand for nutrition rich food, however it is not different from how it should have been before getting pregnant.  
2. Towards the second trimester, the need is increased to around 340 Kcal above TEE, 450 Kcal for the third trimester and around 500 Kcal during the lactation/postpartum phase. It is  important that a pregnant woman is stressed about the exact numbers and listens to her body, focusing on eating high quality healthy protein rich food with every meal and snack.
3. Nausea and food aversions might make one not want to eat food or avoid it. If quantification is a problem, we suggest habit building instead of calorie counting. It is noted that meat, which is a fairly good source of protein, is one of the most common foods to which a pregnant woman can develop nausea in her first trimester. In such a case, add other sources of protein to  every meal.

Habits to Develop

• Include protein from a variety of sources in all meals and snacks
• Include portions of vegetables and seasonal fruits in the daily diet. This will help keep constipation at bay.
• Include good fats also known as essential fats that your body cannot make on its own and must be obtained from your diet. Omega 3 is super food for a baby’s eye and brain development. Some omega-3 rich foods are Fish, salmon, walnuts, seed butters and nut butters and fish oil supplements. Good fats help in attaining satiety, reduce cravings, and also in the absorption of fat-soluble vitamins.
• Making smart carbohydrate choices. Carbohydrate is a growing bump’s best friend, with frequent hunger pangs and many meals spread across the day. Choose rice, wheat, amaranths, oats, quinoa which are also a good source of B-vitamins, over refined carbohydrates and fast foods. 
• Water and hydration hold good importance throughout 40 weeks and beyond. Dehydration and tiredness can be a problem during pregnancy. When a pregnant lady is dehydrated, she can be constipated and is more prone to hemorrhoids. 
• Shift your meal timing and portion size of each meal depending on your nausea and energy levels throughout your pregnancy.

Vitamin and Mineral Requirement in Pregnancy

There are a handful of supplements that are recommended to all pregnant women worldwide. These are known as prenatal supplements. Before starting any new supplement or even continuing the ones you are currently taking, you should discuss with your gynecologist.

Prenatal Supplements like Iron, Calcium, Magnesium, Vitamin B6, Zinc, Selenium and vitamin C are generally required to provide for the extra need of micronutrients during the time of pregnancy. The recommended daily allowance (RDA) for pregnant women is  27 mg/day of iron and 1200 mg/day of calcium. Food sources of iron are eggs, meat, chicken etc. and that of calcium are milk, cheese, paneer, nuts like almonds. Having inadequate iron status before and during pregnancy can have a significant impact on fetal development by reducing infant growth rate. If iron deficiency is present before conception, it  can impact the development of the placenta during early pregnancy, and this is when iron supplements are necessary.

Folic Acid is the first supplement that your doctor prescribes, and it reduces the risk of neural tube defects. Its RDA is 600 mcg/day. Foods that are rich in folic acid are beetroot, pomegranate, spinach etc. 

Vitamin B12 is also a prenatal supplement and is important to prevent birth defects, along with folic acid. RDA of Vitamin B12 for pregnant and nursing moms is 2.8 mcg/day. Though there are enough B12 sources for non-vegetarians like animal liver, meat, fish, eggs; vegetarians can include milk, cheese, yogurt, fortified cereals and fortified nutritional yeast can be included by  vegans.

Fish oil supplements which have EPA and DHA that are beneficial in congenital development, nervous system function and brain development and have an RDA of 100 mg/day.

Vitamin D is associated with benefits of increased cognition and bone strength. Make sure to expose to sunlight, which facilitates its production and helps in absorption of calcium.

Nutritional Risks and Myths in Pregnancy

The Indian culture celebrates a woman’s pregnancy with utter caution, and with that comes a lot of many does and don’t’s. Let’s discuss the risks involved regarding food.

Dispelling Myths Around Pregnancy

1. If you don’t have morning sickness, your pregnancy is not right: The truth is that morning sickness is just one of the most common symptoms of pregnancy which arises due to hormonal changes in your body and not every single pregnant woman will experience nausea. Some might not even feel any discomfort around the first trimester, and some may carry nausea until the day they deliver. 
2. Touching your tummy might harm the baby: Not true, your baby is well protected in your uterus and is well cushioned from minor bumps, stumbles, and falls by the amniotic fluid in which your baby floats. But if you experience any vaginal bleeding or painful cramps, get in touch with your health provider. 
3. Carrying or lifting heavy objects will induce labor: A partial myth, there is no harm in doing your household chores, carrying grocery bags or your older kids. Keeping posture right while doing this is important. Bend your knees and don’t let the entire pressure be on your spine. 
4. Exercises are a big NO, you must just walk: Not true, although you do need clearance from your gynecologist before beginning any new routine. If you have been training, doing yoga, swimming, or practicing any form of exercise before pregnancy, you can safely continue doing the same at a reduced or modified intensity throughout your pregnancy. 
5. Air travel is not safe during pregnancy: Not true, you can travel any time before 6 weeks of the due date. Domestic Airlines rules mention that expectant mothers shall not be allowed to travel beyond 32 weeks of pregnancy in case of complicated pregnancy. A Fit to Fly certificate from the treating obstetrician, dated not more than 3 days before the date of travel, is required only if the pregnancy is between 28th & 32nd week.
6. Microwaves, security scanners, are harmful: Microwaves are a risk only in case of a leakage of radiation. Passing through  security is also fine and not harmful. But if you are anxious about it, you can always avoid it. 
7. Hair color during pregnancy: Ammonia and chemicals can get absorbed by the scalp and get into the bloodstream. Hair color during the first trimester is good to be avoided. Many makeup products have lead and mercury, these too should be avoided as far as possible. 
8. Papaya can cause miscarriage: The truth is that raw papaya is suspected to contain chymopapain, which is supposed to induce abortion or early labor. But ripe papaya is considered to be safe. Moreover, ripe papaya is a good source of vitamin A.
9. Your belly shape determines the sex of your baby: It’s just an old wives’ tale and has no scientific significance. 
10. Mothers must eat for two: Time and again this repeats itself, but one doesn’t need to eat for two. Since the requirements of pregnant mothers increase, eat a little extra, about around ~300 kcal more. A pregnant woman actually needs a well-balanced nutritious diet that consists of all the food groups so that it fulfills the needs of all the nutrients adequately. 
11. Drinking coffee is bad: False, research says an allowed limit of 200 mg caffeine does not harm. So, you can have your cup of coffee a day and enjoy it. Although it might cause some women heartburn, in that case you can avoid caffeinated drinks.

Please note:

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