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Calling all parents: diet during pregnancy & breastfeeding

 

During pregnancy and breastfeeding, a mother’s – or mother-to-be’s –nutrition influences the development of her child. With the right foods and exercise, you will promote a healthy pregnancy, alleviate pregnancy discomfort and reduce the risk of your child becoming ill during breastfeeding.

In the United Kingdom, over 700,000 women give birth each year.[1] All these women experience countless changes during pregnancy – and it’s no wonder, as the body needs to undergo through physical and hormonal changes to keep both mother and child healthy.

Nutrition plays an important role during pregnancy – the body needs more nutrients than usual, which is why iron, iodine and vitamin B12 levels, among other things, can sometimes become low. This also applies to breastfeeding – how many nutrients the child receives through breast milk depends on whether the mother’s nutrient levels are healthy.

So, without further ado, find out which foods you should eat or avoid during pregnancy and breastfeeding, and discover which nutrients should be taken through dietary supplements.

How does pregnancy change your body?

Within the nine months of pregnancy, the female body undergoes one change after another: the stomach grows, mammary glands in the breast become larger and the body produces more blood. In addition, you may be plagued by fatigue, a ravenous appetite or the classic morning sickness. During pregnancy, the body directs its attention to the unborn child, so that it develops healthily in the womb.

Which health changes occur during pregnancy?

During pregnancy, the levels of the female sex hormones oestrogen and progesterone increase rapidly. However, the concentration of unhealthy LDL cholesterol also increases, which in high amounts can increase the risk of cardiovascular disease. To reduce the risk, exercise and avoid foods that are highly processed and fried.[2]

In addition, the body produces more blood to provide the baby with sufficient nutrients. Pregnancy also stimulates kidney activity: the kidneys excrete more nutrients, especially proteins and vitamins. Due to further hormonal changes, the body accumulates more water (oedema) and fat.

Did you know that the body can store up to eight litres of water during pregnancy?[3]

What discomfort can occur during pregnancy?

morning sickness remedies during pregnancy

The larger the child becomes, the more the uterus presses against the bladder and intestines – this means the expectant mother experiences a more frequent urge to urinate and may suffer from constipation, flatulence and heartburn. With an increasing abdominal girth, the risk of back pain also increases.[4] Hormonal changes cause bleeding gums and morning sickness in the first weeks of pregnancy.[4]

Morning sickness usually occurs from the fifth week of pregnancy and can last until the twelfth week. If you still suffer from it after that, you should consult a doctor.[5]

Weight gain during pregnancy

In the first three months, women gain an average of up to three kilogrammes – this corresponds to a weight gain of 300 to 400 grammes per week. From the sixth month, you can even gain 500 grammes a week.

Whether this weight gain is within a healthy range depends on the pre-pregnancy body mass index (BMI): the ratio of body weight to height. For example, a healthy woman with a BMI of 21 can gain up to 16 kilogrammes during pregnancy. If the expectant mother is overweight before pregnancy (BMI of 25 to 29.9), weight gain should not exceed nine kilogrammes.[6]

What are the consequences of being overweight during pregnancy?

Obesity in pregnancy can increase the risk of the following pregnancy complications:[7]

  • Pre-eclampsia
  • Gestational diabetes
  • Premature birth
  • Miscarriage

Pre-eclampsia is one of the most common complications of pregnancy. It is associated with hypertension, severe water retention and protein loss.[8]

Foods to eat during pregnancy

pregnant lady prepares foods to eat during pregnancy

Mother and child need proper nutrition during pregnancy. The mother loses more nutrients through urinating and must provide additional nutrients for her child. In addition, there are some foods to avoid during pregnancy.

Calories & diet during pregnancy

The expression ‘eating for two’ is considered long outdated. It may sound tempting to eat twice the amount as usual – however, it is unhealthy. During pregnancy, a woman’s daily calorie requirement increases by only 300 kilocalories in the first few months. From the sixth month, this rises to 500 kilocalories. If you eat more than this requirement, your risk of becoming obese and suffering from subsequent health problems increases.

Tip: Supplement the increased requirement with wholegrain products, berries, fruits and vegetables. For example, oatmeal with fruits and nuts are considered great foods to eat during pregnancy. Otherwise, you can enjoy two snacks a day. This way, you can reach those daily nutrient requirements.

Healthy diet during pregnancy

During pregnancy, nutrients flow from the mother’s blood via the umbilical cord into the placenta. From there, they reach the growing foetus. Since both mother and child need their daily nutrients, the intake of vitamins, minerals, proteins and fatty acids increases during pregnancy.[9,10]

Nutrients of which a higher intake is needed

Function

Vitamins B1, B2, B3, B6, B12

Nerve formation

Folate

Cell formation and prevention of neural tube defect

Vitamins A, C, E

Structure of organs and immune system

Magnesium, iodine, zinc, iron

Blood, nerve and hormone formation

Proteins, omega-3 fatty acids

Tissue and brain development


How do I meet nutritional needs during pregnancy?

diet during pregnancy with magnesium

Proteins, B vitamins, folate, magnesium and zinc are found in high amounts in wholegrain products, legumes, nuts and chicken eggs. Vitamin B12, on the other hand, mostly appears in animal foods such as meat, fish, eggs, milk and dairy products – these foods also contain high amounts of protein.[9] When you combine animal- and plant-based proteins, your body can utilise them much better. 

You absorb enough vitamin A and vitamin C if you eat three servings of vegetables and two servings of fruit a day. Omega-3 fatty acids and vitamin E are found in abundance in vegetable oils such as flax, olive, canola, walnut, wheat germ and soybean oil. Cold-water fish such as mackerel, herring and salmon will provide you with additional omega-3 fatty acids and iodine. Iodised table salt is a suitable additional source of iodine. However, do not consume more than five grammes of salt per day.[9, 11]

Did you know that high amounts of salt can impair the development of your child’s kidney in the womb? In addition, salt promotes the formation of oedema.[3,12]

Can you be a vegan while pregnant?

If you are vegetarian or vegan and are pregnant, you should make sure that both you and your little one are receiving enough vitamin D, iron and vitamin B12 – the latter two of which are predominantly present in meat and fish. Some tips on suitable foods to eat during pregnancy for vegetarians and vegans include the following:

  • pulses
  • dark-green vegetables
  • wholemeal bread
  • fortified breakfast cereals (with added iron and/or vitamin B12)
  • dried fruit, such as apricots[30]

Let’s also not forget about calcium. For all pregnant vegetarians and vegans out there, you can enjoy dark-green leafy vegetables, pulses, fortified unsweetened soya, rice and oat drinks, brown and white bread, sesame seeds, tahini and dried fruit! These all serve as great sources of calcium.[30]

Food supplements during pregnancy: folic acid, iron, iodine

During pregnancy, women need to consume higher levels of folate, iron and iodine. Folate is a vitamin that forms new body and nerve cells. If the mother and thus the foetus lack folate, the risk of the child developing a neural tube defect increases.[10] Artificially produced folate is called folic acid. Folic acid is available as a dietary supplement and is also added to some foods.

Iron contributes to blood formation and thus to supplying the child with sufficient oxygen and nutrients. The mineral iodine stimulates the formation of important thyroid hormones in the child. Since the need for these three nutrients greatly increases during pregnancy, women should discuss the use of dietary supplements with their doctor if they cannot receive the amounts they need through their diet.

Results of a large review study show that receiving adequate vitamin D levels with the help of dietary supplements can reduce the risk of the following pregnancy complications:[13]

  • Pre-eclampsia
  • Gestational diabetes
  • Baby with a low birth weight

    What is a neural tube defect?

    The child’s nervous system forms from the neural tube during pregnancy. During the first four weeks of pregnancy, folic acid and vitamin B12 close the neural tube so that the nervous system can fully develop. A deficiency of these nutrients can lead to a neural tube defect. Malformations may subsequently occur that severely impair the child’s movement after birth.[14]

    Foods to avoid during pregnancy

    Pregnant women may only eat foods containing heavy metals such as lead, arsenic and mercury in small quantities. Heavy metals can be deposited in the organs and can also enter the body of the unborn child via the placenta and disrupt its development.

    Here’s how you can reduce heavy metal intake during pregnancy:

    • Wash rice, fruits, vegetables and herbs thoroughly
    • Avoid types of fish such as tuna halibut and eel – these large sea fish often contain a lot of mercury.
    • To avoid food-borne infection, wash your hands thoroughly before and after preparing meals and keep work areas clean. This is because toxoplasmosis and listeriosis pathogens in raw foods also increase the risk of premature births and miscarriages. Animal foods should be well heated before consumption. Since fruits and vegetables are also a source of pathogens, you should also wash them thoroughly.[15]

    Please note: During pregnancy, you should not deliberately avoid certain foods to prevent the occurrence of certain allergies in the child. Nutrient deficiencies may occur. To reduce the risk of certain allergies developing, opt for a natural childbirth and a diet rich in omega 3 – and avoid smoking and the presence of mould in your home.[16–18]

    Is coffee good for health during pregnancy?

    Coffee is not taboo during pregnancy: according to all studies, you can consume a maximum of 200 to 300 milligrammes of caffeine per day. Two to three cups of filter coffee or black tea are therefore usually not a problem. Larger amounts of caffeine, however, can increase the risk of miscarriage, premature birth and developmental disorders.[19-22]

    How much alcohol can I drink during pregnancy?

    Excessive alcohol consumption during pregnancy increases the risk of malformations, reduced intelligence and nerve damage in the child. One often hears that a glass of red wine is allowed during pregnancy. But researchers have not yet been able to define alcohol levels that are really safe. Therefore, medical professionals recommend that, to be on the safe side, you should avoid alcohol altogether during pregnancy.[15]

    Exercise during pregnancy

    If you were already exercising before you became pregnant, then you can also be physically active during pregnancy. Exercise during pregnancy can bring many great health benefits.

    What are the benefits of exercise during pregnancy?

    Experts recommend exercising for 30 minutes five times a week. This could improve back pain, and your body releases happiness hormones that reduce stress and mood swings. In addition, body cells are supplied with more oxygen, which boost metabolic processes. Exercise during pregnancy can additionally reduce the risk of pre-eclampsia.

    If you are pregnant, suitable sports include:[15]

    • Jogging, walking
    • Swimming
    • Yoga, Pilates, aqua fitness, tai chi
    • Light weight training
    Always check with your doctor whether your health permits physical activity during pregnancy. If any discomfort occurs during exercise, you should stop immediately.

    Do not exercise during pregnancy to lose a lot of weight. Losing a lot of weight during pregnancy can increase the risk of pregnancy complications.

    A healthy diet while breastfeeding

    woman breastfeeding

    Nothing connects mother and child more than breastfeeding: through physical contact, the body releases more of the happiness hormone oxytocin, which is said to strengthen the mother–child relationship. Breast milk is individually adapted to suit the baby’s nutritional needs. Up to the fourth and sixth month, breast milk contains all the important nutrients your baby needs. To ensure that neither you nor the baby suffer from nutrient deficiencies, you should also make sure you optimise your diet while breastfeeding.

    Foods to avoid during breastfeeding

    The tips we have mentioned about maintaining a healthy diet during pregnancy also apply during breastfeeding. Foods to avoid during pregnancy that we have written about should also be taken into consideration while you are breastfeeding. Here is the list of foods to avoid during breastfeeding:

    • fish high in mercury (tuna, swordfish)
    • alcohol
    • lots of caffeine (no more than two or three cups per day)

    Exercise, on the other hand, should only be started after consulting your doctor. As a rule, you can start light exercises after six to eight weeks.

    What are the benefits of breastfeeding?

    No food is as accessible and germ-free for a human being as breast milk. It not only provides vital nutrients, but also boosts the child’s immune system. Breastfeeding thus not only strengthens the mother–child bond, but it can also reduce the risk of subsequent diseases in both mother and child:[23]

    Mother

    Child

    Breast cancer

    Asthma

    Ovarian cancer

    Obesity

    Type 2 diabetes

    Type 2 diabetes

    High blood pressure

    Ear and respiratory infections

    When should I stop breastfeeding?

    According to the WHO guidelines, mothers should breastfeed their children for at least four to six months. There is nothing to stop children from breastfeeding alongside complementary food until the age of two.[31, 24, 25] However, breastfeeding mothers should not stop breastfeeding abruptly; this should be a gradual process.

    Nutrients to pay attention to when breastfeeding

    As a breastfeeding mother, you pass on many nutrients to your child through your breast milk. Therefore, your own need for some nutrients increases greatly:

    • B vitamins
    • Vitamins A, C, E
    • Iron, magnesium, zinc, selenium

    When you are breastfeeding, you need very large amounts of vitamin B12 and iodine. Discuss with your doctor whether it may be useful to take food supplements.

    In order for the mammary glands to produce enough breast milk, the body needs sufficient fluids. The German Nutrition Society recommends 3.1 litres of water per day. Your calorie requirement during pregnancy increases by 500 kilocalories during breastfeeding. In addition, you should continue to avoid raw foods and foods contaminated with heavy metals.

    Supplements while breastfeeding

    Taking nutrients in supplement form can help you reach the recommended intake amount whilst you breastfeeding your baby. Adapting to the changes of bringing a baby into the world is no mean feat, and supplements are especially a great idea if you’re struggling to maintain a balanced diet. Here is a list of supplements you could take while breastfeeding – you should discuss these with your doctor.

    • vitamin D – to decrease the risk of bone loss and even rickets[26]
    • calcium – pregnancy and breastfeeding can lead to slight bone depletion in some women
    • vitamin B12 – you should take this especially if you are vegetarian or vegan
    • omega 3 – omega-3 fatty acids are vital for brain function
    • vitamin K – newborns are usually born low in vitamin K

    Increasing milk supply for breastfeeding mothers

    You may be relieved to hear that there also various supplements you can take to promote and boost your milk supply during breastfeeding. 

    One supplement is fennel. It contains phytoestrogen, which is believed to stimulate the production of breast milk.[27] Although studies on this matter are inconclusive, fennel is generally tolerated well and is safe to consume during pregnancy.[28] Another supplement you may want to take note of if you are breastfeeding is lecithin – a fatty substance found in eggs, sunflower seeds and nuts, for example – as well as in your body itself. Some women find that this supplement helps to prevent their milk ducts from blocking, leading to painful, swollen breasts.[29]

    Diet during pregnancy and breastfeeding – at a glance

    How does pregnancy change your body?

    Within nine months, the female body undergoes multiple changes: the stomach grows, mammary glands in the breast become larger and the body produces more blood. In addition, you may feel tired, be very hungry or experience the classic morning sickness. 

    What are foods to avoid during pregnancy?

    Although there are little foods to avoid during pregnancy, pregnancy women should cut down on any foods that contain heavy metals such as lead, arsenic and mercury – such as tuna or eel. Heavy metals can be deposited in the organs and can also enter the body of the unborn child via the placenta and disrupt its development. You should not purposefully avoid certain foods unless advised to do so by your doctor, as this may increase the chances of the baby developing an allergy.

    What are the benefits of exercise during pregnancy?

    Experts recommend exercising for 30 minutes five times a week. This could back pain can improve and your body releases happiness hormones that reduce stress and mood swings. In addition, body cells are supplied with more oxygen, which boost metabolic processes. Exercise during pregnancy can additionally reduce the risk of pre-eclampsia.

    What are foods to avoid during breastfeeding?

    The tips we have mentioned about maintaining a healthy diet during pregnancy also apply during breastfeeding. Foods to avoid during pregnancy that we have written about should also be taken into consideration while you are breastfeeding.

    Sources

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    [2]        Bartels, Ä. und O’Donoghue, K. Cholesterol in pregnancy: a review of knowns and unknowns’, Obstet Med, vol. 4(4), p. 147–151, December 2011, doi: 10.1258/om.2011.110003.

    [3]        Davison, J. M. Edema in pregnancy’, Kidney Int. Suppl., vol. 59, p. S90–96, June 1997.

    [4]        Fredriksen, E. H., Harris, J, Moland, K. M. Web-based Discussion Forums on Pregnancy Complaints and Maternal Health Literacy in Norway: A Qualitative Study’, J. Med. Internet Res., vol. 18(5), p. e113, May 2016, doi: 10.2196/jmir.5270.

    [5]       Pschyrembel Online | Hyperemesis gravidarum’, available at https://www.pschyrembel.de/Hyperemesis%20gravidarum/K0A8M/doc/, accessed on 14 August 2019.

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    [7]        Stubert, J., Reister, F., Hartmann, S., Janni, W. The Risks Associated With Obesity in Pregnancy’, Dtsch Arztebl Int, vol. 115(16), p. 276–283, April 2018, doi: 10.3238/arztebl.2018.0276.

    [8]       Pschyrembel Online | Präeklampsie’, available at https://www.pschyrembel.de/Pr%C3%A4eklampsie/K0QTM/doc/, accessed on 19 Aug 2019.

    [9]        Elmadfa, I. Ernährungslehre, 3. Edition, Verlag Eugen Ulmer Stuttgart, 2015.

    [10]      Kasper, H. Ernährungsmedizin und Diätetik, 12. Edition, Urban & Fischer Verlag/Elsevier GmbH, 2014.

    [11]     Häufig gestellte Fragen (FAQ) zum Thema Salz’, 12 February 2019, available at http://www.euro.who.int/de/health-topics/disease-prevention/nutrition/news/news/2011/10/reducing-salt-intake/frequently-asked-questions-about-salt-in-the-who-european-region, 12 February 2019.

    [12]      Mao C. et al. High-salt diets during pregnancy affected fetal and offspring renal renin–angiotensin system’, J Endocrinol, vol. 218(1), p. 61–73, July 2013, doi: 10.1530/JOE-13-0139.

    [13]     Is vitamin D supplementation beneficial or harmful for women during pregnancy?’ /CD008873/PREG_vitamin-d-supplementation-beneficial-or-harmful-women-during-pregnancy, accessed on 19 August 2019.

    [14]     Pschyrembel Online | Neuralrohrdefekt’, available at https://www.pschyrembel.de/Neuralrohrdefekt/K06FG/doc/ accessed on 19 August 19 2019.

    [15]     Ernährung und Lebensstil vor und in der Schwangerschaft: Neue nationale Empfehlungen’, available at https://www.bzfe.de/inhalt/supplemente-in-der-schwangerschaft-5065.html, accessed on 11 January 2019.

    [16]     Allergien: Omega-3-Fettsäuren helfen - Haug Verlag - Naturheilverfahren’, Thieme, available at https://www.thieme.de/de/naturheilverfahren/allergien-omega-3-fettsaeuren-helfen-44428.htm, accessed on 2 January 2019.

    [17]      Miles, E. A., Calder, P. C. Can Early Omega-3 Fatty Acid Exposure Reduce Risk of Childhood Allergic Disease?’, Nutrients, vol. 9(7), July 2017, doi: 10.3390/nu9070784.

    [18]     Ciaccio, C. E., Girdhar, M. The Effect of Maternal Omega-3 Fatty Acid Supplementation on Infant Allergy’, Ann Allergy Asthma Immunol, vol. 112(3), p. 191–194, March 2014, doi: 10.1016/j.anai.2014.01.009.

    [19]      Poole, R., Kennedy, O. J., Roderick, P., Fallowfield, J. A., Hayes, P. C., Parkes, J. Coffee consumption and health: umbrella review of meta-analyses of multiple health outcomes’, BMJ, vol. 359, November 2017, doi: 10.1136/bmj.j5024.

    [20]      van der Hoeven, T., Browne, J. L., Uiterwaal, C. S. P. M., van der Ent, C. K., Grobbee, D. E., Dalmeijer, G. W. Antenatal coffee and tea consumption and the effect on birth outcome and hypertensive pregnancy disorders’, PLoS One, vol. 12(5), May 2017, doi: 10.1371/journal.pone.0177619.

    [21]      Weng, X., Odouli, R., Li, D.-K. Maternal caffeine consumption during pregnancy and the risk of miscarriage: a prospective cohort study’, Am. J. Obstet. Gynecol., vol. 198(3), p. 279.e1–8, March 2008, doi: 10.1016/j.ajog.2007.10.803.

    [22]      Hey, E. Coffee and pregnancy’, BMJ, vol. 334(7590), p. 377, February 2007, doi: 10.1136/bmj.39122.395058.80.

    [23]     Breastfeeding and the Use of Human Milk | From the American Academy of Pediatrics | Pediatrics’, available at https://pediatrics.aappublications.org/content/129/3/e827, accessed on 19 August 2019.

    [24]     Stilldauer - Empfehlung der Nationalen Stillkommission am BfR vom 1. März 2004’, p. 2.

    [25]      Schäfer, T. et al. S3-Leitlinie Allergieprävention’, Allergo J, vol. 23(6), p. 32–47, October 2014, doi: 10.1007/s15007-014-0635-4.

    [26]       Jones, W. Vitamin D and Breastfeeding’, The Breastfeeding Network, June 2020, available at https://www.breastfeedingnetwork.org.uk/vitamind/, accessed on 23 April 2021.

    [27]      ‘Fennel’, available at https://www.safeinbreastfeeding.com/fennel/, accessed on 23 April 2021

    [28]       ‘Fennel’, Drugs and Lactation Database (LactMed), 2006, available at https://www.ncbi.nlm.nih.gov/books/NBK501793/, accessed on 23 April 2021.

    [29]       Mastitis’, la leche league international, available at https://www.llli.org/breastfeeding-info/mastitis/, accessed on 23 April 2021.

    [30]       ‘Vegetarian or vegan and pregnant’, NHS, reviewed 8 August 2018, available at https://www.nhs.uk/pregnancy/keeping-well/vegetarian-or-vegan-and-pregnant/, accessed on 23 April 2021.

    [31]       ‘Breastfeeding’, World Health Organization, available at https://www.who.int/health-topics/breastfeeding#tab=tab_1, accessed on 23 April 2021.

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