Planning for your pregnancy |13 April 2018

According to the Nutrition Unit at the Ministry of Health, the preconception period (three months prior to pregnancy) is the time to make plans and make changes that can help boost fertility, reduce problems during pregnancy, reduce the risk of harm to the baby and assist in recovery from birth.

Pre-conception nutrition is a vital part of preparing for pregnancy, however, many women do not eat a well-balanced diet before pregnancy and hence may not have the proper nutritional status to meet the demands of their pregnancy.

In an attempt to further sensitise women who are planning for a pregnancy, the Nutrition Unit shares its knowledge and advice with regards to pre-pregnancy nutrition.

Eat a healthy balanced diet

As the nutritional requirement increases during pregnancy, it is very important that women planning for pregnancy consume a well-balanced, nutritious diet and continue with it throughout the three trimesters.

The Seychelles Food Guide categorises foods into 5 groups to help you consume a healthy diet by encouraging a variety of healthy foods with different nutrients.

A growing baby needs these nutrients right from conception or the start of the pregnancy:

Folic acid

Folic acid is a type of B vitamin which helps your body produce and maintain new cells, and also helps prevent changes to deoxyribonucleic acid (DNA). Folic acid is normally found in foods such as some green leafy vegetables, e.g. spinach and broccoli, nuts, beans, lentils, peas, beetroots, citrus fruits, e.g. oranges, avocado and fortified breakfast cereals. However, the amount of folic acid obtained from food is not enough, especially during pregnancy.

When you are pregnant, you need a good supply of folic acid to help with the development of the baby.  Ideally, it is better to take folic acid supplement tablets from at least one month before you get pregnant; continue taking them until at least the end of the 12th week of pregnancy. If the pregnancy is unplanned then start taking folic acid tablets as soon as you know that you are pregnant. This applies even if you are healthy and have a good diet.

Folic acid helps to provide the best health outcomes for your baby when it is growing. If you take folic acid tablets daily and in early pregnancy, you reduce the risk of having a baby born with brain and spinal cord problems called neural tube defects.  The most common neural tube defect is spina bifida which can lead to varying degrees of paralysis, incontinence and sometimes, intellectual disability.

According to the World Health Organisation (WHO) recommendation during pre-pregnancy women should take 400 microgrammes (0.4 mg) of folic acid per day. If you have a higher risk of having a child with a spinal cord problem, then the dose is 5 mg a day. You need a prescription for this higher dose - that is, if you:

• Have had a previously affected pregnancy.
• Or your partner have (or have a family with) a spinal cord defect.
• Are taking medication for epilepsy.
• Are obese (especially if your body mass index (BMI) is 30 or more).
• Have coeliac disease or diabetes.
• Have sickle cell anaemia, or thalassaemia.

Iron

Many women have low iron stores as a result of monthly menstruation and diets that are low in iron. Building iron stores helps prepare a mother's body for the needs of the fetus during pregnancy. The body uses iron to make extra blood (hemoglobin) for the mother and the baby during pregnancy. Iron also helps move oxygen from the mother’s lungs to the rest of the body and to the baby's. Getting enough iron can prevent a condition of too few red blood cells that can make you feel tired, called iron deficiency anemia. Good sources of iron include the following:

• Meats, e.g. beef, pork, lamb, liver and other organ meats.
• Poultry, e.g. chicken, duck and turkey (especially dark meat).
• Fish and shellfish, including sardines, fresh tuna, mackerel, bonito and ‘karang’.
• Leafy greens, e.g. broccoli, spinach and moringa leaves (bred mouroum).
• Legumes, e.g. lentils, beans and green peas. 
• Whole-grain breads and iron-enriched cereals.

Calcium

Preparing for pregnancy includes building healthy bones. If there is not enough calcium in the pregnancy diet, the fetus may draw calcium from the mother's bones, which can put women at risk for osteoporosis later in life.

According to WHO, the recommended calcium intake for women is 1,000 milligrammes. Three servings (NB: One serving of milk and milk product is equivalent to: 1 cup of milk (250ml), 1 small piece of hard and semi-hard cheese (40g) and 1 small tub of yoghurt (150ml) of milk or other dairy products such as cheese and yoghurt per day provide about 1,000 milligrammes of calcium. Other sources include dark green leafy vegetables such as moringa leaves (bred mouroum) and spinach, almond, sardines and fortified foods such as some cereals.

Alcohol

There is no safe amount of alcohol to drink during pregnancy. Alcohol can affect the health and development of an unborn baby for life. In the first three months of pregnancy, drinking alcohol makes you more likely to have a miscarriage. In these early stages, the baby is developing rapidly and alcohol can cause abnormalities. If you are pregnant or planning a pregnancy, it is wise and safer to avoid alcohol intake or stop consuming it.

Smoking

Quitting smoking before pregnancy is the single, most effective means of protecting your baby and yourself from the development of serious complications during pregnancy. Smoking can reduce your chances of getting pregnant, hence, by quitting smoking you are more likely to conceive naturally and without delay.

Smoking when you are pregnant gives a higher risk of:

• Having a miscarriage.
• Having a pregnancy which develops outside the uterus (ectopic pregnancy).
• Slow growth of the baby leading to a low birth weight.
• Premature labour.
• Bleeding towards the end of pregnancy due to the placenta coming away from the wall of the womb early (placental abruption). The placenta is the tissue which supplies the nutrients the baby needs, so this may harm the baby.
• Stillbirth.
• Your baby having abnormalities such as a cleft lip or palate.

Even after birth, children of smoking parents have an increased risk of:

• Chest infections.
• Asthma.
• Cot death or Crib death (sudden infant death syndrome).
• Behavioural problems such as attention deficit hyperactivity disorder (ADHD).

Overweight and obesity

Your pre-pregnancy weight directly influences your baby's birth weight. If you are obese or overweight, try to lose some weight before becoming pregnant. Women who are overweight or obese have a greater risk of:

• Having difficulty in conceiving.
• Diabetes in pregnancy.
• High blood pressure in pregnancy.
• Blood clots in pregnancy.
• Needing a caesarean section.
• Premature deliveries.
• Babies with abnormalities such as spina bifida.

The more overweight you are, the greater the risks. Being underweight is also associated with problems in becoming pregnant and complications in pregnancy. If your BMI is between 18.5 and 24.9, you have an ideal body weight in preparation for pregnancy.

Supplements

Folic acid supplements are recommended for all pregnant women. Otherwise, no other supplements are routinely advised if you have a normal diet. However, some women have low iron stores which put them at risk of becoming anaemic during pregnancy; the routine blood tests that are done during pregnancy will detect anaemia and the need for iron supplements.

Medical conditions

Diabetes

If you have diabetes, it is extremely important to see your doctor before you become pregnant. This is because good control of your sugar levels, both before pregnancy and during early pregnancy, can reduce various risks.

Diabetes increases your risk of miscarriage and stillbirth and increases the risk that your baby will be born with abnormalities or become seriously ill after birth. However, good control of sugar levels starting before pregnancy can reduce these risks. Your medication (and/or insulin) may be changed, so it is better to consult with your doctor.

High blood pressure (hypertension)

If you are on medication for high blood pressure, ideally see your doctor before becoming pregnant. There are some blood pressure tablets which should not be taken if you are pregnant. Your doctor will advise if you need to change and may refer you to a specialist for further advice.

Most pregnancies go well and without any major problems. However, it is wise to reduce any risks as much as possible and therefore, it is advisable to consider the mentioned points before becoming pregnant and as soon as you realise you are pregnant.

Further information for women who are planning for pregnancy or are pregnant, or for weight loss contact the Nutrition Unit, Ministry of Health on 4388062/4388168.

For help to stop smoking, contact UPCCD, Ministry of Health on 4388272/8507.