Nutrition and Weight in Pregnancy

Weight gain is a normal part of pregnancy, however gaining too much weight can put you and your baby’s health at risk.

BMI is a measure of your weight in relation to your height. A high BMI over 30kg/m² predicts your risk of developing complications during pregnancy or ill health later in life.

Attempting to lose weight during pregnancy is not advised but limiting weight gain during pregnancy can be helpful. The heavier you are at your booking appointment, the less weight you should gain during your pregnancy. If your BMI is 30kg/m² or more, you should aim to gain no more than 5kg to 9kg over the course of your whole pregnancy.

BMI (kg/m2) at booking appointment	Advised weight gain during pregnancy
18.5–24.9	11.5kg to16 kg (25 to35 lbs)
25-29.9	6.8 to11.4kg (15 to 25lbs)
30 +	5 to 9kg (11 to 20lbs)

Useful tip: controlling your portion sizes will be important to limiting your weight gain.

Pregnancy Nutrition – The Essentials

Ensuring adequate intake of specific vitamins during pregnancy is essential. Please ensure you take the following:

Vitamin	Why should I take it?	Recommended dose	Dietary supplements/ recommendations
Folic Acid	Folic acid is required for the development of your baby’s organs and has been shown to reduce the risk of neural tube defects such as Spina Bifida.	400 micrograms/day   If your BMI is greater than 30kg/m2: 5mg/day	Folate rich foods: dark green leafy vegetables (e.g. spinach, Brussels sprouts and broccoli), fortified breakfast cereals, peas, beans, granary bread, nuts, citrus fruits and juices, raspberries, strawberries and blackberries. These are required for the development of healthy bones and teeth.
Calcium and Vitamin D	Calcium is needed for the development of healthy bones and teeth.   Vitamin D is essential to absorb calcium that you consume.	10 micrograms/day (equivalent to 400 international units or ‘iu’)   This should be taken throughout pregnancy and continue during breastfeeding.	It is recommended you eat three servings of dairy foods each day to ensure you get enough calcium.   Other sources of calcium include tinned fish with bones like sardines; tofu and baked beans.   Vitamin D is found in a small number of foods but we get most of our vitamin D from sunlight. If you are of Asian origin, if you always cover up all your skin when you’re outside, or if you rarely get outdoors, you may be particularly short of vitamin D.
Vitamin A (retinol)	Only needed in small quantities by your body.   High intakes during the first few weeks of pregnancy may harm your developing baby.	Supplementing with vitamin A is not recommended.	During pregnancy avoid taking supplements or eating foods that are very high in Vitamin A (retinol). This advice does not apply to supplements or foods rich in carotene, another form of Vitamin A.   Liver, liver sausage, liver pate and cod liver oil are all high in vitamin A and should be avoided during pregnancy.   However, a well-balanced diet containing milk and dairy foods, eggs, fruits and vegetables will provide you with just the right amount of vitamin A for a healthy pregnancy.

Healthy Start Vitamins: if you receive Income Support or Jobseeker’s Allowance, you’re entitled to free vitamin supplements which contain vitamin C, vitamin D and folic acid. Find out more online or from your GP. Please see www.healthystart.nhs.uk for more information.

How can I limit weight gain during pregnancy?

Iron and Vitamin C

Food group	Why do I need it?	How much should I be eating	Dietary recommendations
Starchy Foods	Energy for fuel and growth. Iron to prevent anaemia and maintaining the placenta. B vitamins to allow you to obtain energy from food and help support your pregnancy.	Include a starchy food at each meal. Approximately 1/3 of your plate.	Bread, rice, pasta, potatoes, cereals, crackers, cous cous, pitta bread etc. Wholegrain varieties are higher in fibre – will keep you fuller for longer and prevent constipation. Fortified breakfast cereals are particularly rich in iron, vitamin D and folic acid which are essential in pregnancy.
Fruit and vegetables	Vitamin C to build new tissues and help iron absorption. Rich in folic acid to prevent anaemia and neural tube defects in your baby. They are low in calories so good for filling up on when trying to manage your weight.	Try to eat a variety of fruit and vegetables and include at least 5 to 7 portions a day. Eat a variety! Different coloured fruit and vegetables contain their own combination of vitamins and minerals, so try to include a variety of colours in your diet.	1 portion = – 1 medium apple, orange, banana, pear – 2 smaller fruits (satsumas, plums etc) – 1 handful of berries, grapes, cherries – 3 tablespoons of raw/cooked vegetables – 1 small bowl of salad
Milk and dairy foods	Protein for tissue repair and growth. Calcium to maintain your bone density and to develop strong bones for your baby. Vitamin A to support your immune system and support your baby’s growth Vitamin B1 (thiamin) and B2 (riboflavin)	Aim to eat 3 portions a day. Useful tips: Limit your intake of cheese to 90g a week – even half fat cheese is still high in saturated fat. Choose instead low-fat cheese spreads or cottage cheese. Choose fat free yoghurt and fromage frais rather than thick and creamy alternatives. If you are lactose intolerant opt for lactofree milk or calcium fortified soya milk to ensure your intake of calcium is adequate.	1 portion = – 200mls or 1/3 pint of semi skimmed/ skimmed –  1 pot of fat free or diet yoghurt A matchbox sized piece of cheese (30g) Low fat varieties contain the same amount of calcium but fewer calories.
Meat, fish, eggs, beans and alternatives	Protein for tissue and organ growth. Iron to prevent anaemia and maintaining the placenta. Rich in folic acid to prevent anaemia and neural tube defects in your baby.	Aim to include at least 2 portions of protein a day. This should include 2 portions of fish a week, one of which should be oily. Useful tips: Try to avoid: Fatty and processed meats e.g. sausages/salami/pies; any visible fat and skins; frying and adding excessive amounts of oil or butter. Healthier option: Extra lean mincemeat; Chicken/ turkey/fish; trim off any visible fat and remove the skin; steam, poach, bake, grill instead.	Beef, pork, lamb, ham, chicken, turkey, fish, eggs, soya, lentil, tofu, Quorn, nuts, texture modified protein. Oily fish (e.g. mackerel, sardines) provides vitamin D to maintain bone density and provide essential omega 3 fats which maintain heart health and are vital for the baby’s developing nervous system and retina.

• Iron is essential for healthy blood. If you do not have enough iron you may become anaemic and feel tired.

• Meat, sardines and pilchards are the richest sources of iron, so if you are vegetarian you may need extra advice about iron in your diet. Other sources of iron are pulses, fortified breakfast cereals, wholemeal bread, nuts, dried fruit and dark green leafy vegetables and Ovaltine.

• Eating (or drinking) foods which are good sources of Vitamin C with iron rich foods helps the iron to be used by the body e.g. grapefruit or orange juice with breakfast cereal or toast. Good sources of Vitamin C include most fruits, fruit juices and vegetables. Include some with each meal.

Foods and drinks high in fat and/or sugar

These foods and drinks provide us with very little nutrition but are high in calories and therefore can often lead to weight gain.

If you do want a treat, limit your portion size and choose a low-fat and low sugar alternative instead.

Useful tips

Try to avoid: added sugar; butter, oils, and other fats; fizzy drinks and energy drinks.

Healthier option: use sweetener in drinks, food and cooking; low fat spread and spray oils; ‘diet’ or ‘sugar free’ alternatives.

Nourishing and tasty snacks

If you get hungry between meals, don’t eat snacks that are high in fat and/or sugar, such as sweets, biscuits, crisps or chocolate. Instead, choose from the following nutritious snacks:

• Wholemeal sandwiches or pitta bread filled with grated low-fat cheese, lean ham, salmon or sardines and salad.
• Salad vegetables, such as carrot, celery or cucumber.
• Low-fat yoghurt or fromage frais.
• Hummus with bread or vegetable sticks.
• Ready-to-eat apricots, figs or prunes.
• Vegetable and bean soups.
• Unsweetened breakfast cereals, or porridge, with milk.
• Milky drinks or unsweetened fruit juices.
• Fresh fruit.
• Baked beans on wholemeal toast or a baked potato.

Food Safety

• Wash fruit, vegetables and salad to remove all traces of soil that may contain toxoplasma, a parasite that can be harmful to your unborn baby.
• Avoid unpasteurised cheeses and blue vein cheese (includes Camembert, Brie, Goats cheese) during pregnancy as these can contain a bacteria which could harm your baby.
• Ensure all meat and eggs are well cooked.
• Avoid tuna, marlin, shark, and swordfish in the first trimester as these can contain heavy metals and pollutants that can be harmful to your baby when pregnant. Limit tuna to 2 steaks/ 4 tins per week for the remainder of pregnancy.
• Limit caffeine to no more than 200mg per day.

The benefits for you include:

• Improved well-being and energy levels.
• A stronger body, with better posture.
• Decreased risk of gestational diabetes and preeclampsia.
• Improved pregnancy weight management.
• Reduced levels of back and pelvic pain.
• Reduced stress levels and better sleep.
• Better pelvic floor muscle function – this means no problems with continence.
• Decrease risk of varicose veins.

There are also benefits for birth and beyond:

• Some evidence has shown that exercise can decrease the length of labour and decrease risk of complications during birth.
• Improved cardiovascular fitness.
• Facilitated weight loss.
• Raised mood, reduced anxiety and depression.
• Increased energy.

Exercise can be a great way to meet other expectant mums and socialise at the same time!

How much exercise should I be doing?

It is recommended by the American College of Obstetricians and Gynaecologists that pregnant women should aim to do 30 minutes or more of low to moderate intensity exercise on most, if not all, days of the week. This includes walking and swimming. If you were previously very sedentary, begin with 15 minutes 3 times a week and increase gradually.

Conditions requiring medical supervision while undertaking exercise in pregnancy:

Cardiac disease, persistent bleeding in the second and third trimesters, pre-eclampsia or pregnancy-induced hypertension, preterm labour (previous/present), multiple gestations, body mass index greater than 40, poorly controlled diabetes mellitus, anaemia.

You don’t have to join the gym, just limit the amount of time that you are sat still. As always, start with small, achievable changes. For example:

• Take the stairs instead of the lift.
• Park your car at the far end of the car park and walk.
• Get off the bus one stop earlier and walk.
• Go for a brisk walk with friends, children or pets to the park.

Other useful websites:

www.healthystart.nhs.uk

www.readysteadybaby.org.uk

Contacts

Perinatal Nutrition Team

020 8934 3433