A mother’s nutrition before conception and during pregnancy has significant consequences for the health of the unborn child and greatly affects the child’s health after birth and throughout their life. There is a growing body of scientific research examining the impact of maternal nutrition during pregnancy on the risk of developing diseases that appear in childhood and later in adulthood.

It appears that the risk of heart disease, diabetes, hypertension, and many other conditions can be programmed by inadequate nutrient supply during pregnancy and infancy. It is well known that pregnant women with good nutritional status experience fewer spontaneous miscarriages, lower rates of anemia, less general physical weakness, and fewer of the common discomforts of pregnancy. Additionally, their children are more likely to grow and develop properly.

By adopting proper eating habits and a healthy lifestyle, we not only protect our own health but also lay the foundation for our children’s future health.

Why is it important to monitor body weight before and during pregnancy?

During pregnancy, the body undergoes many changes. The most visible of these is certainly weight gain, which depends on many factors, including body weight and body mass index (BMI) before pregnancy.

Most of the weight gained during pregnancy is distributed to the growth and development of the placenta, increased size of the uterus and breasts, blood volume, and the newborn itself, which weighs on average 3.4 kg. There is also an increase in body fat, which provides the energy needed for childbirth and breastfeeding. Additionally, digestive mobility decreases, which can cause digestive discomfort during pregnancy.

A woman’s body weight before conception and her weight gain during pregnancy significantly affect fetal growth. Undernourished women are at higher risk of premature birth and neonatal death. They are also more likely to give birth to babies with low birth weight, especially if they fail to gain the necessary weight during pregnancy.

Obesity also carries risks, such as an increased chance of preeclampsia, gestational diabetes, hypertension, the likelihood of fetal neural tube defects and macrosomia (birth weight over 4 kg), as well as delivery by cesarean section.

Most of these negative outcomes can be avoided if ideal body weight is achieved before conception and maintained during pregnancy through proper nutrition.

If a pregnant woman does not have appropriate prenatal nutritional supervision, her weight can increase by as much as 35 kg instead of the usual 12 kg.

Let’s assume that the baby weighs around 3.4 kg. This accounts for part of the weight gain during pregnancy. But what about the rest of the weight?

An approximate distribution of weight gain during pregnancy is shown in the following table:

Recommendations for Total Weight Gain Depend on Pre-Pregnancy Body Mass Index (Calculate your BMI here)The lower the BMI, the higher the recommended weight gain. Since every woman and every pregnancy is unique, it’s important to keep in mind that these recommendations are only general guidelines. Individual care and monitoring by a qualified healthcare provider are essential.

In addition to total weight gain, the pattern of weight gain over time is equally important. Therefore, it is essential to define a target weight gain from the very beginning of pregnancy and to closely monitor the expectant mother’s progress.

During the first trimester, gastrointestinal symptoms such as nausea and vomiting are common, so it’s normal for body weight to remain unchanged or for slight weight loss to occur. Nevertheless, a weight gain of 1 to 3.5 kg is considered desirable during this period. In the second and third trimesters, women with a normal pre-pregnancy weight should aim for an average weight gain of approximately 0.5 kg per week, while overweight or obese women should gain weight more gradually, at about 0.3 kg per week.

Nutrition during pregnancy

From conception to birth, the growth and development of the fetus depend on the substances the mother takes in through food, as well as from other sources.

First and foremost, the body should be cleared of harmful substances such as alcohol, nicotine, pesticide residues, and toxic metals to be properly prepared for pregnancy and lactation.

Since cells divide rapidly and organs develop during pregnancy, adequate nutrient intake is essential for the proper growth and development of the fetus. In addition to supporting fetal development, nutrition is also extremely important for the mother, in order to prevent deficiencies of essential vitamins and minerals needed to maintain her health during pregnancy and breastfeeding.

During pregnancy, the need for certain nutrients increases, making them key (or critical) for the healthy growth and development of the baby, as well as for the well-being of the mother. Critical nutrients include folic acid, vitamin B12, vitamin C, vitamin D, vitamin A, omega-3 fatty acids (especially DHA), and minerals such as calcium, zinc, magnesium, iron, and iodine.

If dietary intake alone is not sufficient to meet the needs for the above-mentioned nutrients, it is recommended to use supplements, but only after consulting with a doctor, pharmacist, and/or nutritionist.

Although the requirements for certain nutrients increase during pregnancy, the general principles of planning a diverse and balanced diet still apply to pregnant women. It’s important to remember that there are no perfect foods that can meet all the nutritional needs required for a healthy pregnancy. Therefore, variety and careful dietary planning are essential to achieve the recommended energy intake and to meet the needs for proteins, fats, vitamins, minerals, and many other biologically active substances from food.

The diet before and during pregnancy should be rich in high-quality and minimally processed foods such as vegetables, especially dark green leafy vegetables, fruits, whole grains, legumes, lean meat, eggs, fish, and dairy products. Fat sources should be of high quality, rich in unsaturated fatty acids, such as olive oil, pumpkin seed oil, seeds, nuts, fatty fish, and poultry meat.

It is important to choose foods from all six food groups daily in adequate amounts:

• Grains and grain products
• Vegetables and fruits
• Nuts and seeds
• Milk and dairy products
• Fish, eggs, and meat
• Fats and oils

During pregnancy, adequate fluid intake is also especially important. It is recommended to drink 8 to 12 glasses of water and other fluids such as natural pasteurized juices, unsweetened herbal teas, soups, and milk.

What should pregnant women avoid eating?

Raw food is a much more common source of infection than cooked food, so raw meat, fish, and eggs should be avoided in a pregnancy diet. Dairy products made from unpasteurized milk can cause listeriosis, an infection caused by the bacterium Listeria monocytogenes, which increases the risk of miscarriage, preterm birth, or stillbirth. For this reason, it is also advised to avoid soft and semi-soft cheeses such as feta, brie, camembert, gorgonzola, and roquefort, as well as unpasteurized juices and processed meats like sausages and salami. However, pasteurization destroys this bacterium, so soft cheeses made from pasteurized milk, such as gouda, mozzarella, cream cheese, and cottage cheese, are considered safe to consume during pregnancy.

During pregnancy, I’m not eating for two!

The additional energy needed during pregnancy supports the metabolic demands of pregnancy itself and fetal development. The recommended daily calorie intake varies depending on individual differences in energy expenditure.

Energy needs increase during pregnancy for two main reasons: increased metabolic activity of all organs and tissues, and protein sparing. During pregnancy, proteins are used primarily for intensive tissue building rather than as an energy source.

Due to increased hormone secretion, including thyroxine, adrenal cortex hormones, and sex hormones, the basal metabolic rate of a pregnant woman increases by about 15% in the second half of pregnancy, which is why she often feels warmer than usual. Additionally, because of the extra weight she carries, more energy is expended for muscle activity than normal.

Energy needs in the first trimester remain the same as before conception, unless the woman enters pregnancy with depleted energy stores. In such cases, an additional 300 kcal per day is recommended throughout the entire pregnancy.

In the second trimester, pregnant women need to ensure an additional 300 kcal per day compared to before conception.

How much is 300 kcal?

In the third trimester, energy needs increase by an additional 100 kcal, which means that compared to pre-pregnancy needs, total energy requirements are about 400 kcal higher.

Nutritional guidelines for overweight and obese pregnant women

Obesity during pregnancy can increase the risk of various health issues and complications. However, it’s important to know that you can improve your condition through lifestyle and dietary changes.

1. Diet Quality

Include as much variety of vegetables and fruits as possible (especially non-starchy vegetables and water-rich fruits). Focus on foods rich in vitamins, minerals, and phytonutrients.

2. Do not attempt weight loss

Pregnancy is definitely not the right time to lose weight. Weight loss can release harmful substances stored in fat tissue into the bloodstream. Both you and your baby need a diverse and balanced diet to meet the nutritional needs for fetal growth and development and to maintain your own health. Work with your doctor to monitor weight gain and ensure it remains within healthy limits.

3. Supplementation

Due to increased body weight, additional supplementation may be required (for example folic acid and vitamin B12).

4. Medical nutrition therapy (diet therapy)

One potential consequence of obesity during pregnancy is gestational diabetes. Once diagnosed, it is essential to implement appropriate medical nutrition therapy.

Vitamin and mineral supplementation during pregnancy

During pregnancy, the need for almost all vitamins and minerals increases.

Among vitamins, the greatest increase in demand is for B vitamins, especially folic acid (B9). Among minerals, the most significant increases are for iron (Fe) and zinc (Zn).

Healthy women who eat a balanced diet generally do not need multivitamin-mineral (MVM) supplementation during pregnancy.

However, since it is difficult to assess the full dietary habits and nutritional status of pregnant women, such supplementation is routinely prescribed to all pregnant women. Certain groups of women are at higher risk of vitamin and mineral deficiencies, including: those who use tobacco, alcohol, or drugs, those with pre-existing anemia, women with multiple pregnancies and vegans or those following alternative diets

Prenatal supplements typically contain higher levels of folate, iron, and calcium compared to standard multivitamin-mineral supplements. Taking prenatal supplements can reduce the risk of preterm birth, low birth weight, and congenital defects.

Practical tips for supplementation

If you are taking both a multivitamin-mineral supplement and calcium, do not take them at the same time, as calcium competes for absorption with many other minerals. Take the multivitamin-mineral supplement in the morning, and calcium in the evening, ideally before bed, to ensure optimal utilization.

To increase iron absorption from supplements, take it with vitamin C in supplement form. For a significant effect, vitamin C should be present in a 7:1 ratio to iron, because the absorption dynamics from supplements are different from those in food. Many supplements that contain both iron and vitamin C do not provide enough vitamin C to significantly enhance iron absorption.

Dietary challenges during pregnancy

1. Morning Sickness and Vomiting

Morning sickness affects 50–90% of all pregnant women during the first trimester and usually subsides after the 17th week of pregnancy. Frequent and excessive vomiting may lead to hospitalization, especially if it causes dehydration, acidosis, or significant weight loss.

Hormonal changes early in pregnancy are responsible for increased sensitivity to certain foods as well as changes in smell and food texture perception.

Small dietary adjustments can help alleviate morning sickness. Eating small, frequent, dry meals that include easily digestible carbohydrates helps some women, while others find relief with protein-rich foods.

2. Gastroesophageal Reflux

Gastroesophageal reflux is common in the later stages of pregnancy, often occurring at night. In most cases, it results from the increased pressure of the uterus on the intestines and the relaxation of the esophageal sphincter, allowing stomach contents to flow back into the esophagus. Pregnant women are advised to eat smaller, more frequent meals and to stay upright for about an hour after eating.

3. Constipation

Constipation affects about 11–44% of pregnant women. It can reduce quality of life, as well as psychological and social well-being, and increases the risk of other complications, such as hemorrhoids.

Constipation occurs due to hormonal changes in the gastrointestinal system during pregnancy, mechanical pressure from the growing fetus, decreased levels of progesterone, which reduces muscle contractility and slows intestinal transit time, as well as reduced physical activity, inadequate fluid intake, and iron supplementation.

Non-pharmacological measures that can positively affect digestion include dietary changes—increased intake of fiber-rich vegetables and fruits, higher fluid intake (about 2 liters per day), and regular physical activity (if possible).

Among dietary supplements and pharmacological options, supplementation with functional fibers may be helpful.

During pregnancy, the use of certain laxative agents is allowed, such as: bulk-forming agents (fiber-based), osmotic laxatives, only if these do not provide relief should stimulant laxatives which affect intestinal motility, be used, and even then, with caution.

Conclusion

A healthy diet is one of the prerequisites for a healthy pregnancy without complications. Achieving and maintaining an adequate nutritional status before and during pregnancy is extremely important for both the mother and the newborn. Nutrition during pregnancy should be balanced and varied, rich in nutritious foods to ensure adequate fetal growth and development, as well as to preserve the health of the expectant mother. Since every woman and every pregnancy is unique, it is important to remember that these recommendations are only general guidelines and that an individual approach from both the attending physician and nutritionist is necessary.

Check if your diet is adequate for the pregnancy period through the following questionnaire.

*Association of women affected by cancer EVERYTHING for HER created the Centre for psychological help for women affected by cancer. Through educational workshops as well as individual and group work with users, dietary topics take a significant place which is why the centre for diet counseling has been formed so that affected women can receive advice from a nutritionist about an individual diet system, adjusted to personal needs and possibilities.