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Pregnancy Nutrition - Trimester 2


During the course of pregnancy, a remarkable series of physiologic changes occur, aimed at preserving maternal homeostasis while at the same time providing for fetal growth and development.


Trimester 2 in particular denotes a time of rapid growth and development in which additional nutritional intake is required.


Nutrition in pregnancy


It has also been shown that correcting nutritional deficiencies during pregnancy can reduce the chance of pregnancy and birth related complications making the experience of pregnancy more enjoyable for the mother and unborn child.


Outlined below are nutrients of particular importance to a pregnant woman in trimester two and advice on how much and what type is required.


Protein


During pregnancy a woman experiences rapid growth and development requiring adequate dietary protein to keep up with protein deposition in maternal and fetal tissue demands and ensure a healthy outcome.


The current RDA recommendations of approx. 1gm per kg apply to all stages of pregnancy. So if you weight 70kg, eat 70gm of protein per day. However if you are under or over weight this may not be as accurate a measure for you.


We recommend 75gm of protein in 3 divided doses of 25gm per main meal.


Protein containing foods


The best sources of protein are a mix between heme, non-heme and vegan. Look at our guide here for more information on what 25gm of protein looks like.


Tips

- Avoid eating in excess of 30gm of protein from meat sources daily

- Incorporate 2 eggs daily as this will also account towards your choline intake

- Avoid eating more than 30gm of protein from legumes daily as this can cause gastrointestinal upset


Calcium


Calcium ingestion is associated with a reduced risk of pregnancy-induced hypertension known as pre-eclampsia, protection against low-birthweight newborns, post-partum haemorrhage, supports fetal skeletal growth and a reduced risk of maternal bone density depletion.


The bulk of fetal skeletal growth takes place from trimester two onward, with maximal calcium accretion occurring during the third trimester. Amazingly our body adapts to the increased need for calcium by up-regulating it's absorption from 57% during the second trimester to 72% during the third trimester. However we still do need to increase our daily intake as while absorption goes up so does calcium excretion and maternal & fetal skeletal needs.


A pregnant woman requires 1000mg of calcium per day.


Calcium containing foods


Goats dairy - preferred

Cows dairy - organic only

Sardines - bones kept in

Tahini, almonds, chia seeds

Kale, broccoli, watercress


Tips

- Ensure adequate vitamin D and magnesium status

- Vegans are encouraged to supplement with 500mg to 1000mg per day

- Take calcium away from iron supplementation to prevent it's blocking effect on iron absorption


Choline


Higher choline exposure in utero improves fetal memory and reaction time. Choline has also been shown to improve the release of cortisol‐regulating genes when the hypothalamic-pituitary-adrenal axis (HPA) is triggered showing an improved stress-response.


Dosage recommendations are between 480-920mg daily.


Some studies suggesting intake to increase in trimester 3 however we recommend from trimester 2 with a dosage of 600mg daily.

Choline containing foods


- Eggs

- Lecithin

- Peanuts

- Meat (red, chicken, fish)

- Cruciferous vegetables


Tips

- We recommend 2 eggs daily which provide 300mg choline

- Choose sunflower lecithin over soy lecithin


Iron


Globally, over 40% of pregnant women are anemic, an extraordinary rate that needs to be mitigated through appropriate dietary and supplemental intake. However excess iron intake can be damaging and cause oxidation that damage DNA, proteins, lipids, other cellular molecules and stem cells. All women should be checked for iron deficiency before falling pregnant or as soon as they conceive to determine their needs during pregnancy.


During pregnancy the need for iron doubles by the second trimester in order for us to be able make enough maternal and fetal haemoglobin. Amazingly a pregnant woman's blood volume will increase by 50% which equates to more than 1L of extra blood circulating. Low iron stores (ferritin) in pregnancy can increase the chance of low birth weight, preterm delivery, pre-eclampsea and bleeding. Affected mothers frequently experience breathing difficulties, fainting, tiredness, palpitations, and sleep difficulties.

We recommend 48mg of iron in a iron deficient pregnant woman and 24mg of iron in a iron sufficient pregnant woman.


Iron containing foods

- Beef, pork - red meat is the best source

- Mussels

- Oats

- Chanterelle mushrooms

- Spinach

- Pistachios

- Millet


(This is a good resource to follow)


Tips

- Increase your concurrent intake of foods that will improve iron absorption - such as animal protein and vitamin C-rich fruits and vegetables (e.g. steak and broccoli).

- Decrease your concurrent intake of iron inhibitors – such as tea, coffee, red wine, dairy and calcium supplementation. Separate them from meals by 1 hour.

- Studies show that the probiotic Lactobacillus plantarum 299v can improve iron absorption by up to 50%.


Iodine


Pregnancy induces several major changes to thyroid physiology. From early pregnancy thyroid hormone production increases by 50% (partly due to the increase in estrogen and hCG) putting a demand on thyroid supporting nutrients such as iodine. Iodine intake is also important during pregnancy due to the increase in renal excretion.


As a woman steps into her second trimester the fetus starts a process called thyroidogenesis and by the 20th week the fetus is able to uptake iodine to start producing thyroid hormone.


Severe dietary maternal iodine deficiency in pregnancy has the potential to cause both maternal and fetal hypothyroidism. Severe iodine deficiency is associated with spontaneous abortion, prematurity, stillbirth and mental retardation.


Pregnant women require 150-250mcg daily.


Iodine containing foods


- Seaweed

- Fish

- Whey

- Goats milk


Tips

- We recommend testing your urinary iodine before supplementation to determine your own personal needs

- Work with a naturopath or specialist if you have graves/hashimoto's during pregnancy

- Smoking during pregnancy will affect your thyroid function

- Iodine content of seaweed can vary significantly, we recommend only consuming a modest amount


Adequate nutritional intake across each stage of pregnancy is important not only in optimising pregnancy, birth and neonate health and outcomes, but for the prevention of disease and discomfort for the mother.


Author

Jennifer Ward, Adv dip Nat, BCom Econ, competing Masters Repro Med

Jennifer is a qualified naturopath with a focus on fertility, pregnancy, hormonal imbalances.

Learn more about Jennifer here

Book a session with Jennifer here

If you have questions relating to your pregnancy or need further guidance on supplementation and nutritional testing please speak with one of our qualified practitioners.


For speaking enquiries on this topic get in touch at hello@halsahealth.com.au


Reference

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4942872/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561751/

https://www.ncbi.nlm.nih.gov/pubmed/29217669

https://www.ncbi.nlm.nih.gov/pubmed/22549509

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375689/

https://www.ncbi.nlm.nih.gov/books/NBK279618/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134395/

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