Some tips for proper diet during pregnancy

• Regarding the various complaints that can be faced during pregnancy, what are some remedies for nausea and other symptoms? 

1. Constipation: Progesterone can lead to a decrease in the tone of intestinal muscles and thus slow down peristalsis (intestinal contractions) inducing constipation. This is why it is necessary to pay attention to the diet, which should be rich in fibre and water, and to exercise regularly during the week;
2. Nausea and vomiting: it often happens that a woman in the first few weeks of pregnancy experiences nausea and/or vomiting, which are very unpleasant but usually pass by 16-20 weeks of pregnancy. Often, due to nausea, many mothers-to-be find themselves skipping whole meals or breakfasts: in this case it may be helpful to have recourse to ginger, fresh or candied or even boiled in water and drunk hot or cold, depending on taste, or to munch on low-fat crackers or other crunchy, dry foods, wait for the nausea to subside and proceed with small, frequent meals.
3. Reflux: Reflux in pregnancy is a common complaint and changing your diet can reduce your symptoms. It is important to eliminate coffee but also tea, cola drinks and energy drinks containing caffeine. Eliminating spicy foods from the diet and reducing high-fat foods can reduce reflux. I would also advise you to maintain an upright position after meals and slightly elevated during sleep, and not to go to bed immediately after eating dinner.

• What foods should women choose for a healthy, varied and nutritious diet during pregnancy and why? 

Let's dispel a false myth: a pregnant woman does not have to "eat for two", as some grandmothers used to say, and perhaps still do, but rather she should eat twice as well! The indications for a healthy diet in pregnancy are actually very similar to those for non-pregnant women, with a few exceptions due to the fact that the slightly higher calorie requirements of the expectant woman are easily met with small, healthy snacks (dried fruit, fruit, crackers, etc.).

The pregnant woman's diet will also require some extra attention in terms of quality, especially in relation to protein, type of fat and certain vitamins and minerals. The main recommendation is a diet based on the principles of the Mediterranean Diet, which includes

1. a prevalent consumption of foods of vegetable origin: vegetables and fruit, complex carbohydrates, preferably wholegrain (bread, rice, pasta...), pulses (beans, chickpeas, lentils, peas) and dried fruit (walnuts, hazelnuts, almonds, etc.);
2. limited consumption of foods of animal origin such as meat, cheese and dairy products such as milk and yoghurt, eggs and fish, the latter being preferred over other animal sources for its contribution of 'good' fatty acids, omega 3 (DHA);
3. limit the simple sugars contained in sweets, drinks and packaged products. Always check the food label: prefer products with more fibre and less simple sugars and saturated fats;

Among the vitamins and minerals, pregnancy results in much higher requirements for calcium because 200mg is needed daily for the growth of the fetus' skeleton and if the pregnant woman does not get enough from her diet, it will be taken from her bones. Iron is another critical nutrient, whose needs are almost double that of the adult woman, so supplementation may be necessary. Some vitamins, such as B1, B2, B12 and vitamin A, are particularly important. It is therefore necessary to enrich the habitual diet with calcium-rich foods such as milk, yoghurt, or certain vegetables (such as broccoli, cabbage and other brassicas), certain fish (anchovies, mackerel), consume a wide variety of fruit and vegetables, favouring those coloured yellow-orange and dark green broad-leafed vegetables. I would remind you that water can also be a good source of calcium... so watch the label!

• What foods should be avoided during pregnancy and why?

During pregnancy it is advisable to pay attention to the way certain foods are cooked. In addition to this, common health and hygiene precautions should also be remembered (such as making sure to wash fruit, vegetables and aromatic herbs well if eaten raw, protecting food from contact with insects and washing your hands very well before eating or cooking), it is a question of paying more attention to behaviour that is valid for everyone, but which in pregnancy can avoid high-risk situations.

Because of their specific characteristics, some foods must be eaten with special care, as they are possible vehicles for pathogens (Listeria monocytogenes and Toxoplasma gondii) responsible for pathologies affecting the foetus and others responsible for food infections or toxins. It is therefore sufficient to adopt some simple but important rules to consume food safely (and with peace of mind):

1. Raw milk should only be consumed after boiling;
2. Eggs should only be eaten after cooking (the yolk must be curdled);
3. Foods such as raw or undercooked meat (including poultry and game), fresh sausages and salami should only be eaten after thorough cooking (the pink colour must disappear), as should fish (which must be well cooked);
4. Ready-to-eat smoked fish products and short-aged, soft or semi-soft cheeses with mould should be avoided;
5. Vegetables should only be eaten after thorough washing, as should fruit, which should be well washed (and preferably peeled).

In addition, during pregnancy it is good to remember that there are also indications to follow for the consumption of large fish: large fish which may contain a high concentration of methyl-mercury are tuna (consumption should be limited to no more than two medium-sized tins or one portion of fresh tuna per week), swordfish and shark.

Finally, let's talk about coffee: coffee consumption during pregnancy is always very confusing... let's clarify!

Coffee can be consumed during pregnancy, but care must be taken not to exaggerate so as not to expose the foetus to excessive quantities of the nervine substances contained in this drink. Excessive exposure to caffeine during pregnancy can lead to foetal abnormalities, so it is recommended not to exceed 200mg of caffeine per day (half the adult recommendation). A cup of espresso contains between 70 and 120mg, and it should be remembered that caffeine is contained not only in coffee but also in other drinks (tea, cola) and some foods (chocolate). It is therefore better not to exceed 2 coffees a day during pregnancy and to use decaffeinated coffee if you feel the need for more.

• Are you in favour of taking supplements during pregnancy? Why?

Vitamin and mineral supplementation may be necessary during pregnancy and can and should be considered, especially in cases where energy intake needs to be limited or where we are already starting from critical values of certain vitamins. Supplementation must be supported by a diet that is as appropriate as possible to the needs of the mother-to-be. However, it is also advisable for supplementation to be determined on the basis of an individual clinical assessment which, in addition to the doctor's prescription, also involves constant monitoring.

• Tell us about gestational diabetes, how can it be addressed and treated?

Gestational diabetes is an alteration in glucose regulation, which is diagnosed during pregnancy and generally regresses after delivery, but can recur years later as type 2 diabetes (also called adult diabetes) and is diagnosed following appropriate diagnostic tests.

In the majority of women, gestational diabetes can be controlled with diet and physical activity: complete meals with a low glycaemic load (it is therefore advisable to avoid eating just one plate of carbohydrates but always add proteins and vegetables), whole grains, lots of vegetables and constant exercise during the week. Sometimes it is possible to learn how to manage it through the diet and lifestyle advice provided by the Metabolic Diseases and Diabetes Unit, in other cases it is necessary to start treatment.

The prevention of gestational diabetes is mainly identified with the prevention of overweight and obesity: the goal is to achieve and maintain good blood glucose control throughout gestation to minimize the risk of complications for the mother and foetus.

• Can you give us a typical day for a pregnant woman, with recipes divided into meals?

The meals I am proposing present a balanced and vegetarian variety, which are suitable for an expectant mother:

1. Breakfast: a glass of cow's milk with wholemeal spelt biscuits with oat flakes and fruit to be supplemented with a portion of fruit in season (in summer we are lucky enough to be able to enjoy sweet, thirst-quenching fruit, so prepare a nice fruit salad to eat throughout the day);
2. Mid-morning snack: a portion of seasonal fruit with some Senatore Cappelli crackers and puffed quinoa;
3. Lunch: A single course of wholemeal Basmati rice topped with 150g of cherry tomatoes, 150g of chickpeas and pitted olives;
4. Mid-afternoon snack: a pot of yoghurt with 1 tablespoon of Orecchiette di Crusca and some dried and oily fruit;
5. Dinner: Penne Pasta with Spirulina with parmesan flakes (minimum 12 months) and courgettes trifle with a portion of fruit.

• Do you think it is advisable to follow a vegan or at least a vegetarian diet during pregnancy? Are there any risks? Would it be possible to achieve a good intake of nutrients by following this type of diet?

During pregnancy it is even more important to eat the right diet, one that provides the necessary nutrients to meet the needs of both mother and baby. The best choice in this case is to follow a varied and balanced diet.

At this particular time, it is essential that the pregnant woman's diet provides her with two elements in particular: folic acid and vitamin B12, which are indispensable for the development of the central nervous system of the foetus. Folic acid is very present in vegetables (specifically dark green leafy vegetables, legumes and whole grains), but supplementation is generally necessary. Vitamin B12, on the other hand, is found mainly in foods of animal origin and therefore supplementation should also be considered.

In the case of pregnancy, the least risky vegetarian diet is probably the lacto-ovo-vegetarian diet, as it is less drastic in eliminating food groups. In fact, this diet includes the consumption of eggs, milk and dairy products but still ensures a supply of calcium, vitamin D, protein and vitamin B12.

A vegan or vegetarian diet, if not properly balanced, could cause the mother-to-be to lack calcium, zinc, omega-3 fatty acids, iron, protein, iodine, various vitamins such as vitamin A, vitamin B2 and vitamin D, as well as creatine, which is only found in foods of animal origin.

It is possible to have a healthy pregnancy with a vegetarian diet, but my advice is to seek professional advice to minimise the risk of nutritional deficiencies.

• Could you give us some tips on postnatal nutrition related to weight restoration and breastfeeding?

Post-partum nutrition must represent, even more, a support for the physical and mental recovery of the new mother, it is necessary to respect the body's recovery time without forcing the weight loss.

As during pregnancy, it is not necessary to drastically change eating habits during breastfeeding to meet the demands for energy and certain nutrients, which are greater during breastfeeding. Milk production requires a lot of calories, some of which are derived from fat reserves accumulated during pregnancy. This is why it is important to wait for the physiological time (it can take up to several months!) to return to your pre-pregnancy weight, while avoiding making excessive demands on your body.

The dietary pattern for the nurse is similar to that recommended for pregnant women, with a few variations, in particular a greater demand (compared to adult women) for protein, omega-3, iodine, zinc, copper, selenium, vitamin A, group B vitamins and vitamin C, as well as water. For the mother, the best way to meet these increased needs is to follow a diet that includes large amounts of liquids (water, milk, vegetables and fruit, etc.), olive oil as a seasoning fat (preferably raw), frequent consumption of fish, dairy products and legumes.