Preconception Nutrition – Healthy Weight and Dietary Choices before Pregnancy

Preconception nutrition is one of five aspects of preconception care. Preconception care refers to the care that a woman and her partner receive before getting pregnant. This care plays a critical role because it focuses on improving the couple’s health, and subsequently of the child to be born. Preconception care is key because it improves the outcomes of maternal and child health for families and communities. There are different facets of preconception care, among them:

  • Preconception Nutrition
  • Mental Health
  • HIV
  • Genetics

Read More: Preconception Care

This post focuses on preconception nutrition and the role that diet and lifestyle changes play.

Healthy nutrition before pregnancy

A woman’s reproductive years present a key stage of life. For this reason, access to proper health care not only impacts their wellbeing, but also that of the children that they may carry in the future. This health care ought to include healthy pre-pregnancy weight, healthy and accessible dietary choices as well as a preventive approach as far as nutrition is concerned.

Healthy pre-pregnancy weight

A woman’s pre-pregnancy weight has a direct impact on the baby’s weight at birth. According to research carried out, women who are underweight tend to deliver smaller babies compared to average weight women. This has been seen to happen, despite the fact that they may add on the same weight as average weight women. Women who are overweight on the other hand, get bigger babies. This sometimes poses a challenge during labour and delivery. Additionally, women who are obese are at a higher risk of increased blood pressure and gestational diabetes.

Read More: Gestational Diabetes – Why it occurs and its management

Birth preparation and preconception nutrition

Other concerns associated with pre-pregnancy weight include:

  • Chronic health conditions that accompany obesity such as stroke, heart disease and osteoarthritis among others.
  • Obesity has also been linked to infertility and pregnancy loss. There is also an increased likelihood of premature labour and delivery as well as stillbirths.
  • Underweight women have also been shown to be at risk of perinatal mortality as well as a host of complications during and after pregnancy (Source).

This is why maintaining a healthy weight is recommended during the pre-conception phase. By attaining a healthy weight before getting pregnant, women are more likely to have a healthy pregnancy.

“After pregnancy, addressing postpartum weight reduction is an important aspect of interconception care. Women often retain excess weight gained during pregnancy thus increasing the risk for entering a subsequent pregnancy at a higher weight. This may lead to an ongoing cycle resulting in obesity.”

Association of State Public Health Nutritionists (ASPHN)

Healthy and accessible dietary choices

It is recommended that women and families consume healthy nutrient-rich foods. This becomes even more important during the pre-conception stage when healthy dietary choices have a ripple effect – both for present maternal health and future fetal health.

A healthy diet that comprises whole grains, vegetables, fruits, protein and dairy should provide a woman with the necessary nutrients for overall health. Examples of foods in these food group categories include:

Preconception nutrition diet

Whole grains

Whole grains include foods that are sourced from rice, cornmeal, wheat, barley and oats among others.

Vegetables

There is a wide array of veggies to choose from, including dark green leafy vegetables, red and orange vegetables. Other options include legumes (such as peas) and starchy vegetables (like peas, plantains and potatoes).

Fruits

It is advisable to take fruits and fruit juices (go for 100% fruit juice) as these provide a wide range of vitamins for proper reproductive functioning.

Protein

When it comes to proteins, go for lean cuts of meat. Add to your protein diet by including plant-based proteins such as beans, seeds and nuts. Try to avoid animal fats as they are high in saturated fat which is known to increase abdominal obesity.

Dairy

Dairy and dairy products are rich in calcium. Since the body cannot make its own calcium, it should be included in the diet. This is especially important during pregnancy as the calcium will be required for the proper development of the fetal skeleton.

In addition to these major food groups, there are other nutrients that are an integral part of preconception care and nutrition. These include:

Folic acid

The recommended daily intake of folic acid for women in their reproductive years is 400 micrograms of folic acid. Excellent sources of folic acid include green leafy vegetables, citrus fruits, nuts and select vitamin supplements. Folic Acid is important during pregnancy because it reduces the risk of fetal defects in the brain and the spinal cord. These defects re collectively referred to as neural tube defects.

One of the most common neural tube defects is spina bifida. Spina bifida is a condition develops when the spine and spinal cord do not form completely in the early stages of pregnancy. Since this affects the nerves, it can lead to incontinence and mobility challenges.

With this in mind, folic acid is most important in the first 28 days after a woman conceives as this is when most of these defects develop. Sadly, most women do not realize they are pregnant within this period. That is why preconception care includes the intake of folic acid. In many health facilities in Kenya, healthcare providers will often prescribe a supplement so that a pregnant woman’s nutritional needs are met adequately.

Calcium

As mentioned above, Calcium is required for the baby’s skeleton. The unborn baby gets its calcium from the mother’s diet. If this is insufficient, the baby takes calcium from its mother’s bones. If this is managed with diet, there increased likelihood of osteoporosis (a condition that is characterized by weak and fragile bones).

Vitamin D

Vitamin D is required for the absorption of calcium and for healthy teeth and bones. Inadequate levels of Vitamin D often lead to a deficiency of Calcium and this has been linked to low birth weight and pre-eclampsia. It is possible to get enough Vitamin D by spending time in the sun, especially in Kenya where there is fair weather almost all-year long.

Read More: Preeclampsia and eclampsia – what you need to know

Iron

Women in their reproductive years are already predisposed to low iron levels, thanks to menstruation and diets with low amounts of iron. During pregnancy, the body uses iron to produce more blood for both mother and baby.  Iron in the blood is used to bind to the oxygen before it is transported to the body tissues. Adequate iron helps prevent a condition known as iron-deficiency anemia.

Some great sources of iron include red meat and organ meats, poultry, green leafy vegetables (kale, collards, broccoli and spinach) as well as iron-fortified breads and cereals.

Nutritional Therapy for women with existing health conditions

Nutritional therapy is the third aspect within preconception care. Nutrition plays a fundamental role in women with existing conditions such as diabetes, hypertension, anaemia and HIV. These conditions require nutritional intervention during preconception care, pregnancy and postpartum.

With diabetes and hypertension for instance, diet is a fundamental part of the treatment and management plan. Anaemia too, can be managed using diet and prescribed medication, while HIV-positive moms may need medicines that change their nutritional status.  This link shows that nutrition therapy must be included as part of the treatment and management of specific conditions.

Lifestyle changes to go with preconception nutrition

In addition to preconception nutrition, there are lifestyle changes that a woman can make to ensure that she is at her best before getting pregnant.

Exercise – An active lifestyle

As mentioned above, healthy pre-pregnancy weight improves maternal and child outcomes. To maintain a healthy weight, it is recommended that women exercise before pregnancy. Whilst most exercises are safe to do during pregnancy, it is imperative that you raise any concerns you may have with your doctor. Generally, low-impact exercises, aqua-exercises, brisk walking and swimming are recommended. Water workouts are particularly helpful as the water supports the extra weight and helps prevent injuries.

Apart from maintaining healthy weight, exercises also have the following benefits:

  • Exercise prepares the body for labour and delivery.
  • Increase energy levels during the day, helps improve mood and aids in a good night’s sleep.
  • Reduces back pain.
  • Eases constipation.
  • Preconception nutrition and exercise during pregnancy
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Alcohol and substance abuse

The use of alcohol before and during pregnancy has been linked to pregnancy loss, premature birth and low birth weight babies. Research is still ongoing as far as fetal alcohol spectrum disorders are concerned. Since there is no assured safe amount of alcohol consumption, it is advisable that alcohol should be avoided during the preconception period and pregnancy.

Read More: Preterm Birth – Risk Factors and Symptoms

Drug and substance abuse has a similar effect as it increases the chances of a preterm birth, low birth weight and brain haemorrhage. Current research shows that exposure to marijuana before and during pregnancy my alter brain development in the fetus, as well as lead to low birth-weight babies. The effect of marijuana on stillbirth is still been studied, but it is recommended that women planning to get pregnant avoid drugs and alcohol.

Overall, preconception nutrition ought to be on the forefront of healthcare for women in the reproductive age.

Additional Resources

Pharmaceutical Journal: Preconception Nutrition