Medical Nutrition Therapy For Pregnancy

Introduction

Definition of medical nutrition therapy (MNT)

So what exactly is medical nutritional therapy (MNT)? MNT is a nutrition-based treatment given to you by a registered dietitian nutritionist by providing nutrition diagnosis and counselling services to help manage and treat certain diseases and conditions.¹

Importance of MNT during pregnancy

In pregnancy, the saying “eating for two”, is not very accurate as pregnant women only have to increase their caloric intake by 10 to 25%, for a healthy weight gain. So, rather than increasing calories, it is important to consume nutrient-dense foods instead of low-nutrient foods.^1,2

Goals of MNT for pregnancy

Having a healthy gut flora during pregnancy can help to improve the immune functions of the mother and reduce the risk of certain diseases and pregnancy complications, such as gestational diabetes and pre-eclampsia, which can affect the baby and their well-being.² 

Nutritional requirements during pregnancy

Macronutrient requirements 

These are nutrients that provide you with calories and energy, which include protein carbohydrates and fats:³

Protein

Protein is essential to ensure the proper growth of the baby, including the baby’s tissues, organs and brain. It can also help with breast and uterus tissue growth during pregnancy. To the mother, it can also help to increase blood supply, making sure your baby gets more blood. 

Your protein should be increased during each trimester. It is important to eat about 70-100g of protein each day, depending on your weight and the trimester you are in.

Micronutrient requirements

Micronutrients are dietary components that are only required in smaller amounts, such as vitamins and minerals.³ 

Folate

Folate, also known as folic acid, is essential because it reduces the risk of neural tube defects. These are birth defects that can affect the baby's brain and spinal cord. Approximately, around 600-800 mcg of folate is recommended. 

Iron

Iron, with sodium, potassium and water work together to increase the blood flow, making sure there is enough oxygen supply for both you and your baby. It is recommended you take 27 mg of iron per day, along with vitamin C to increase the absorption. 

Calcium

Calcium can help build the baby's bones and regulate your body’s fluids. Ideally, you need at least 1,000 mg (2 doses of 500 mg) of calcium per day.

Other essential vitamins and minerals

Other essential vitamins include choline, salt and vitamin B. 

Common nutritional challenges during pregnancy

Gestational diabetes 

A type of diabetes that usually develops during pregnancy causing the mother to have high blood sugar levels in the blood, which can then affect the baby.⁴ 

Dietary considerations

• Having healthier carbohydrates 
• Cutting down on sugar
• Portion sizes - with the help of you dietitian, you can portion your carbs 
• Manage your weight
• Monitoring blood glucose levels

If you are diagnosed with gestational diabetes, your GP and your healthcare team will monitor your blood glucose levels to make sure everything is within the normal range. 

Hypertensive disorders 

Hypertensive disorders, like preeclampsia, cause high blood pressure during pregnancy. It can pose a risk to both you and your baby, so early detection is essential.⁵ 

Sodium intake guidelines

According to UCSF Health, the sodium intake should be around 3000 mg per day, but this can be restricted depending on your dietitian. 

Role of potassium 

If you have a hypertensive disorder, then your dietitian and your healthcare team may advise you to take potassium supplements because potassium is known to decrease blood pressure very quickly. 

Meal planning and dietary guidelines

Sample meal plans for different trimesters 

Many companies can provide mothers with delicious meal plans according to their trimester. These can be discussed with their dietitian:⁶

• 1st Trimester – most meal plans will include dishes rich in folate, which is amazing for the baby’s nervous system. Other foods should contain vitamin B6, which helps your body store energy. It is also good to have foods rich in iron because they can help to increase blood volume

• 2nd Trimester – during the second trimester, most meal plans will include dishes rich in calcium and vitamin D, to help the growth of strong bones and teeth. Omega-3 fatty acids are also important for the brain development of the baby

• 3rd Trimester – in this trimester, it is important to have meals that provide a boost of energy. Foods containing vitamin K will help your body after birth

Dietary guidelines for a healthy pregnancy ⁷

Balanced diet

A healthy and balanced diet is essential at any time, but it is also important when you're pregnant or planning to be pregnant. Eating healthily, during pregnancy will help the baby grow and develop healthily. Mothers do not need to be on a special diet; however, it is essential to eat a range of different foods every day to get the right balance of nutrients for you and your baby. 

Hydration 

• Limit drinks with caffeine and added sugars
• Drink plenty of water instead of sugary drinks, such as fizzy drinks, sweetened waters and energy drinks. It can also be a good idea to add fruits and herbs to your water, for additional flavour

Safe food handling

It is very important to safely prepare food:

• Wash fruits, vegetables and salads to remove traces of soil
• Wash all utensils, surfaces, and your hands after handling raw foods, such as meat, eggs, poultry, and shellfish to help you avoid food poisoning
• Using a separate knife and chopping board for raw meat
• Meats, eggs and whole cuts of meat must be cooked very thoroughly

Lifestyle factors and MNT

Exercise during pregnancy⁸

Benefits

The more active and fit a mother is during pregnancy, the easier it will be for her to adapt to the changes in weight and shape, which helps to cope with labour. It is okay to keep a normal daily physical activity, such as sports, running, yoga, walking and dancing as long as it is comfortable. And remember, exercise is not dangerous for the baby!

Precautions

Even though it is good to exercise, certain precautions must be taken for the health of the baby:

• Do not lie flat on your back for long periods
• Do not do any extreme sports or exercises, such as judo, squash, and kickboxing or scuba diving

Monitoring and evaluation

Regular nutritional assessments 

During the nutritional assessments, the team will check for:^2,3

• Weight gain
• Blood tests - checking for nutrient levels in the blood
• Adjust the MNT plan based on results

Summary

During pregnancy, it is important to have MNT, because it can help a mother and the baby have better health. It can also help to manage certain disorders during pregnancy that can be dangerous for a baby. So it is important to take a step towards having a better diet, and with the help of a team, mothers can improve their well-being and the safety of their baby.