If you are pregnant and decide to do a search on the Web on what to eat and what not to eat, you will find a lot of articles. Some of these articles may even contradict each other. Who should you listen to and what can you eat?
For starters, when in doubt, ask your gynaecologist. He or she would be the best person to answer all your questions. Don't be afraid to ask even if you think it's a silly question. If your gynae is reluctant to answer properly, find another gynae who is.
If you can't wait for the next visit to ask all your questions, then read on.
Medical & Scientific Affairs Manager at Danone Dumex Malaysia, Tan Ee Ping, a nutritionist by training, helps answer some questions on the matter.
Is it okay to only start watching what you eat when you find out you are pregnant?
There is a common thought that once the doctor says 'Congratulations! You're pregnant', you start changing everything – your lifestyle, eating and sleeping habits. The truth is once you and your partner decide to start a family you have to start changing your lifestyle and eating habits because you wouldn't know when you would get pregnant.
A general rule is to start leading a healthy life and eating healthily three months before you're actually pregnant. Three months is how long it takes to store up the nutrients in your body.
What can you eat when pregnant?
Basically a lot of people are very worried if they can eat this or that. The general rule is that you can eat almost anything that you have been eating but of course you need to eliminate alcohol and stop smoking.
You just have to keep in mind these three things: Balance, moderation and variety.
So, you can eat all the healthy food in balance, in moderation (that means don't eat only fruits and vegetables if your doctor asks you to eat more of these) and have a variety (this means don't eat oranges and no other fruit just because it is high in Vitamin C).
Eat different types of food because different foods will give you different nutrients. There is no one food or fruit that can give you everything. So you should have a variety in your diet.
You should look at a picture of the food pyramid – at the base there's the carbohydrates and on top of that are the fruits and vegetables, then the protein, followed by milk and dairy, and finally the fats and oils. You should follow the food pyramid and as long as there is balance you are fine.
We also encourage people not to take food that is very white in colour. Instead of white bread, take wholemeal bread. Instead of white rice, take brown rice.
Go towards the natural foods which are not so polished and not so processed.
We have heard that mothers should have quality food in the first half of the pregnancy and quantity in the second half. Is this true?
You should have quality and quantity in your diet throughout the pregnancy. The point is not to eat more but to eat the nutrients that you need.
It is not about how many plates of rice you should eat but how many nutrients you should consume and whether there is a balance and whether you are getting everything.
So, quality and quantity should go hand in hand throughout the pregnancy.
How important is folic acid?
Usually, folic acid is something that the doctors will prescribe. You can also get it from milk and vegetables but if your doctor gives you the folic acid supplement you should really take that.
Deficiency in folic acid can cause severe damage to the baby's central nervous system. That's when they can get spina bifida or neural tube defects. In severe cases the baby can be paralysed and suffer from incontinence when they are born.
Folic acid is very important. It helps you make new cells for your body and your baby's body. It also helps you to make red blood cells. You lose a lot of blood during delivery so it's very important to take folic acid.
If you are planning to get pregnant, you should already start taking folic acid.
There is the initial and critical stage during pregnancy where the baby's internal organs are developing. From Week 2 to Week 8, the heart and central nervous system are actively developing. If during that time you do not get enough of the nutrients that you need, you can never reverse it later by taking a lot of the nutrients after that period has passed. It's too late. They call it a critical window of development.
That's why we encourage people to start taking folic acid even before they are pregnant.
If you have not been taking folic acid, then you should immediately see the doctor once you suspect you are pregnant and if the doctor detects that you are indeed pregnant, he or she will prescribe the supplements needed.
How about calcium and iron?
Calcium and iron can be obtained from milk and green leafy vegetables like spinach. Iron is important to make blood. Calcium is also important but it's especially important during the second and third trimesters. The first trimester is when the baby's body is being formed. The second trimester is the building period – whatever is formed is now built. The third trimester is the storage period.
So, if the baby is born premature hopefully he or she would have enough nutrients by then. Especially during this storage period, the baby consumes a lot of calcium to make their bones and teeth. If the mother is not consuming enough calcium then the baby will get the calcium from the mother's bones. This might affect the mother later in life when she's old as it might be one of the reasons why she develops osteoporosis.
Should you have small and frequent meals?
Small and frequent meals are recommended for pregnant women as well as everyone else, too. We should all be taking small but frequent meals. Pregnant women should have three meals and two healthy snacks in between.
For pregnant women who experience a lot of morning sickness, it is even more important for them to eat. They shouldn't think that they cannot eat because they are throwing up so much. If they don't eat their body isn't getting additional nutrients.
Even if you throw up, continue taking small meals. It's good to snack in between meals otherwise you won't get all the nutrients you need if you're throwing up a lot.
Is there a cut-off time when you should stop eating to allow time for the food to digest? Is it okay to snack after dinner?
We encourage people to end their last meal for the day at least four hours before they go to bed. So, if you go to bed at 11pm, you should stop eating at 7pm.
For pregnant women, if after dinner they feel uneasy and they are vomiting, then it's good to take something, a healthy snack, before they go to bed.
Should you give in to cravings?
A lot of times your diet can change quite a bit. You could begin craving food that you have not been enjoying or even food that you used to hate.
So, a lot of times pregnant women are advised to go easy. You can take these foods but take them in moderation.
If you realise that you suddenly like durian, don't go all out to eat a lot of durian. You can take durian but in moderation.
How much should you eat if you're having twins or triplets?
Usually if you're carrying twins, triplets or more, the babies are born earlier and they are smaller. In these cases, we suggest you follow the doctor's advice because the doctor will scan and check and detect any abnormalities. So, you really have to follow the doctor's advice on how much to eat.
How much of weight should you gain? Should you be worried if you've gained too much weight?
Don't be overwhelmed if you were a normal weight mother before pregnancy and now at Month 8 you have already gained 16kg; don't diet from Month 8 to Month 9. You can still continue to eat as you have been doing. As long as the doctor tells you that everything is normal, you shouldn't worry.
Any time during your pregnancy is not a good time for you to go on a diet, even if you are obese. Some people are very worried that they won't be able to lose the excess weight after delivery. You should not go on a diet. You should be more worried if the food you eat is nutritious or not.
Some books say one glass of red wine and one cup of coffee a day is okay. Is this correct?
Alcohol is a strict no-no.
Caffeine is fine up to 200mg – that is about two cups a day. That covers all caffeine, not just coffee. So, if you've taken two cups of coffee don't go and have a glass of teh tarik (tea) and a carbonated drink, as well. Green tea also has caffeine so watch how many cups you take.
Caffeine may retard the growth of the baby and in some cases it may lead to an early delivery.
So, don't try to go beyond two cups of caffeinated drinks. If you can go without caffeine, then good.
It's also better to make your own coffee than to take the 3-in-1 coffee which is high in sugar. When you make your own coffee, you can control how much sugar you add.
How about herbal teas and remedies?
A lot of gynaecologists advise pregnant women to be very cautious with herbal teas and remedies. If you're not careful, some of these herbal remedies may lead to heavy bleeding. Especially avoid dong quai as it has been known to cause bleeding.
Chinese herbal remedies are not encouraged because the data on them is still not proven at this stage.
What can you take if you're not taking coffee, tea and carbonated drinks?
Fruit juices, plain water and milk. These are more healthy alternatives to the caffeinated drinks.
In fact, with regards to fruit juices we don't encourage pregnant women to take the carton drinks that can be bought in the supermarket. We encourage them to make fresh juices because of the high sugar content.
But even these you have to take in moderation because of the sugar content. You can't just decide to have three glasses of watermelon juice today.
It is a very unhealthy way of consuming a healthy drink.
Is it okay to take artificial sweeteners?
Artificial sweeteners are not encouraged for anybody, actually. You can take normal sugar, blackstrap molasses or brown sugar. These are healthier choices; just remember to limit your intake.
Artificial sweeteners contain chemicals that may sometimes lead to headaches. So it is not encouraged unless the person is diabetic and has to take an alternative to sugar.
What should you not eat?
You have to stop eating raw food – sushi, sashimi and others – as it may contain some bacteria and can cause food poisoning. If you really are craving Japanese food, go for smoked salmon or grilled fish.
No raw fish, shell fish (oysters, raw prawns, raw crabs) – these are some of the foods we say you really cannot eat! Cooked shellfish is okay but again don't take too much as it could be high in cholesterol or certain proteins.
Unpasteurised milk or dairy products is another real no-no. This includes blue cheese.
Do not eat unwashed fruits and vegetables.
No raw eggs or half-boiled eggs either. Better to have fried or hard-boiled eggs.
The risk for all of these is food poisoning because there could be some bacteria in these foods when they are not cooked or half cooked or not washed properly.
Are there any fish to avoid?
We encourage pregnant women to eat deep sea fishes that are high in Omega 3 and DHA (docosahexaenoic acid) like tuna, mackerel, herring and sardine. If you're taking tuna and sardine, it's better to go for the fresh fish rather than the canned version. You are encouraged to take three servings a week.
There isn't any fish that we say they really cannot eat.
There has been some controversy about deep sea fishes which are said to be high in mercury content. However, until now this is not conclusive. Doctors still encourage everyone to take deep sea fishes.
Is it okay to take preserved fruits for nausea?
Don't have preserved fruits as they are high in sodium and sugar.
Is it okay to take spicy food?
There is some data to suggest that spicy food can induce delivery but this is still not conclusive.
There is also data that suggests certain ingredients in spicy food helps digestion. So, spicy food is okay to take but what are you cooking it with? If you're adding a lot of coconut milk then it's not healthy. So, watch what you have it with or how it is prepared, as well.
Any additional advice for pregnant women?
If they are worried about anything, they should consult the doctor and find out what they can and cannot do.
After delivery you should continue eating healthy food because this is when you are healing your wounds. It's a time when you have to heal after losing a lot of blood. If you are breastfeeding you should continue living a healthy lifestyle and eating well. Nutrients from what you eat gets transferred to the breastmilk. So, do be very careful of what you eat when you're breastfeeding.