September 2003

The five stages of pregnancy: First trimester

by Dr. Howard Loomis

In the first part of my series on the nutrition of pregnancy, I explained pre‑conception planning for the mother and father, stressing how important it is that both of their bodies be healthy and well‑nourished before bringing a child into the world.

Next, I dealt with the absolute importance of good fat digestion and assimilation. Fatty acids are the precursors of prostaglandins which control the ability to impregnate and conceive, prevent spontaneous abortion, induce labor appropriately, and commence lactation. It is easy to see how proper nutritional planning should be part of essential care before, during, and after pregnancy.

The nutritional status of the mother prior to conception is of prime importance in determining her requirements during pregnancy. While general guidelines for the population as a whole are widely practiced by physicians, we must keep in mind that those recommendations are based on national averages. The further removed from average our expectant mother is, the more inappropriate those recommendations tend to be.

What tests are performed to determine specific nutritional needs of a mother‑to‑be?

I believe that you, as a health care practitioner, can have a tremendous impact on the health of expectant parents (and their children). Start with the standard nutritional recommendations and modify them to meet the needs of each individual. And remember, what's important is what the patient can and cannot digest and assimilate ‑‑ not what's in the diet.

Calories and weight gain

A pregnant woman does not have to eat for two. Ideally, the diet should be adequate enough to nourish the fetus without extensive modification. Certainly there must be a slight increase in calories and proteins. On average, caloric intake should be increased by 300 calories per day. This means that, ideally, an average healthy woman should gain 22 to 29 pounds during pregnancy. It is imperative that special attention be given to protein and fat digestion. Regular readers of my column are aware of this area of weakness in most women.

In the first trimester, the pregnant mother may not put on any weight especially if she is suffering from morning sickness. The mother‑to‑be commonly begins to gain weight during the third month, with the most weight gained between the fifth and seventh months. However, care should be taken to ensure that weekly weight gain is not more than 2.2 pounds.

Nutritional requirements

Protein requirements increase only slightly during the first three months, yet protein digestion and assimilation may be the key to many problems encountered during this period. In various nutrition textbooks, the recommendation is that daily protein intake be increased to 70‑100 grams. This represents a large increase for most women.

Generally, women do not eat as much protein as men, and many hormonal and pregnancy problems may be related to protein deficiency. Adequate protein digestion depends on adequate stomach acid needed to activate the protein‑digesting enzyme pepsin in the stomach.

Iron supplementation should be increased from 30 to 38‑40 mg per day. It is usually recommended that vitamin C be taken to help with iron absorption. But, it is never stated that adequate stomach acid must be present to ionize iron in the stomach as this is essential for absorption. Additionally, even after iron is ionized, protein is essential for the absorption and transportation of iron.

Biliary function and bile flow is reduced by inadequate stomach acid entering the duodenum. I have already explained the importance of adequate fat and fatty acid metabolism in pregnancy in previous columns.

Calcium intake needs to be increased to at least 1,000 mg per day, not only for calcification of the baby's bones and teeth but also to protect the mother from calcium depletion. It is always recommended that vitamin D be used to enhance the absorption of calcium. What is never mentioned is that inadequate stomach acid severely reduces calcium absorption and that unemulsified fat binds with calcium, making it insoluble.

In future columns, I will discuss other nutritional requirements during pregnancy, such as folic acid and B vitamins. For now, I would like to finish this column by commenting on the symptoms associated with digestive and assimilation problems.

A certain amount of nausea or morning sickness is considered "normal" during the first three months. Morning sickness simply indicates that the kidneys are stressed and unable to cleanse the blood adequately. Since plasma proteins are responsible for detoxifying and transporting waste, the connection is obvious. Moreover, by nutritionally supporting the kidneys, the morning sickness will subside.

Finally, edema is a common problem. The usual advice is to elevate the legs and mildly reduce salt intake. You will find, however, that improved protein digestion and assimilation will eliminate the problem altogether.