Safe Food: What to eat and drink in pregnancy

Women who do not eat meat will probably still get enough vitamin B12 from other animal foods, but women who do not eat any animal produce at all (a vegan diet) can become short of vitamin B12. If you follow a vegan (or near vegan) diet, it is a good idea to eat plenty of fortified foods, and consider a B12 supplement. Ask your family doctor or a pharmacist to recommend a suitable supplement.

Foods rich in vitamin B12 (best first)

lamb’s kidney

other meat – beef, pork, lamb, sausages

fish – such as cod, tinned sardines and pilchards

eggs

milk and hard cheese

breakfast cereals – only fortified ones (check the nutritional information chart on the carton)

soy ‘meat’ and soya milk are often fortified with vitamin B12

Vitamin A: harmful if you have too much

We all need small amounts of vitamin A to keep our skin healthy. A balanced diet containing a range of fruit and vegetables, margarine and eggs will provide all the vitamin A we need. There is no need to take extra during pregnancy.

It may be harmful to your developing baby to have too much vitamin A. There are two ways in which this may happen: first, if you eat large amounts of liver, and second, if you take supplements of either vitamin A or fish oil.

Animal liver and liver products may contain high levels of vitamin A. This is related to the type of food on which the animals have been fed. It is therefore best that you do not eat liver, or foods made from liver (such as pate) while you are pregnant. It is OK to eat these foods once you have had your baby.

Fish oil supplements (tablets, capsules or medicine) may also contain high levels of the wrong type of vitamin A. Fish oil contains essential fatty acids – but it is better to eat oily fish like mackerel, herrings, pilchards and salmon, rather than take a supplement.

If you feel you need to take a vitamin supplement, avoid ones that contain the ‘retinol’ form of vitamin A. Too much (more than 3,300 microgrammes, or mcg or μg) of this type of vitamin A may harm your developing baby. The ‘carotene’ form of vitamin A is safe – so check the label carefully and ask your pharmacist for advice.

Vitamin C: needed every day

Our bodies need a good supply of vitamin C to help fight infection and disease, to repair damage within our bodies, and to help heal wounds. Vitamin C also plays a role in preventing anaemia (lack of iron in the blood). Unlike other vitamins, vitamin C cannot be stored in our bodies – so we need to eat some foods rich in vitamin C each day.

Some women may need more vitamin C than others. If you smoke, or cannot avoid the smoke of other people’s cigarettes, your body needs more vitamin C. Similarly, if you have been ill, or have had surgery, or have suffered an injury, your body will be using large amounts of vitamin C. In these circumstances, it is a good idea to increase your intake of foods rich in vitamin C.

Foods rich in vitamin C (best first)

citrus fruits – oranges, grapefruits

citrus fruit juices – fresh juice can be expensive; carton juice is just as good

green vegetables – brussels sprouts, broccoli, cabbage

other fruit and vegetables – kiwi fruit, blackcurrants, tomatoes, green peppers

potatoes (yes, really! – especially if thinly peeled or scraped)

Tips for preserving vitamins

Cook vegetables whole or cut into large pieces – this reduces the loss of vitamins during cooking. Try not to leave peeled vegetables soaking in water for a long time before cooking.

When cooking vegetables on the hob, use only enough water to cover the vegetables. Bring the water to the boil, add the vegetables, cover the pan and boil briskly for a few minutes. Test the vegetables with a fork or knifepoint and stop cooking while the vegetables are still crisp. Leafy vegetables such as cabbage or spinach may only take 2–3 minutes to soften.

Use the cooking water to make gravy or stock – to save some of the vitamins that have seeped out into the water during cooking.

Try steaming vegetables – it takes longer but is an excellent way of preserving both vitamins and taste (as is cooking in a microwave oven).

Eat some vegetables raw: grated carrot and finely chopped white cabbage in coleslaw, chunks of sweet pepper, crispy stalks of celery – maximum vitamins and maximum taste!

Eat most fruit raw – but do wash first in plenty of cold running water.

If you wish to cook fruit on the hob, use only a small amount of water and cook gently, for as little time as possible. Redcurrants or ripe plums need only a moment’s cooking – delicious on breakfast cereals or mixed into plain yoghurt.

Try baking large apples or bananas in the oven, wrapped in foil with a sprinkling of dried fruit and served with a dollop of low-fat fromage frais.

Vitamin C is easily destroyed by cooking. If you need to cook vitamin C foods, use only a small amount of water and cook for as little time as possible.

Antioxidants: nutrients fighting pollution

Antioxidants are a special group of nutrients that work to protect our bodies by blocking the action of ‘free radicals’.

Free radicals are molecules (groups of particles) produced by our bodies. They are produced during many normal body processes – for example, the destruction of bacteria (germs) by our white blood cells, and the digestion of essential fatty acids. A certain level of free radicals is therefore normal.

The problem is that levels of free radicals within our bodies seem to be rising, as more and more are produced in response to pollutants such as cigarette smoke, exhaust fumes, and other toxic substances. If left unchecked, free radicals damage the cells of our bodies and weaken our defences against diseases such as heart disease and cancer.

The main antioxidants are:

vitamins C and E

two minerals called selenium and zinc

beta carotene (the safe form of vitamin A).

Vitamin C is probably the most effective antioxidant. Most fruit and vegetables are good sources of vitamin C, especially citrus fruits, kiwi fruit, blackcurrants, peppers, tomatoes and green leafy vegetables. Vitamin E is found in vegetable oils, wholegrain bread and cereals, avocado pears and other green vegetables, eggs, butter and margarine.

We can get zinc from lean meat, cheese, milk, wholemeal bread and cereals. Cereals are also a good source of selenium, along with fish, pork, cheese, eggs and brazil nuts. Two other mineral antioxidants – copper and manganese – are found in wholegrain cereals, nuts, vegetables, meat and fish.

Beta carotene (and similar nutrients) are found in yellow and orange fruits such as mangoes, apricots, peaches and plums. Green leafy vegetables are rich in beta carotene, as are carrots, pumpkins and tomatoes. Cooked and processed tomatoes, in particular, are considered to be an excellent source of lycopene, another useful antioxidant.

Antioxidants are important for all of us, whether pregnant or not. A balanced diet, with plenty of fruit, vegetables and wholegrain bread and cereals will provide plenty of antioxidants.

Vitamin D: the sunlight vitamin

Vitamin D helps our bodies absorb and use a mineral called calcium. Calcium is needed for strong bones and teeth. A good intake of calcium is especially important during pregnancy when your baby’s bones and teeth are developing.

Vitamin D is found in oily fish, such as sardines and mackerel, eggs, milk and other dairy products, and fortified foods such as margarine and breakfast cereals. Vitamin D is also made within our bodies, a process started by sun-light on our skins. People who spend some time out of doors each day, and who eat plenty of foods rich in vitamin D, usually have good stores of the vitamin.

The UK government recommends that pregnant (and breastfeeding) women should take a supplement of 10μg of vitamin D each day (sometimes written as 10mcg or 10 microgrammes). This is because some women in the UK may not build up adequate stores of vitamin D to meet the extra needs of pregnancy. You may like to talk to your GP about a vitamin D supplement if:

you do not eat milk foods, and other animal foods such as fish and eggs

you do not spend some time out of doors between 11am and 3pm each day (it doesn’t matter if the sun isn’t shining)

you usually cover your arms, legs and head when out of doors

you live in the north of England or in Scotland, where the winter days are short.

Calcium: a mineral for strong bones and teeth

Calcium and vitamin D are closely connected because we need vitamin D to help our bones and teeth make use of calcium. Dairy products are the best source of calcium.

One piece of research suggests that not having enough calcium may mean that some women are more likely to develop pre-eclampsia – but more proof is needed.

Foods rich in calcium (best first)

milk, yoghurt and hard cheese (soft cheeses, like cottage cheese and cream cheese, also contain calcium – but less than hard cheeses such as parmesan, Cheddar and Double Gloucester)

tinned fish – especially sardines and pilchards (including the soft bones!) and salmon

soya milk and tofu (made from soya) often have calcium added (check the labels – the normal level for cow’s milk is 120mg in 100ml)

foods made using white flour (which is fortified with calcium) – white bread, pizza bases and pastry

spinach and spring greens

chick-peas, kidney beans and tinned baked beans

sesame seeds and almonds

oranges and dried figs

Zinc: the fertility mineral

Zinc plays an important part in fertility (getting pregnant) and healthy pregnancy. It is also needed for growth and healing, and for good immunity to infections and disease. Meat, milk foods and seafood are all good sources of zinc. Some experts are concerned that the absorption of zinc by our bodies can be reduced by an excessive amount of fibre in our diets, and by unnecessary iron and folic acid supplements. This is one reason why it is important to consult your GP, midwife or pharmacist before taking any nutritional supplements during pregnancy.

Foods rich in zinc (best first)

meat – beef, lamb

sardines – especially good for zinc!

cashew nuts, lentils and chick-peas

wholemeal bread

other fish – smoked mackerel and prawns

hard cheese, milk and eggs

baked potatoes

sunflower seeds and peanuts

Iron: for healthy blood

Iron is needed to make haemoglobin, a pigment that is found in our red blood cells. Haemoglobin carries oxygen around our bodies. If our red blood cells are not healthy, the transport of oxygen around our bodies may not be good enough. We may begin to feel tired, breathless, dizzy and miserable. These are some of the signs of anaemia.

Doctors and midwives used to give all pregnant women supplements of iron routinely. We now know that unnecessary iron supplements may interfere with the absorption of other minerals, such as zinc. They may also cause constipation. It is usually better to prevent anaemia by eating more iron-rich foods. Iron supplements are, however, necessary to treat anaemia; your doctor or midwife will advise you as to whether you need an iron supplement.

Foods rich in iron (best first)

lean beef, lamb and kidney

dark chicken or turkey meat

fortified breakfast cereals

sardines

wholemeal bread

red lentils, chick-peas, baked beans, kidney beans

leafy vegetables – broccoli, peas, curly kale, spring greens, spring onions, spinach

cashew nuts, sunflower seeds

dried fruits – apricots, prunes and figs

baked potatoes

eggs

Tips on getting plenty of iron from your food

Eat some food rich in vitamin C with every meal – fresh fruit or vegetables. This will help your body absorb iron, especially from non-meat iron foods. Vegetables such as peas, broccoli and spinach contain vitamin C as well as iron – provided they are not over-cooked. Spring onions are also full of vitamin C and iron – a convenient no-cook snack!

Eat a variety of leafy green vegetables. (Spinach contains plenty of iron but this iron is not well absorbed by our bodies – so try other vegetables as well.)

Eat meat or fish with non-meat iron foods. This will help you absorb as much iron as possible from the non-meat food – for example, minced beef eaten with leafy green vegetables.

Drink tea and coffee between meals – rather than with your food. Both drinks contain chemicals that can reduce the amount of iron that your body can absorb from food. If you drink tea, have a cup an hour before your meal – or two hours afterwards.

Certain foods reduce the amount of iron that our bodies can absorb from a meal. One example is rhubarb!

What about salt?

Most of us eat more salt than we need. Processed foods – such as ham, cheese, bread, baked beans and biscuits – all contain lots of salt. Savoury spreads (like yeast extract and beef extract), crisps, olives and salted nuts are obviously salty foods. In the long term, too much salt in your diet may contribute to high blood pressure and related health problems later in your life.

During pregnancy, however, the situation is more complicated. Restricting your salt intake at this time has not been shown to reduce the risk of high blood pressure during pregnancy. But this does not mean that you should add extra salt to your food. Use salt to flavour your food, as you would normally.

When you have had your baby, you can try reducing the amount of salt you use in cooking and on your food. This will help when your baby starts taking solid food, since babies should not have any salt at all added to their food.

There is no proof that cutting your salt intake during pregnancy will reduce swollen ankles. Similarly, there is no proof that leg cramps during pregnancy are caused by a lack of salt or of any other minerals.

Understanding food labels

What are calories?

A calorie (cal or kcal, for short) is a measure of how much energy a particular food gives us. Calories are sometimes called ‘kilocalories’. They mean the same thing. A ‘kilojoule’ (kJ) is another measure of food energy. One calorie is equal to about 4 kilojoules.

What is the ‘RDA’?

RDA stands for ‘recommended daily amount’. The recommended daily amount of a certain nutrient is the amount that most of us need to keep healthy. RDAs vary from person to person. For example, children’s nutritional needs are different from those of older people, and pregnant women’s nutritional needs are different from those of men, or women who are not pregnant. Very active people need more energy than people who don’t exercise much. The RDAs given on food labels usually refer to adult men.

Food labels usually list the RDAs of vitamins and minerals. The percentage figure given after each nutrient tells us how much of our RDA would be met by a portion of that particular food. For example, ‘Folic acid 34mg (17%)’ means that the food would give us 34mg of folic acid – or 17% of the daily requirement. This sounds very good – but remember that the RDA used is that of an adult man, rather than a pregnant woman whose need is much greater.

Next time you pick up an item of packaged food – a loaf of bread or a tin of baked beans, maybe – take a look at the panel of ‘Nutritional Information’ on the label. This information can be very useful when planning a balanced diet – especially when deciding whether or not to include a new food.