For anyone who is expecting and you have an interest in the thought: foods to avoid during second trimester. You will discover many valuable information and facts on this particular topic, as well as tips, suggestions, opinions, and answers to help questions related to pregnant state, correct nutrition and diet habits.
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There are a series of alterations in pregnancy that, physiologically, can alter nutritional patterns. We describe them below.
An increase in progesterone concentrations causes a reduction in the tone of the smooth muscles. This affects the digestive system causing an increase in gastroesophageal reflux, an increase in gastric emptying time and a reduction in gastrointestinal peristalsis.
As a result, some of the complaints that pregnant women report are frequent nausea and vomiting in the first phase of pregnancy, postprandial heartburn and constipation.
There is, with regard to hematic volume, an increase in plasma volume greater than the erythrocyte volume. By reducing the hematocrit, a false anemia occurs.
The kidney increases its filtration so we can find glucose, amino acids and folates in the urine.
With regard to the respiratory system, hyperventilation appears due, on the one hand, to progesterone and, on the other, to the pressure of the uterus on the diaphragm.
From the second trimester of pregnancy there is an increase in appetite that facilitates the supply of food and nutrients. In any case, in industrialized countries it has been observed that energy intake is lower than recommended, but this is offset by a decrease in physical activity and basal metabolism.
Weight gain during pregnancy
The Committee for Maternal Nutrition of the National Research Council recommends a physiological weight gain during pregnancy of 11 kg, and a weight gain between 9 and 12 kg can be considered normal. This increase is due not only to the fetus but also to the placenta, amniotic fluid, uterus, breasts and maternal blood. A pre-pregnancy weight less than 10% of the ideal or an overweight greater than 20% is inappropriate.
If we take into account the nutritional status of the woman at the beginning of pregnancy, according to her body mass index, the recommended weight gain varies (table 1).
In any case, the general pattern of weight gain in pregnant women should be assessed by recording its evolution in graphs, as is usually done in childhood.
During pregnancy, an increase of less than 1 kg per month, or an increase of more than 3 kg per month, is not recommended. Sometimes there are incidents that can cause an insufficient or excessive increase (table 2).
Since heartburn occurs when the stomach is empty, frequent, low-volume meals must be eaten to restrict gastric secretions
Anyway, it should be noted that many women in developed countries restrict their intake during pregnancy to have lower-weight children and thus avoid complications in childbirth. Some studies show that children who are low birth weight have increased health risks.
The amount of extra energy provided during pregnancy should be 200 kcal per day throughout pregnancy or 300 kcal / day from the second trimester of pregnancy.
The objectives of the distribution of the diet are: to reduce the volume of food per feeding, to facilitate digestion, not to promote excessive weight gain and to adhere to a balanced diet. Therefore, the most appropriate way to distribute the diet is reflected in table 3.
With regard to culinary techniques, all of them can be used, although we will preferably recommend some of them for several reasons: either they respect the nutritional value of the food as much as possible, or they reduce the cooking time as much as possible, or they use a minimum of added fats (table 4).
There are genetic predisposing factors to obesity, but despite this, excess weight acquired during pregnancy can predispose to later obesity
The way the dishes are seasoned is also important, especially in certain pathologies such as hypertension, in which salt consumption must be restricted. It will also be useful to avoid the worsening of edema.
With regard to the use of sweeteners, it should not be forgotten that many of them constitute an important contribution of calories to the diet (sugars, honey, candies).
Addition fats are also important, as in any type of balanced diet. Virgin olive oil is recommended for its high content of antioxidants, such as vitamin E and hydroxytyrosol. Its contribution in monounsaturated fatty acids such as oleic acid also make it interesting.It is better to moderate the consumption of butter and only use it raw, since cooking it can alter the properties of its lipids (table 5).
Diet-related disorders
Nausea and vomiting
Drink little fluids during any meal.
Drink at least 1.5 l of liquid during the day (in the form of water, juice, milk, broth), but outside of meals.
Distribute the diet in 5-6 daily intakes of little volume every 2-3 hours to avoid overloading the stomach and avoid digestive discomfort.
Concentrate most of the ingestion of food in the meal, afternoon and night, since nausea usually disappears towards the middle of the day.
Consult a doctor in case of repetitive vomiting since they could cause significant nutritional deficiencies.
An example of a menu for this type of pathology is shown in table 6.
Iron supplementation is a nutritional prevention measure that should be started in the second trimester of pregnancy
based on 60 mg / day in the form of elemental iron from a ferrous preparation
Since heartburn occurs when the stomach is empty, frequent, low-volume meals must be eaten to restrict gastric secretions, try not to increase caloric intake above the recommended values, and try to avoid the following foods:
Strong foods. Very cured cheeses and highly fermented Roquefort type cheeses; pickles, pickles, salted, smoked and others that contain vinegar or lemon juice.
Very fatty foods.
Very salty foods, due to their worse digestibility.
Acidic fruits such as kiwi, orange, grapefruit, plums or pineapple.
Strong or spicy seasonings for being irritating to the gastrointestinal mucosa (paprika, pepper, nutmeg) or vinaigrette-type sauces.
On the other hand, it should be taken in moderation:
Foods that contain a lot of fiber. The total intake of fiber in the diet must be limited.
Raw vegetables. Leeks, asparagus, whole legumes and whole grain products.
The preferred foods are:
Well-cooked vegetables and legumes, passed through the masher, thereby improving their digestibility and tolerance.
Ripe or cooked fresh fruit, roasted or in syrup.
Mild flavors are better, since the flavor excites gastric secretions.
Dyspepsia and colitis
The recommendations are as follows:
Increase fluid intake, but always outside of meals.
Chew food slowly to help insaltivation, thereby improving digestion.
Avoid foods that cause flatulence (artichokes, onions and raw peppers, brassicas vegetables such as cabbage and cauliflower, whole legumes, meats rich in collagen, fatty sausages such as chorizo, chistorra or white sausage).
Also avoid pâté and foiegras.
Include in the diet rice, semolina, tapioca, pasta, boiled potato.
Also include astringent-type vegetables such as carrots.
Among the fruits, choose grated apple (with which we favor its predigestion) ripe banana, quince, compotes, non-acidic fruit juices.
With regard to protein intake, choose non-fat meats and white fish. The preferred culinary technique for eggs is soft-boiled, poached, or in an omelette with very little oil.
It is better if the broth is exclusively made from vegetables; if not, use it defatted.
The contribution of liquids should be abundant in the form of broth, lemon juice, soft infusions (chamomile, pennyroyal, lemon verbena, lemon balm). If you drink coffee, it must be very diluted and if you drink tea, do not let it pass (to avoid the formation of tannins).
Include preferably olive oil as cooking fats. This can also be used as a dressing, which will make better use of its vitamin and antioxidant qualities. If butter or margarine is used, use them in a small quantity and raw.
There are genetic predisposing factors to obesity, but despite this, excess weight gained during pregnancy can predispose to later obesity. This has also been seen to get worse after each pregnancy.
An increase of between 15 and 20 kg during pregnancy can predispose to obesity and this type of obesity is the one with the worst prognosis. The recommendations are as follows:
Eat as balanced a diet as possible during an obese woman’s pregnancy.
Avoid very restrictive diets to avoid possible risks to the fetus.
Preeclampsia is hypertension with proteinuria and / or edema that occurs after the 20th week of pregnancy.
Nutritional deficiencies are believed to be important for the development of hypertension during pregnancy, but there is insufficient evidence to show a cause-and-effect relationship. The recommendations are as follows:
Restrict excessive salt intake.
Diuretics may be indicated.
Normal pregnancy presents a metabolic response with hyperinsulinemia, hyperglycemia, hypertriglyceridemia and a decrease in insulin sensitivity.
If the woman is diabetic, there is an increase in insulin needs and greater ketosis and ketoacidosis.
The recommendations are as follows:
In case of being a diabetic woman, carry out an exhaustive control of maternal hyperglycemia.
To avoid nocturnal hypoglycemia, give a snack before going to bed.
The diabetic pregnant woman should follow a diet similar to the normal pregnant woman with strict control of weight and distribution of meals throughout the day regularly to adapt to insulin guidelines and avoid sudden variations in blood glucose.
Carbohydrates should provide about 45-50% of the total energy value avoiding simple sugars and favoring the supply of fiber to delay the absorption of carbohydrates.
The protein and mineral intake should be slightly higher than a normal pregnancy.
The only supplements that should be administered during pregnancy are iron and folates. In both cases, there are bibliographic sources that widely support its use and, therefore, a clearly favorable risk / benefit ratio.
Do not forget the possibility of interaction, especially between micronutrients.
Theoretically, iron metabolism could compensate without any type of extra contribution the increased needs of pregnancy, as long as the deposits of this nutrient are in adequate conditions.
This is not always the case and the iron stores of most women of childbearing age are at suboptimal levels.
On the other hand, anemia in pregnant women can be considered almost physiological, so it must be given relative importance depending on the hematocrit values that are reached.
Iron supplementation is a nutritional prevention measure that should be started in the second trimester of pregnancy based on 60 mg / day in the form of elemental iron from a ferrous preparation. If it is not tolerated, it is advisable to administer iron in heme form with better absorption and greater digestive tolerance.
They are essential for cell division and for the differentiation of the different tissues of the embryo. If there is a folic acid deficiency, there may be an absence of neural plate closure in the embryo between days 25 and 27 after conception.
The recommended dose is 40 mg per day for women planning a pregnancy. For this reason, folic acid supplements are given preventively from 4 weeks before conception to 8 weeks afterwards.
Some studies show us that the contribution of folic acid reduces anemia and the possible development of cardiovascular diseases.
The folate supply is also capable of maintaining optimal levels of homocysteine in the blood.
Jackson AA, Robinson SM. Dietary guidelines for pregnanacy: a review of current evidence. Public Health Nutr 2001; 4 (2B): 625-30.
Krishnaswamy K, Mahavan Nair K. Importance of folate in human nutrition. Br J Nutr 2001; Suppl 2: S115-24.
Muñoz M, Aranceta J, García-Jalón I. Applied nutrition and diet therapy. Pamplona: Eunsa, 1999; p.524-38.
Rivero M. Nutrition and dietetics. Sanitary aspects. Madrid: General Council of COF, 1993; p.353-78.
Salas-Salvadó J, Bonada A, Trallero R, Saló ME. Nutrition and clinical dietetics. Barcelona: Masson, 2000; p.99-106.
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