Newspaper "News of Medicine and Pharmacy" Gastroenterology (348) 2010 (thematic issue)

During the period of intrauterine development, the baby’s body completely depends on the lifestyle of the expectant mother. If a woman does not experience nervous overload, gets full rest, and eats right, then the child feels protected. Particularly conscious young ladies switch to a proper diet even when planning a pregnancy. However, in most cases, questions about nutrition during the perinatal period arise after an event has occurred. Advice from gynecologists, nutritionists, and pediatricians will help you develop a personal menu.

Nutrition during pregnancy raises many questions. Firstly, the older generation advises “eating for two”, and women are afraid of gaining extra pounds. Secondly, hormonal changes in the body dictate new gastronomic preferences. Fearing harm to the child, the expectant mother is lost between “would I like to” and “can I?” Thirdly, the pseudo-medical advice on nutrition that is poured in abundance on women from social networks is confusing. How to choose healthy foods, safe cooking methods, and create a diet during pregnancy? Read our article.

Nutrition during pregnancy

Organization of nutrition during the perinatal period is aimed at maintaining the health of the woman and ensuring the harmonious development of the baby. The main tool in achieving the goal is the responsible attitude of the expectant mother to her daily diet. Poor nutrition during pregnancy results in nutritional deficiency. This leads to the occurrence of intrauterine pathologies, complications of gestation, increases the chances of the child developing autoimmune reactions, and activation of unfavorable genetics (hereditary predisposition to diseases).

The causes of nutritional imbalance in the body of a pregnant woman are:

• Calorie deficit and surplus. The low energy value of the diet forces the baby’s body to turn on the mechanism of accelerated absorption of everything that the mother eats. Nutrigeneticists claim that the habit of eating everything continues after birth, threatening obesity. In the female body, a lack of calories is reflected in the weakness of the uterine muscles. There is a danger of miscarriage. Excess calories lead to excess weight gain, and this puts stress on joints, blood vessels, and the risk of developing gestational diabetes mellitus, hypertension, and varicose veins. • Lack of vitamins. Hypovitaminosis during pregnancy is a direct threat to the life and health of the child. Deficiency of vitamins A and E slows down fetal growth and provokes premature birth. Deficiency of B1, B9 causes defects in the development of the nervous system. Vitamin D deficiency is the cause of neonatal rickets and visual impairment. Hypovitaminosis B2 results in heart defects, cleft palate, and deformation of the arms and legs of a newborn. • Lack of minerals. Microelements participate in embryonic development no less than vitamins. Copper deficiency leads to a decrease in the immune status of mother and child, calcium, phosphorus - to demineralization of fetal bone tissue, iodine - to a delay in the neuropsychic development of the baby, iron - to iron deficiency anemia in a pregnant woman, the threat of miscarriage, magnesium - to premature birth, development arrhythmias in the mother, zinc - to slow growth of the embryo.

Eating right means ensuring your child’s stable growth and development, and protecting yourself from perinatal risks and complicated childbirth. A pregnant woman needs to eat not “for two,” but “for two.”

Approximate vitamin and mineral norm per day (in mg)

Minerals

• calcium - 1200
• phosphorus - 700
• magnesium – 360
• iodine - 200
• zinc - 15
• iron - 30
• copper - 2-3

Vitamins

• retinol (A) - 1.2
• thiamine (B1) - 1.8
• pyridoxine (B6) - 2.1
• folic acid (B9) - 400 mcg
• tocopherol (E) – 10
• ergocalciferol (D) – 500IU
• ascorbic acid (C) – 100

To prevent vitamin and mineral deficiency, it is recommended to supplement your diet with special vitamins for pregnant women.

Difficult first trimester

The female body adapts to new conditions. Fatigue, drowsiness, and unstable mood are typical for a pregnant woman. There are problems with urination and bowel movements, acute reactions to tastes and smells. And at this time, the foundation of the baby’s health is laid. His nervous and circulatory systems are formed, and his heart begins to work intensively. Proper nutrition in the first trimester is a way to stabilize the mother’s condition and mitigate the risks of intrauterine anomalies.

Principles for creating a diet in the 1st trimester:

• Don't be greedy. Overeating increases the symptoms of toxicosis and provokes digestive failure. You need to eat in modest portions at intervals of 3-3.5 hours. • Take care of “building materials”. The basis for the formation of fetal cells is protein. From it the body receives 20 essential amino acids that it cannot produce on its own. The menu should include lean meat - turkey, chicken, veal. Twice a week you need to eat fish, alternating low-fat varieties (pollock, cod) with fatty ones (salmon, pink salmon, salmon). • “Agree” with the intestines. The problem for many women at the beginning of pregnancy is constipation. Fiber, which is found in raw vegetables, hard fruits, and bran, helps to cope with them. • Replenish supplies. During the formation of the nervous system, the baby squeezes iodine and B vitamins from the mother’s body. To prevent vitamin and mineral deficiency, shrimp, squid, seaweed and cauliflower, buckwheat porridge, eggs, and nuts should be introduced into the diet. • Do not experiment with drinks. It is recommended to drink water - still bottled or filtered. Adding freshly squeezed lemon juice will help calm nausea.

Daily caloric intake is 2500-2700. Nutrient distribution: proteins - 110 g, carbohydrates - 350 g, fats (vegetable + animal) - 75 g.

What are the symptoms of heartburn and indigestion?

Broadly speaking, symptoms of reflux may include:

• Sour taste in the mouth, sometimes accompanied by nausea;

Hoarseness and a bitter taste in the mouth – this condition is also called “silent reflux” or reflux esophagitis.

If we talk about heartburn, it is characterized by the following sensations:

• Burning pain in the chest area, most often behind the sternum;
• Sensations of compression in the chest area.

Heartburn may last for a few minutes or several hours, especially if you suffer from severe heartburn.

Indigestion usually manifests itself in the form of:

• Pain in the lower chest, abdomen and stomach (usually occurs after eating, although this is not a necessary condition);
• Feelings of fullness; in this case, you feel bloating in the stomach area;
• Belching;
• Nausea and even vomiting.

Second trimester - needs increase

By about 14-15 weeks, the woman’s well-being returns to normal - toxicosis goes away, physical and emotional activity increases. The baby begins to produce blood cells, strengthens bone tissue, the pituitary gland begins to work, the first hair and nails appear, bone mineralization progresses, and muscles begin to contract. To meet the increased needs of the child, the mother needs to eat more. At the same time, it is not the caloric intake that needs to be increased, but the amount of nutrients. At this time, both organisms need vitamin D, calcium, and iron.

Mandatory foods in the diet:

• to provide calcium - cheese, cottage cheese, milk, almonds, sesame seeds; • sources of vitamin D - fatty fish, cod liver, eggs, butter, flaxseed, olive oil; • for the prevention of iron deficiency - beef and pork liver, cocoa, beans, cabbage, apples, blueberries, greens (spinach, parsley, mint). In the second trimester, it is important to control the amount of table salt and fluid you drink. This will help avoid surges in blood pressure and cardiac overload. Recommended values: calories - 2800-3000, proteins - 120 g, fats - 85 g, carbohydrates - 400 g.

Third trimester - diet correction

From the 27th week of pregnancy, the female body begins to prepare for childbirth, and the baby begins to be born. At this time, gastronomic fads give way to heartburn, constipation, shortness of breath, swelling, and rapid weight gain.

A properly composed menu will help you adjust your well-being in the 3rd trimester. What should be done:

• Reduce the amount of protein foods. A protein surplus leads to kidney dysfunction and the accumulation of uric acid. • Avoid heartburn triggers - sour foods, black coffee, fried foods. • Replace 50% of animal fats with vegetable oils. They contain essential polyunsaturated acids Omega-3 and Omega-6, which are not synthesized by the body, but are needed for the absorption of minerals and vitamins. • Limit salty foods. Salt is the cause of edema, unstable functioning of the kidneys, heart, and blood vessels. • Set a limit on sweets. Simple carbohydrates quickly turn into extra pounds, causing flatulence, dyspepsia, and skin problems. • Eat more vegetables, fruits, berries, greens. Natural sources of vitamins provide energy and strengthen the immune system - this will come in handy during childbirth. Standards for KBJU: calories - 2900-3100, proteins - 100 g, fats - 75 g, carbohydrates - 400 g.

Features of treatment

Before eliminating an unpleasant taste in the mouth, it is imperative to find out the cause of its appearance. To do this, you first need to consult with a therapist, who, after an initial examination and interview, will refer you to a gastroenterologist. Depending on the disease, treatment may involve taking medications or adjusting your diet.

Diet food

If an unpleasant taste appears, especially if it is a symptom of a digestive tract disease, the pregnant woman needs to change her diet. A few recommendations for creating a diet menu:

• exclude smoked, fatty, fried foods from the menu;
• include fresh vegetables and fruits in your diet, but do not get carried away with cabbage and legumes;
• eat more iron-containing foods - buckwheat, apples, pomegranates, seaweed and liver;
• The basis of the dishes should be lean meat and fish, which can be boiled, baked in the oven or steamed.

Equally important is the frequency and regularity of food intake. If you have gastrointestinal diseases, you need to eat often, but the portions should be small. Under no circumstances should you overeat, but you shouldn’t starve either.

Drug therapy

What medications can help with bitterness or sourness in the mouth? Medicines for pregnant women are prescribed only by a doctor, taking into account medical indications. The treatment regimen directly depends on the cause of the unpleasant taste in the mouth. The following groups of medications are most often prescribed:

• prokinetics - affect the motor function of the stomach (Domperidone, Cerucal, Motilium, Itoprid, Fractal, Osetron);
• antisecretory drugs - Rennie, Almagel, Maalox, Phosphalugel;
• preparations containing iron - Maltofer, Aktiferrin, Sorbifer, Ferlatum, Venofer;
• enzymes to improve digestion - Pancreatin, Creon, Mezim, Festal, Somilase;
• multivitamin complexes - Elevit, Vitrum, Complivit Mama, Pregnakea, Materna, Femibion.

Traditional medicine

How to get rid of acid or bitterness in the mouth using traditional methods? The most effective decoctions of medicinal herbs and vegetable juices are:

• To eliminate bitterness, it is recommended to regularly drink vegetable juices, especially carrot juice;
• Potato juice is suitable for rinsing;
• if the unpleasant taste in the mouth is associated with dental problems and inflammation of the gums, rinsing with chamomile decoction will help;
• To disinfect the oral cavity, it is recommended to rinse your mouth with a solution of soda and salt.

What should you not eat or drink?

There is no place for harmful foods in a properly composed diet for a pregnant woman. Throughout the perinatal period, the following are blacklisted:

• fast food; • flavored snacks; • hot sauces; • smoked meats; • products containing many preservatives; • alcohol.

The expectant mother is advised to limit the consumption of sausages, confectionery products, and sweet pastries. You also need to be careful with citrus fruits, strawberries, mushrooms, and coffee. It is advisable to exclude packaged juices, bottled tea, sweet cocktails, and soda from the grocery basket.

Dieting is difficult, but necessary. This will help minimize the harmful effects on the fetus, maintain pregnancy, improve well-being, avoid weight gain, and the development of gestational complications - preeclampsia, pyelonephritis, diabetes.

Acid and sweet

Acidity in the mouth is not a very pleasant sensation

A pure taste sensation is rare. Since there are receptors in the oral cavity for determining and analyzing various combinations.

In a pathological process, acid may predominate, but in most cases other flavors are also present. This provides additional information to find the cause of the unpleasant sensation.

Sweet and sour taste is caused by the following conditions:

1. increased blood glucose levels due to stress, physical exertion;
2. state of depression;
3. excessive consumption of sweets;
4. disruption of the gastrointestinal tract;
5. liver pathologies;
6. toxic effects of pesticides, gaseous chemicals;
7. smoking cessation period;
8. diabetes with a slight increase in blood glucose levels, a latent form of the disease;
9. pathologies of the maxillofacial system, which are accompanied by purulent processes - gum disease, caries, periostitis, gumboils and abscesses.

Before contacting a doctor, you should analyze the factors that contribute to the appearance of a sour taste in the mouth.

Diet rules

The principles of constructing a diet during the perinatal period differ little from the general rules of healthy eating. After all, pregnancy is not a disease.

Organizing a proper diet includes:

• Refusal of junk food and drinks. Carcinogens, preservatives, flavorings, flavor enhancers, and alcohol increase perinatal risks. • Control of KBJU. Helps maintain stable weight and nutritional balance. • Daily consumption of healthy foods containing protein, minerals, vitamins. These substances are necessary for the development of the fetus and the health of the mother. • Compliance with the drinking regime (1.5-2 liters per day). Clean water ensures normal blood flow, regulates the functioning of the urinary organs and intestines. • Small meals: 5-6 times a day with an interval of 3-4 hours. This schedule helps you not to overeat and properly absorb nutrients. • Cooking foods in healthy ways. Cooking dishes by boiling, stewing, and baking allows you to reduce calories, reduce the load on the digestive organs, and get rid of nausea and heartburn. • Limiting salt. A slight salt deficiency during pregnancy reduces the load on the kidneys and heart muscle and prevents the appearance of swelling. • Limit on fast carbohydrates. The body gets glucose from sweet foods, the main source of energy, so you can’t give them up completely. But excessive passion for confectionery products leads to metabolic failure, obesity, and the development of insulin resistance. • Keeping a food diary.

The diet for pregnant women has its bonuses. A woman will master healthy menu recipes, get used to eating right, and easily get into shape after giving birth. Of course, you shouldn’t make a cult out of food, forgetting about your own comfort and appearance. Special underwear for pregnant women will help you feel confident, and hypoallergenic products will take care of the beauty of your skin - stretch mark creams, gels, balms. Today, all products for pregnant women and nursing mothers can be ordered from an online pharmacy with home delivery.

Early signs of pregnancy

For women with a regular monthly menstrual cycle, the earliest and most reliable sign of pregnancy is a missed period. However, there are other early signs of pregnancy that you should also pay attention to.

During pregnancy, a distinction is made between obstetric and embryonic periods.

Gynecologists count the obstetric period from the first day of the last menstruation, due to a simpler calculation, since the exact date of ovulation and conception is difficult to determine.

How do the first symptoms of pregnancy appear:

Each woman is individual, which means the first signs of pregnancy are not always identical. In this connection, it is difficult to notice the first symptoms, which may occur even before the delay.

The complete absence of early symptoms of pregnancy in the first weeks is very rare, and this is due to the increased level of sensitivity of the woman’s body to hCG (a hormone produced by the embryo in the first 14 days of its development).

And since this condition is not observed often, in most cases, it is still not difficult to notice the period of the first symptoms of pregnancy.

Among which a woman has:

1. Feeling sick or vomiting (usually called morning sickness, but can happen at any time of the day or night).
2. Metallic taste in the mouth.
3. Flatulence (bloating).
4. Dizziness.
5. Feeling tired (common during pregnancy).
6. Increased emotionality, depressed mood.
7. Chest pain (manifests in the early stages).

At the same time, you may notice other signs of pregnancy:

• Constipation;
• Increased vaginal discharge (without pain or irritation);
• Strange tastes, smells and cravings for foods that previously disgusted you;
• Or, conversely, in the early stages of pregnancy you may find that you no longer enjoy some foods and drinks that you previously enjoyed;
• Loss of interest in smoking;
• The breasts become larger and there are diseases, as before menstruation;
• Veins may become more visible and nipples may darken and stand out.

In the early stages of pregnancy, frequent urination may be a concern. And such symptoms are easily confused with cystitis. This is why treatment without consulting a doctor can be harmful.

So, if you crave new foods, lose interest in certain foods or drinks you used to enjoy, such as tea, coffee or fatty foods, have a more sensitive sense of smell than usual, such as the smell of food or cooking, you often go to the toilet - talk to your doctor.

If you're sick all the time and can't suppress anything, see a therapist.

You may have hyperemesis gravidarum, a serious condition during pregnancy that causes severe vomiting and requires treatment.

Can pregnancy occur during menstruation?

Pregnant women sometimes experience bleeding that feels like a very light period, with some spotting. This is called “implantation bleeding,” which women confuse with real menstruation. This condition does not require treatment and, especially, the prescription of hormonal drugs - progesterone!

According to leading gynecologists, discharge in the early stages of pregnancy is almost always possible. However, implantation bleeding stops a little earlier than menstruation.

And this happens due to the fact that the fertilized egg, trying to attach to the wall of the uterus, causes slight bleeding.

Therefore, we can say with confidence that pregnancy does not happen if you have your period. If normal menstruation occurs, it means that the egg was not fertilized.

Delayed menstruation without accompanying symptoms is also not the main criterion for pregnancy. Since the reason may lie in a woman’s hormonal imbalance, which is provoked by stress, nervous strain, heavy physical activity or gynecological pathologies.

It is always very important to listen to your health and visit a gynecologist in a timely manner - this will help not only not to miss the first signs of pregnancy, but also gynecological pathologies.

What to do if you notice the first symptoms of pregnancy?

If you find clear signs of pregnancy in the first two weeks, you need to consult a gynecologist.

If pregnancy is confirmed, you need to listen to the doctor’s recommendations, get rid of bad habits (if any) and adjust the correct diet.

And of course, don’t forget about planned visits to the gynecologist, which are prescribed by the doctor on an individual basis.

Planned appointments for ultrasound examinations, tests, monitoring are the responsibility of the gynecologist managing the pregnancy.

During pregnancy, three scheduled ultrasounds are prescribed - once in the first trimester, in the second and sometimes in the third.

Additional unscheduled ultrasound examinations of a pregnant woman may be performed according to individual indications. This should not scare you, as it is necessary for making timely decisions to avoid certain complications.

Comprehensive support for women during pregnancy, qualified organization and support of childbirth is the main specialization of the Irkutsk City Perinatal Center. Here, all young mothers receive full medical care with an individual approach from doctors.