In addition women are choosing to have children at an older age eg. while the fertility rate for woman between the ages of 15-29 has declined by up to 50%, the number for the 30-39 years age group has increased by up to 94%. These changes reflect the range of choices and the better economic status of women.
The time from conception to birth is 280 days (or 10 lunar months). The length of the pregnancy is calculated from the first day of the last menstrual period to birth - this gives the probable date of the birth. An ultrasound during pregnancy may also help to establish the actual date.
Health Care During Pregnancy
The most important outcome of pregnancy is a healthy baby of adequate birthweight - low birthweight is an indication of increased risk of ill-health and death. Risk factors for low birthweight include age and previous births, socio- economic status, smoking, alcohol, drugs and poor diet - the last 4 are all avoidable risks. Statistics show that low birthweight contributes to the incidence of asthma, behaviour problems and even IQ during early school years.
Some scientists even believe that healthy development of the foetus, associated with adequate nutrition, can shape our health throughout life. Professor David Barker of the Medical Research Council at England's University of Southampton suggests that primary protection from heart disease, stroke, osteoporosis and diabetes depends on nutrition of the foetus.
The exact physiological cause of morning sickness is yet to be established, however 50% of women suffer the symptoms of nausea and vomiting in the morning, or even throughout the day. Morning sickness usually resolves after the first trimester, and there are a number of natural remedies which can alleviate symptoms, including vitamin B6 and powdered ginger. Peppermint tea is also helpful in relieving symptoms - good advice would be to drink a cup of peppermint tea and eat a piece of toast before getting out of bed, and two more cups during the day.
It is normal during pregnancy to feel tired and fatigued, and should be taken as a sign that the body needs rest. Iron deficiency may also contribute to fatigue.
Heartburn and indigestion are prevalent in the final 3-4 months of pregnancy. Heartburn is a result of the stomach acids flowing back into the oesophagus, causing burning pain. This is a result of the pressure of the growing foetus on the stomach - the pressure can be reduced by eating smaller meals more often, and by minimising fatty and spicy foods in the diet.
It is normal to retain fluid during pregnancy, particularly during the latter stages. Hot weather and standing for long periods may exacerbate the problem. Try to drink at least 5 glasses of water each day - it is important to remember that cutting down on water intake will not help reduce fluid retention and, in fact, water itself has a diuretic effect and will aid kidney function. However, if fluid retention is severe, consult your healthcare professional.
It is normal to increase weight by 10 to 13kgs during pregnancy. The added weight is in the placenta, amniotic fluid, membranes, breasts and uterus, and in the increased blood volume.
High Blood Pressure
High blood pressure (hypertension) during pregnancy is potentially dangerous - if you suspect you are suffering hypertension, consult your healthcare professional. Both your weight and the foods you eat play an important role in the prevention of hypertension.
This condition is characterised by fluid retention and hypertension, and potentially leads to complications later in the pregnancy. It is a serious condition, it must be diagnosed and should be managed in hospital.
A woman's reproductive role requires special nutritional needs - pregnancy is the most nutritionally demanding period of a woman's life.
Optimal nutrition is necessary to support:
- Growth of the placenta An increase in blood volume An increase in cardiac output An increase in fluid levels Hormonal changes Changes to breast tissue in preparation for breastfeeding Alterations to lung, kidney, urinary and reproductive functions.
Optimal nutrition starts before conception - a good example is the B group vitamin folate (called folic acid in supplement form). This vitamin is required for the normal development of the nervous system, particularly the closure of the neural tube which occurs during the first 6 weeks of pregnancy. Women may not know that they are pregnant for up to 4 weeks, so ensuring adequate nutrient intake of folate around the time of conception is essential. For this reason the National Health and Medical Research Council recommends that all women planning a pregnancy should take at least 400 mcg of folate daily for one month prior to planned conception (women at higher risk may be advised to take more). Supplementation should continue throughout the first trimester. If the neural tube fails to properly close, birth defects such as spina bifida may result - these defects affect one in five hundred pregnancies in Australia.
With the exception of sodium and potassium the recommended dietary intake (RDI) of all essential vitamins and minerals is higher during pregnancy (and breastfeeding). Data from the Australian Bureau of Statistics however reveal that women are not ingesting the RDI level. For example, 96% have less than the RDI for zinc, and almost 97% fail to ingest sufficient folate. An astonishing 100% of pregnant women do not consume sufficient iron, while 60% are deficient in magnesium and 79% do not receive sufficient calcium from the diet. Calcium needs for mother and baby double during pregnancy; calcium is vital for the development of bones and teeth, and some studies show that calcium supplementation may actually prevent post-natal depression.
Essential fatty acids (EFAs) in the diet also affect development of the foetus. One of the most important EFAs is called docosahexaenoic acid (DHA), which is found in fish (and also in breast milk). Some studies show that the amount of DHA in breast milk has fallen by around 35% over the last 10 years due to changes in diet. DHA has a biological role in the structure and function of the brain, retina and nervous system. The brain of the developing baby grows rapidly during the last trimester and is dependent upon the mother's intake of DHA. Clinical studies have shown that increasing the mother's intake of DHA through supplementation with fish oil (oil from fish such as tuna is high in DHA) results in higher blood levels of DHA in the newborn. The brain continues to grow and develop rapidly for the first year and an adequate supply of DHA is necessary over this period.
Requirements for iron increase markedly during pregnancy, particularly during the second and third trimesters. It is essential for the production of healthy red blood cells to carry oxygen to all tissues in the body including the placenta.
Meat sources of iron contain the haem form of iron which is well absorbed in the body. Vegetarians are at greater risk of iron deficiency in pregnancy than meat eaters. Vitamin C increases the absorption of the non-haem iron found in vegetable sources.
Dietary modifications of both parents should ideally be addressed at least 4 months prior to conception and maternal diet maintained throughout pregnancy and the nursing period.
- Eat most: whole grains including breads, cereals, rice, pasta; fruit and vegetables. Eat moderately: protein rich foods including fish, chicken, legumes, nuts, seeds, eggs, dairy products and meat. Eat occasionally: monounsaturated fats e.g. olive, and canola oils Limit: sugar, salt, tea, butter, polyunsaturated fats e.g. sunflower and safflower oils. Avoid: saturated fats e.g. animal fats, coffee, alcohol, cigarettes.
After the first trimester, energy requirements increase on average by about 600 kilojoules per day. Making nutritious food choices should ensure a desired weight outcome. Although a variety of factors may influence weight gain in pregnancy, a gain of 0.7-1.3 kg during the first 3 months and 2 kg per month during the 2nd and 3rd trimesters is considered average.
A moderate amount of exercise such as walking, swimming, or yoga, will encourage fitness, strength and flexibility which will not only enhance well-being in pregnancy, but also be of great benefit during labour.
Nutrition and Breastfeeding
An additional 2500kjs per day is required to produce energy during lactation. Maintain healthy eating habits as recommended for pregnancy to ensure optimal nutrition. Consume 2 litres water per day and pay special attention to calcium needs to ensure adequate milk production. Herbal teas which encourage lactation include fennel and fenugreek.