Preface: With the economic development of the mainland and the change of residents' lifestyle, the diet and nutritional status of pregnant women have been greatly improved compared with the past, but there are still many families who are worried that pregnant mothers do not have enough nutrition during pregnancy, and they are even more afraid that abnormal pregnancy test indicators will affect the baby's health, and the Internet is full of various taboos about pregnancy diet and rumors that are difficult to distinguish between true and false by elders, etc., which make many pregnant mothers confused. In view of how to eat scientifically, manage weight, supplement nutrition and how to adjust diet if you suffer from gestational diabetes, we specially invited Director Tian Junmei of the Department of Nutrition of Luoyang Central Hospital to answer them one by one in the live broadcast room.
Highlights of this issue:
Question 1: As everyone's living conditions are getting better and better, the new generation of pregnant mothers is also paying more and more attention to nutrition during pregnancy, not only pregnancy, but also pregnancy, not only raising children, but also raising healthy children, then will there be nutritional problems in pregnant women now?
A: At present, the nutrition and health of pregnant women in mainland China are facing new challenges, such as: unreasonable dietary structure, excessive eating, insufficient physical activity, excessive weight gain, unhealthy lifestyle, etc., and the problem of overweight and obesity is also more prominent, and some people have micronutrient deficiencies such as iron, calcium, iodine, folic acid, vitamin D, etc. The diet during pregnancy should consist of a balanced diet of multiple foods for balanced nutrition, combined with appropriate physical activity and a healthy lifestyle, to ensure good nutritional status of the mother and baby, as well as short- and long-term physical and mental health.
Problem 2: If you don't eat well, nutrition can't keep up; Make up more, but I am afraid that it will not be enough... What to eat and how to eat has become the most troublesome problem for expectant mothers throughout pregnancy, Director Tian, you tell everyone, how should you eat during pregnancy? How to eat scientifically?
A: The diet during pregnancy is simply summarized into three points: moderation, balance and variety.
First of all, the right amount: it is necessary to ensure that the amount of diet meets the standard, so that the amount of various nutrients can keep up. However, pay attention not to excessive intake, because excessive nutritional intake will not only increase the burden on the body, but also lead to obesity during pregnancy, and then increase the risk of gestational diabetes, pregnancy-induced hypertension, etc. The second is balance: that is, the diet should be "rain and dew", not picky eaters, not partial eating is the basis of pregnancy diet, so as to ensure that all kinds of nutrients are not left behind, are not lacking. Some pregnant mothers eat the food they like, but snub the food they don't like to eat, which may increase the risk of some nutrient deficiencies. The third is variety: the pregnancy diet should be a nutritionally balanced diet composed of a variety of foods. "Chinese Pregnant Women's Balanced Diet Pagoda" recommends that pregnant women should consume a certain amount of cereals, potatoes, vegetables and fruits, fish, poultry, eggs, lean meat, milk, soybeans, nuts, iodized salt and vegetable oil every day, these foods should appear on our pregnant mother's table every day, and more than 12 kinds of food per day, reaching more than 25 kinds per week. An appropriate, balanced and varied diet during pregnancy can ensure sufficient nutrition and avoid nutrient deficiencies and pregnancy-related nutritional problems during pregnancy.
Question 3: During pregnancy, pregnant women's physical functions change, and there are many taboos in diet, so what specific foods can not be eaten during pregnancy?
A: There are many foods that are taboo to eat during pregnancy on the Internet and among the people, and there are different statements, which make everyone very confused, in fact, pregnant women need to strictly avoid food, there are three main types:
➊ Raw or not fully cooked food;
➋ Milk and dairy products that have not been sterilized;
➌ Alcoholic beverages and food;
Avoid these minefields, and what you loved to eat before pregnancy, you can also eat after pregnancy.
In addition to some foods that pregnant women cannot eat, we ordinary people also need to pay attention to: beans such as green beans, lentils, red kidney beans, white kidney beans and other beans can cause poisoning when raw or not completely heated. Raw soy milk contains toxic ingredients such as antitrypsin, which must be thoroughly cooked before drinking, otherwise it can cause food poisoning. The toxin in the sprouting site of the potato is solanine, which is dozens to hundreds of times higher than the fleshy part inside the potato, which is easy to cause poisoning after ingestion, and severe cases can cause heart failure, respiratory center paralysis, etc. Fresh yellow cauliflower contains colchicine, this toxin can cause dry throat, stomach burning sensation, hematuria and other poisoning symptoms, before eating, you need to cook the yellow cauliflower, cook it thoroughly and then boil it with boiling water, and then cook and eat. Also, rotten ginger produces a highly toxic form of safrole. Even small amounts can cause hepatocyte toxicity and degeneration. All of the above requires our pregnant mothers to pay attention to avoid eating these foods during pregnancy.
Question 4: As one of the most important factors, nutrition plays a vital role in the health of both the pregnant mother and the baby. Also, do I need to supplement with nutrients during pregnancy?
A: The diet during pregnancy should be as diverse as possible and reasonably matched. 1 egg a day, 2-3 taels of lean meat, 1 serving of soy products (such as 1 cup of soy milk or 2 taels of tofu), 1 kg of milk, 1 kg of vegetables, and half a catty of fruit. 4-6 staple foods in the first trimester and 6-8 staple foods in the second and third trimesters, of which whole grains and miscellaneous legumes are not less than 1/3; Fresh leafy greens or dark vegetables such as red and yellow account for more than half. Increase the intake of milk, fish, poultry, eggs and lean meat during pregnancy. It is recommended to increase the total amount of fish, poultry, eggs, and lean meat every day from the end of pregnancy. Fish of the same weight provides essentially the same amount of high-quality protein as livestock and poultry food, but fish contains significantly less fat and energy than livestock and poultry. Therefore, when pregnant women gain more weight, they can eat more fish and less livestock and poultry, do not eat meat skin and fatty meat, and give preference to beef with less fat content. In order to ensure the need for animal iron, it is recommended to eat animal blood or liver 1~2 times a week. In addition, fish, especially deep-sea fish, contain more Omega-3 polyunsaturated fatty acids, of which docosahexaenoic acid (DHA) is beneficial to the development of fetal brain and retinal function, it is best to eat fish 2~3 times a week. It is said that pregnant women eat alone and supplement by two people, but if you eat big supplements with the old concept, it will make pregnant mothers soar in weight, increase the risk of gestational diabetes, gestational hypertension and excessive fetal weight, resulting in difficult delivery. Although there are problems with crazy supplementation during pregnancy, incorrect or insufficient supplementation of key nutrients is also a big problem. At different stages of pregnancy, pregnant mothers have different nutrient focus needs.
First trimester (0~3 months): folic acid + iodine + iron + carbohydrate + DHA.
Second trimester (4~6 months): high-quality protein + folic acid + iron + iodine + calcium + DHA.
Third trimester (7~9 months): iron + calcium + high-quality protein + DHA.
If the diet during pregnancy is not balanced and diverse, it is necessary to focus on supplementing relevant nutrients under the guidance of a dietitian.
Question 4+: Speaking of nutritional supplements, we have to mention linolenic acid, which is an "essential fatty acid" for human health and plays an important role in human life activities, as well as "plant brain gold" and "blood nutrients", so what is this linolenic acid? How should I supplement during pregnancy?
Answer: α-linolenic acid belongs to the N-3 series of fatty acids, α-linolenic acid is the basic substance of cell membranes and biological enzymes, which plays an extremely important role in human health. However, the human body cannot synthesize it itself, and must meet the needs of the human body through food or exogenous supplementation. α-linolenic acid is the parent of the n-3 series of polyunsaturated fatty acids, its carbon chain can be extended to longer chain polyunsaturated fatty acids, in the body can be converted to EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). It plays a decisive role in the formation and development of the fetal brain. It can promote brain development, improve nervous system function, enhance retinal function development. α-linolenic acid is mainly found in some vegetable oils, and soybean oil, perilla seed oil and flaxseed oil contain more α-linolenic acid. During pregnancy, you need to pay attention to the intake of a certain amount of high linolenic acid vegetable oil, but the nature of α-linoleic acid is unstable, easy to oxidize, it is recommended to choose a small bottle of flaxseed oil or perilla seed oil when buying, eat as soon as possible after opening the bottle, add an appropriate amount when making a cold dish, it is not recommended to drink oil directly to supplement. Secondly, you can also choose dietary supplements with high content of α-linolenic acid to meet the nutritional needs during pregnancy.
Question 5: It is said that "pregnant women eat one person, two supplements", so many pregnant mothers have no scruples and open the abstinence, so for the health of pregnant mothers and babies, how much weight gain during pregnancy is appropriate?
A: Weight monitoring and management should start from the pregnancy preparation period, weigh at least once a week, and make the weight increase in an appropriate range throughout the pregnancy, which is conducive to the pregnant mother and baby to obtain a good pregnancy process and outcome. On average, the total weight gain of 12kg during pregnancy is more appropriate, of which the weight gain in the first trimester does not exceed 2kg, and the weight gain in the second and third trimesters is about 350g per week. For pregnant women with preconception weight in the normal range, weight gain during pregnancy is 8-14kg, if pregnant women who are overweight before pregnancy (BMI≥24), weight gain is recommended at 7-11kg, if pregnant women who are obese before pregnancy (BMI≥28), the weight gain during pregnancy is controlled as much as possible at 5-9kg, if the preconception weight is low, relatively thin (BMI: 11-16), pregnancy weight can be appropriately gained, can gain 11-16kg. Suitable weight gain during pregnancy is conducive to ensuring nutrition for mother and baby and achieving good pregnancy outcomes.
Question 6: As an expert in nutrition, you will definitely be often asked the question by pregnant mothers, "Doctor, how to supplement folic acid during pregnancy?" Doctor, how to supplement iron during pregnancy?", you are here to give you the answer, how can you meet the need for folic acid and iron during pregnancy?
A: First of all, foods rich in folic acid mainly include animal liver, eggs, legumes, yeast, green leafy vegetables, fruits and nuts. However, folic acid present in natural foods is being cooked or easily decomposed when exposed to heat, resulting in the body not being able to absorb it. Folic acid supplementation is another form of folic acid, which has good stability and high absorption. Supplementing 400 μg of folic acid per day before pregnancy for 3 months can effectively prevent the risk of neural tube malformation in children, and continue to supplement 400 μg of folic acid per day during pregnancy to meet the needs of themselves and the fetus. Secondly, iron-rich foods mainly include animal blood, liver and red meat, the absorption rate is much higher than that of plant food, eat 1-2 taels of lean meat every day, 1 to 2 times a week animal blood or liver 20~50g, can meet the body's need for iron. In addition, the intake of fresh vegetables and fruits containing more vitamin C can help improve the absorption and utilization of iron in the diet.
Question 7: Iodine is also one of the essential trace elements of the human body, if pregnant mothers have insufficient iodine supply in the diet during pregnancy, what harm will it bring? How to supplement iodine during pregnancy?
A: Iodine deficiency can lead to fetal dysplasia, and iodine deficiency during pregnancy may affect the baby's intellectual development and even cause cretinism, commonly known as cretinism. According to China's "Edible Salt Iodine Content" standard, the daily salt intake of 5g can be calculated to ingest about 100μg of iodine, which basically reaches the recommended amount for adults; The need for iodine during pregnancy should also be increased by 110 μg per day, that is, it should reach 210 μg per day. Considering that early pregnancy will cause morning sickness, anorexia and other symptoms that affect nutritional intake, it is recommended that women during pregnancy and pregnancy consume iodine-rich seafood 1~2 times a week in addition to iodized salt, such as: kelp, seaweed, wakame, shellfish, etc. It is effective in reducing the risk of iodine deficiency.
Question 8: Yes, it is important to properly supplement the trace elements needed by the body! It is understood that vitamin D deficiency is still very common worldwide, so what foods can provide vitamin D?
A: The content of vitamin D in natural foods is low, the vitamin D we obtain is mainly synthesized by ultraviolet radiation of the skin, pregnant women receive an average of 10~20 minutes of sunlight every day, and the synthesized vitamin D can basically meet the needs of the body. But now many people have a lot of indoor activities, go out to wear sunscreen, wear sunscreen clothing, umbrellas, etc. to protect against the sun, so the proportion of vitamin D deficiency is quite high, especially in the winter lack of sunlight or outdoor activities are insufficient, women who cannot synthesize vitamin D through sunlight need to take vitamin D supplements 10ug a day to supplement.
Question 9: In the early stages of pregnancy, morning sickness made many mothers have palpitations, and some vomited for many days in a row, unable to eat, what should I do about this situation?
Answer: Early pregnancy reaction is a normal physiological phenomenon, and women in the first trimester who do not have obvious reactions can continue to maintain a balanced diet before pregnancy; Pregnant mothers with obvious morning sickness or poor appetite do not need to overemphasize a balanced diet and regular meals, and can choose light and palatable and easily digestible foods according to their personal dietary preferences and tastes, and eat small and frequent meals. Pay attention to ensure the most basic energy supply, and consume at least 130g of carbohydrates every day. Prefer carbohydrate-rich, easily digestible foods such as rice, noodles, toast, baked bun slices, soda crackers, etc. Secondly, various pastries, potatoes, root vegetables and some fruits also contain more carbohydrates, which can be selected according to the taste of pregnant women. The main components of edible sugar, honey, etc. are simple carbohydrates, which are easy to absorb, and when the amount of food is small or morning sickness is severe, the carbohydrates needed by the body can be quickly replenished. Pregnant women who do not meet basic dietary goals should seek medical help, and patients with hyperemesis gravidum require intravenous supplementation if necessary.
Question 10: Life lies in sports, proper exercise during pregnancy can enhance physical fitness, relieve the pressure and fatigue of expectant mothers, so how to carry out appropriate physical activities during pregnancy?
A: If there are no medical contraindications during pregnancy, it is recommended that pregnant mothers do 30 minutes of moderate-intensity physical activity every day in the second and third trimesters. Common moderate-intensity exercises include: brisk walking, swimming, playing ball, yoga for pregnant women, various household chores, etc. Pregnant women can choose familiar types of activities according to their physical condition and pre-pregnancy exercise habits, combined with subjective feelings, and do what they can.
Question 11: In life, some pregnant mothers will be diagnosed with gestational diabetes during the pregnancy test, Director Tian, you give everyone a popular science, what is gestational diabetes?
A: Diabetes that has normal glucose metabolism or underlying glucose tolerance before pregnancy, and diabetes that appears or is diagnosed during pregnancy, is called "gestational diabetes". At present, the commonly used diagnostic criteria are 24~32 weeks of pregnancy, 75g oral glucose tolerance test, fasting blood glucose ≥ 5.1mmol/L, 1-hour blood glucose ≥ 10mmol/L, 2-hour blood glucose ≥ 8.5mmol/L, one of the criteria can be diagnosed as gestational diabetes, need to be according to diabetes for diet, exercise, blood glucose monitoring, etc. management, reduce the risk of adverse pregnancy outcomes.
Question 12: These pregnant mothers wondered in their hearts, their blood sugar values were not high at all before, why did their blood sugar get high after they conceived a child? What causes gestational diabetes? What is the harm?
A: By the second and third trimesters of pregnancy, the increase in anti-insulin-like substances in pregnant women, such as placental prolactin, estrogen, progesterone, cortisol and placental insulinase, makes pregnant women's sensitivity to insulin decrease with the increase of gestational age. To maintain normal glucose metabolism levels, insulin requirements must increase accordingly. For pregnant women with limited insulin secretion, pregnancy can not compensate for this physiological change and increase blood sugar, pregnancy can make recessive diabetes dominant, so that pregnant women who have not had diabetes in the past develop gestational diabetes, making the original diabetes aggravated. The impact and extent of diabetes mellitus in pregnancy on the mother and baby depends on the condition of diabetes and the level of glycaemic control. Patients with gestational diabetes have a high miscarriage rate, excessive amniotic fluid, gestational hypertension, premature birth, diabetic ketoacidosis, dystocia, and increased cesarean section rate. Effects on fetuses and newborns: macrosomia, fetal malformations, impaired fetal lung maturation, neonatal respiratory distress syndrome, hypoglycemia, neonatal hyperbilirubinemia, and increased risk of neonatal ICU transfer. In addition to the above short-term effects, the long-term effects of hyperglycemia during pregnancy on pregnant women and offspring cannot be ignored. Although most of the blood sugar of pregnant women with gestational diabetes will return to normal after delivery, if they do not pay attention to dietary adjustments and moderate exercise, the probability of developing type II diabetes in the future will increase significantly, and the risk of developing type II diabetes in their offspring will also increase.
Question 13: The diet management of gestational diabetes is the first level of treatment and the most basic treatment, so what should be done?
A: Dietary control is important. The ideal dietary control goal is to ensure and provide caloric and nutritional needs during pregnancy, while avoiding the occurrence of postprandial hyperglycemia or starvation ketosis, and ensuring normal growth and development of the fetus. Most patients with gestational diabetes can control blood sugar in a satisfactory range with reasonable diet control and appropriate exercise therapy. Women with diabetes in the first trimester need basically the same amount of calories as they did before pregnancy. After the second trimester, the weekly calorie increase is 3%~8%. Among them, carbohydrates account for 40%~50%, protein accounts for 20%~30%, and fat accounts for 30%~40%. Control the blood glucose value 1 hour after meals to less than 8mmol/L. Some expectant mothers are worried that their blood sugar is too high and choose not to eat staple foods or eat very little staple foods, such a diet plan is definitely incorrect, and overly controlled diet will lead to starvation ketosis in pregnant women and fetal growth restriction. The dietary principle during pregnancy is to ensure the nutritional needs of the pregnant woman and fetus, maintain blood sugar in the normal range, and do not develop starvation ketosis.
Question 14: Fruit is one of the favorite pregnancy foods of many pregnant mothers, but for pregnant mothers with gestational diabetes, they always look forward to "fruit" and sigh, so can "sugar" mothers eat fruit?
A: In terms of fruits, limit the amount, and try not to choose fruit juice, you can choose low-sugar fruits: such as apples, grapefruit, tomatoes, cucumbers, strawberries, etc. Each time you eat fruit should not be too much, it is best not to exceed 100 grams, about a medium size apple. Eat between meals, avoid eating after meals. Generally, you can choose 9:00~10:00 in the morning, 15:00~16:00 in the afternoon, and about 21:00 at night before going to bed. It is best to eat at the time of additional meals, which can be eaten directly as a meal, which not only prevents hypoglycemia, but also keeps blood sugar from fluctuating greatly. Eating fruit after meals is very detrimental to pregnant women with high blood sugar, and it is not advisable to eat fruits at every meal. After eating fruit, it is necessary to appropriately reduce the amount of staple food. Usually, for every 100~125 grams of fruit eaten, the staple food should be reduced by 25 grams, which is good for regulating blood sugar. Fruits are eaten according to the condition, used within the total carbohydrate range of the day, and eaten as an additional meal between meals, and should not be eaten temporarily if the disease control is not satisfactory. Vegetables such as tomatoes and cucumbers can be used instead of fruits.
Question 15: Sugar mothers because blood sugar is more sensitive, diet will rise blood sugar if they are not careful, which also makes them very careful what they eat, Director Tian, you will share with the majority of sugar mothers, how to eat in life?
A: 1. Pregnant women with gestational diabetes must consult a dietitian for nutritional consultation, and control calorie intake without affecting fetal growth, especially the intake of starch and sweets must be reduced in proportion. According to the amount recommended by the dietitian, keep in mind the total amount of food you should eat in a day, and do not increase or decrease it arbitrarily. Cultivate good eating habits, set meals regularly and qualitatively, but not hungry and full. Reasonable food matching, no partial food, a variety of food. Diet light, control the amount of vegetable oil and animal fat, avoid animal fat oil (cream, lard, butter, etc.). Avoid frying, frying, smoking and other cooking methods in food cooking, and use steaming, boiling, stewing and other cooking methods. Secondly, moderate exercise can also help control blood sugar. After diet control and moderate exercise, most of the pregnant mother's blood sugar control can reach the ideal range, a small number of gestational diabetes patients, after the above methods still can not control blood sugar, at this time must cooperate with drug treatment. 2. Gestational diabetic patients are the same as ordinary pregnant women, calories, protein, calcium, iron, folic acid, B vitamins, etc. are indispensable; Just pay special attention to the number of meals, in the case of the total calorie unchanged, it is best to eat a small number of meals, and pay attention to the distribution of quality and quantity, which can make blood sugar more stable. Gestational diabetics have a lot of food to eat, just like pregnant women in general, and not everything! According to the food exchange table to broaden the recipe, similar foods can be replaced with each other, under the premise of total calorie limitation, choose more foods with low glycemic index and high dietary fiber content to reduce fluctuations in blood sugar concentration in the body. 3. When constipated, you can choose some vegetables with more fiber, such as bamboo shoots, kale, leeks, leek flowers, etc., and rice can also be added brown rice, germ rice, oatmeal, etc., the proportion of coarse grains can account for one-third to half of the staple food. In addition, eating more foods containing more fiber, such as leafy vegetables, can delay the rise of blood sugar, help blood sugar control, and also feel more satiety. 4. If you use root foods with high starch content such as potatoes, sweet potatoes, yams, taro, lotus root, etc. as vegetables, the corresponding amount of staple food should be subtracted from the staple food throughout the day.
5. Eat less or contraindicated foods:
A. Refined sugar: white sugar, cotton-white sugar, brown sugar, rock sugar, etc.;
B. Sweets: chocolate, sweet biscuits, sweet bread, jam, honey, etc.;
C. Starchy foods that have been boiled for too long or too fine, such as rice porridge, glutinous rice porridge, lotus root powder, etc.
These foods have a high glycemic index, which is not conducive to blood sugar control. Dietary control is the basis of gestational diabetes treatment, and gestational diabetes can control blood sugar with strict diet and exercise therapy. For gestational diabetes that cannot be controlled by diet therapy and exercise, drug treatment is required under the guidance of a doctor, because the safety and efficacy of oral hypoglycemic drugs in pregnancy have not been sufficiently proven, and oral drugs to reduce glucose during pregnancy are not currently recommended. Insulin is a large protein that does not pass through the placenta, and insulin is the main treatment for the control of gestational diabetes.
Question 16: Some doctors will advise patients to keep a diet diary, what do they generally need to record? What are the benefits of keeping a diet diary?
A: The record items include date, gestational age, weight, daily eating record sheet (time and type of food, weight), daily blood glucose monitoring value, exercise mode and time. Writing a diet diary has many uses, you can show yourself, in the process of recording, expectant mothers will find out whether they eat reasonably, more importantly, doctors can see the blood glucose monitoring results at a glance through the mother-to-be's diet diary, and adjust the diet plan in time according to blood sugar and weight gain. For patients with gestational diabetes, adhering to healthy diet and living habits can not only ensure the nutritional needs of mothers and babies, but also prevent abnormal glucose and lipid metabolism during pregnancy and reduce the risk of maternal and infant complications.
Conclusion: I believe that through Director Tian's explanation, everyone has a comprehensive understanding of how to properly manage during pregnancy. Pregnant with a new life is a life experience that women must experience, is a normal physiological process, both husband and wife should actively understand the characteristics of physiological changes during pregnancy, learn pregnancy knowledge, pregnant women should regularly carry out pregnancy examinations, prevent and timely detect abnormalities, actively seek professional guidance, obtain necessary help and support, correct handling, positive response, in order to obtain the success of pregnant new life.
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