Expectant mothers are not recommended to eat until they are full, and certainly not to eat for two. The basic principle of the future mother's nutrition is fractional nutrition: it is desirable to eat more often, but little by little. This will not only allow you to control weight gain, keep the concentration of sugar and cholesterol in the blood at a constant level, absorb the maximum amount of vitamins and minerals from food, but also make it possible not to overload the digestive system.

But long breaks between heavy meals lead to a massive simultaneous load on the digestive glands, which subsequently causes their exhaustion, and they will not be able to work at full strength, moreover, in such a situation, the quality of the digestive juice may deteriorate and the process of digestion of food will be drag on.

Advice 2. During pregnancy, you need to follow a diet

In the first half of pregnancy, it is recommended to eat 4 times a day (1st breakfast should be 20% of the calorie content of the menu per day, 2nd breakfast - 15% , lunch - 45%, dinner - 20%).

In the second half of pregnancy, it is better to switch to 5-6 meals a day (respectively, smaller portions). This will reduce the load on the digestive system, the food will be digested and absorbed fully, which means that undigested foods will not accumulate in the intestines, leading to increased gas formation, bloating and discomfort for a pregnant woman.

To improve digestion, before breakfast it is recommended to drink a glass of water at room temperature, in which you can add a teaspoon of honey and (or) the juice of half a lemon.

At the same time, food must be distributed correctly throughout the day. Since proteins increase metabolism, excite the nervous system (this is due to the high content of nitrogenous extractives in protein-rich foods) and stay longer in the stomach, meat, fish and eggs are recommended to be consumed in the morning, and not at night. But for dinner, you can recommend dairy or vegetable dishes.

Starting from 9-10 am, the production of digestive juices is activated, so the absence of a full breakfast in the stomach at this time can lead to so-called "hungry" gastritis (the stomach, as they say, "digests itself"). At the same time, it is better to start the day with foods rich in complex carbohydrates that are slowly digested, do not lead to a rapid release of insulin and do not load the pancreas, and proteins, that is, with hot cereal, yogurt, muesli with milk, scrambled eggs, etc.

After 2 hours, a second breakfast is already needed from products that also contain complex carbohydrates and fiber, with the addition of a small portion (about 80-100 g) of a low-fat protein product - buckwheat or oatmeal, fresh vegetable salad, combined with fish or lean meat in boiled, stewed or baked form, cottage cheese with dried fruits and honey. This is necessary, because the woman's body must accumulate enough energy to have enough strength during the day.

But the peak activity of the digestive system of a pregnant woman falls on 13-15 hours of the day. It is at this time that you need to have a full meal.

It is recommended to have dinner no later than 2–2.5 hours before bedtime, so that the body does not waste energy on digesting food at night, but has time to calmly prepare for rest.

Advice 3. Nutrition for pregnant women: prepare food in gentle ways

Gentle cooking methods include boiling, stewing, baking and steaming. These methods will ensure the maximum safety of all useful substances in the products, and will not allow the formation of carcinogens.

It is important to remember that in order to preserve all the useful substances during cooking, do not fill the product with a large amount of water. In addition, it is better to cook with the lid closed, add salt at the end of cooking (stewing, baking), cook not for too long and not at the maximum temperature. When using a multicooker, it is advisable to set the mode of a double boiler (or steaming) and gentle languishing (an analogue of cooking in a Russian oven).

When cooking vegetable dishes, it is worth observing the rule of “semi-doneness” so that the vegetables remain crispy, which means that the main water-soluble vitamins (especially vitamin C, folic acid and rutin) and trace elements will be in maximum safety. If you are cooking potatoes, then the best way is to bake in the oven (possibly in foil) in a peel. The fact is that the maximum concentration of potassium, necessary for the normal functioning of the cardiovascular system and the prevention of edema, is concentrated precisely under the skin. When boiling peeled potatoes, up to 80% of the nutrients go into the broth, which can be used for cooking first courses.

Tip 4. Nutrition during pregnancy should not fall in the evening

It must be remembered that in the evening, and especially at night, digestion and metabolic processes in the body slow down. Therefore, a plentiful meal in the evening puts an increased burden on the digestive system of the expectant mother and can lead to disruption of night sleep.

Therefore, the last meal before bedtime should be at least 2-2.5 hours before bedtime. At the same time, dinner should consist of dairy and vegetable dishes, since foods rich in carbohydrates help to inhibit the nervous system and improve sleep.

Tip 5. Meals for pregnant women should be freshly prepared

Meals during pregnancy are recommended to be prepared in small portions - for one meal, otherwise useful substances are destroyed during storage and reheating. In addition, in long-term stored food, even in the refrigerator, favorable conditions are created for the reproduction of pathogens and the risk of food poisoning increases.

Freshly cooked food should be stored for no more than 2 hours at room temperature, and in the refrigerator for no more than 24-36 hours, depending on the type of food.

Advice 6. Drink enough fluids

At the beginning of pregnancy, the amount of free fluid (water, juices, fruit drinks, tea, etc.) on the menu can be 1.2-1.5 liters (not counting liquid foods). But in the second and third trimesters, the daily volume of liquid should not exceed 3 glasses, this is not counting the first liquid dishes, as well as the water found in fruits, vegetables, dairy products and other water-rich foods. In total (as part of products and free liquid), the amount of water should be 2–2.5 liters (up to 20 weeks of pregnancy), and from the 21st week it is recommended to gradually reduce this amount, bringing it to 1.5 liters by the 30th week .

To quench your thirst, it is best to drink in small portions, about half a glass. In this case, the water should be at room temperature, then it will not irritate the receptors of the upper respiratory tract (it will not provoke pharyngitis, laryngitis), and will also be able to fully quench your thirst.

Advice 7. There should be no prohibited foods in the diet of a pregnant woman

There are certain foods that pregnant women should not eat:

Prohibited products	Why?
Fatty food (goose, duck, fatty pork and lamb, etc.)	Such dishes are difficult to digest, require high energy costs, and also load the pancreas and biliary system, which are directly involved in the digestion of fats.
Spicy food (pickled, salty, etc.)	Irritant to the digestive organs.
Foods that cause gas (peas, cabbage, carbonated drinks, fresh bread and hot pastries)	The flatulence (bloating) that occurs when using such products not only leads to intestinal discomfort in the pregnant woman herself, but also puts physical pressure on the fetus.
Raw or half-cooked meat and fish dishes	Parasites (worms) may remain in these products if not properly cooked. Therefore, poorly stewed, boiled or baked meat (inside when cutting a piece “with blood”) can be fraught with the risk of infection with diseases such as toxoplasmosis, finnosis or trichinosis, and pathogens of opisthorchiasis and diphyllobothriasis can penetrate with undercooked fish.
Dried or salted fish	It contains too much salt, which retains water in the body, which provokes edema, increased pressure and contributes to the occurrence of gestosis (a complication of the second half of pregnancy, in which edema occurs, pressure increases and protein appears in the urine).
Strong tea and coffee, other drinks rich in caffeine (for example, soft drinks and various energy drinks)	Caffeine is a stimulant of the central nervous system, which, in turn, increases the activity of other organs and systems of a pregnant woman. The use of such drinks can lead to insomnia, nervousness, restlessness, irritability, heart palpitations and high blood pressure.
Canned food	They are rich in purines and uric acid, which put an increased burden on the kidneys and liver in the future

Zakharova I.P.

Obstetrician-gynecologist of the Zhatai hospital

State Autonomous Institution of the Republic of Sakha (Yakutsk) "Medical Center of Yakutsk"

Iron deficiency in pregnant women - why do you need a ferritin test?

Pregnancy is not only a happy time of waiting for a meeting with a future baby, but also a test of the strength of a woman's body. One of the most common problems that future mothers face is anemia. This physiological condition during pregnancy is quite common, so it is necessary to control the level of iron in the body even at the stage of family replenishment planning. One of the important indicators that will tell you about iron deficiency is a ferritin test.

Ferritin levels during pregnancy

Ferritin test is not included in the MHI standards, so the expectant mother may start having problems with iron deficiency. If a woman has low ferritin, then a course of iron-containing preparations is prescribed before conception. This will save not only the future mother herself from feeling unwell during pregnancy, but also help the baby develop normally in the first year of life.

By all international standards, ferritin analysis is a simple diagnostic test for detecting iron deficiency, says Anastasia Arseneva. - It answers the question: is there an iron deficiency or not. But this analysis is not in the CHI standards, the gynecologist can prescribe it, or it can be limited to the UAC. Most often it happens that in the KLA hemoglobin does not cause alarm, but iron stores are depleted. In the 2nd trimester, iron begins to be severely lacking, because the body needs to make more blood cells, providing a growing placenta (so that the baby gets more oxygen). And then the body takes iron from the reserves of ferritin. Food does not provide the right amount of iron, even if a woman eats for two. If a pregnant woman is prescribed iron supplements when hemoglobin has decreased, these are already missed opportunities. If you prescribe drugs in advance, then the expectant mother will spend the iron that she receives from the pills, and not from her reserves. In this case, ferritin will not decrease and hemoglobin will remain normal. Yes, all women have physiological anemia when hemoglobin is low. But it cannot decrease indefinitely, the limit is 110 g / l. If hemoglobin drops below, it is necessary to check whether physiological anemia has become pathological.

There are not always symptoms in the latent stage of iron deficiency, but this condition needs to be corrected. When a woman is preparing for pregnancy, her ferritin levels also need to be known. If it is at the level of 30-40 mcg / l, then, most likely, she needs prophylactic medication, since ferritin will decrease during pregnancy. The ideal ferritin in a woman is 50 to 150 mcg/l. With such indicators, a woman feels good, she has enough energy and there is no chronic fatigue.

Why does a pregnant woman need iron?

Iron directly affects the health of the unborn baby. In utero, the child accumulates iron, which will be consumed in the first months of life. This is a kind of "airbag", since there is a small amount of iron in breast milk. But if the mother has anemia, then the child does not have a source for the formation of a reserve. After birth, the baby will quickly spend the available iron and then anemia begins. Without iron, the nervous system cannot develop normally, resulting in developmental delays.

For the full development of the nervous system and the maturation of nerve cells, iron is an essential element. It is found in proteins that activate genes that cause nerve cells to divide and make connections. Therefore, in the first year of life, a child makes a huge leap in development - from a helpless newborn to an inquisitive and active baby.

Norm of ferritin for women and children:

• Below 30 mcg/l - iron deficiency, anemia.
• From 30 to 50 mcg/l - latent iron deficiency.
• 50 to 150 mcg/L is normal.
• Above 150 µg/L is high and should be further tested to determine if there is iron overload.

Symptoms of low ferritin in pregnant women:

• Tiredness from daily activities, previous activity is difficult to bear.
• Shortness of breath (eg when climbing stairs).
• Dizziness.
• Lazy state - do not want to do anything, want to sleep.
• Sleep disturbance and restless leg syndrome. Usually, discomfort in the legs appears before going to bed - the legs tremble. There is a desire to massage the calf muscles, stretch the legs.

The level of iron in the body is also important for childbirth, because the process itself affects not only the uterus, but also a huge number of muscles. If these muscles contain an insufficient amount of iron, then they cannot quickly engage in work, there is a risk of weak labor and caesarean section.

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