In December 2018 the Healthy Start – Young Family Network in Germany published their recommendations on diet and lifestyle before and during pregnancy. Healthy Start – Young Family is a network of institutions, learned societies and associations whose aim is to provide parents with uniform messages about nutrition and exercise before and during pregnancy. Expectant parents are often highly motivated to improve their lifestyle but women and couples wishing to have children are often less aware that their lifestyle affects fertility, the course of the pregnancy and also the childʼs later health. A balanced diet, regular exercise and a healthy lifestyle are particularly important before and during pregnancy. The time before conception and the first 1000 days of the childʼs life provide an opportunity to lay the foundations for the health of the child, the expectant mother and the family. This potential for prevention should be recognised and utilised on a broad basis. Their published recommendations are as follows:
Body Weight Before Conception and Weight Gain in Pregnancy
- Before pregnancy, the adjustment of body weight to a normal weight is desirable.
- An appropriate weight gain in pregnancy is between about 10 and 16 kg for women of normal weight.
In the case of overweight and obese women, a lower weight gain in pregnancy is desirable.
In underweight women, it should be ensured that there is sufficient weight gain during pregnancy.
Energy and Nutritional Requirements in Pregnancy
- Pregnant women should pay particular attention to the quality of their diet. Compared to the energy requirement, the requirement for individual vitamins and minerals/trace elements increases much more in pregnancy.
- Energy requirements increase only slightly over the course of pregnancy. Pregnant women should increase their energy intake only slightly (up to about 10%) and not until the last few months of pregnancy.
Nutrition
- The diet must be balanced and varied before and during pregnancy. It should be based on the general recommendations for healthy adults.
- In a balanced diet, the food groups should be weighted differently:
- Both calorie-free beverages and plant-based foods (vegetables, fruit, pulses, wholegrain products) should be consumed abundantly.
- Animal-based foods (milk and dairy products, low-fat meat and low-fat meat products, oily sea fish and eggs) should be eaten moderately.
- Sweets, sugar-containing beverages and snacks as well as fats with a high proportion of saturated fatty acids (in particular animal fats) and oils should be only consumed sparingly. Plant oils (e.g. rapeseed and olive oil) should be preferred as sources of fat.
Vegetarian and Vegan Diet in Pregnancy
- A balanced vegetarian diet with the consumption of milk, dairy products and eggs can in principle cover most nutrient needs during pregnancy. Specific counselling is recommended.
- In the case of a purely plant-based (vegan) diet, the supply of critical nutrients must be checked by a physician and individual nutritional counselling given. As well as iodine and folic acid, additional micronutrient supplementation (particularly vitamin B 12 ) is required to prevent a nutrient deficiency and subsequent damage to the childʼs development.
Supplements (to be taken only if advised by the obstetrician or midwife)
Folic acid supplement
- In addition to a balanced diet, women planning a pregnancy must take 400 µg of folic acid daily or equivalent doses of other folates in the form of a supplement.
- Supplementation must begin at least four weeks before conception and continue until the end of the first trimester of pregnancy.
- Women who start folic acid supplementation less than 4 weeks before conception should use higher-dosed products.
Iodine supplement (according to WHO criteria, Germany is an area with mild to moderate iodine deficiency)
- In addition to a balanced diet, pregnant women must take a daily supplement of 100 (up to 150) µg iodine. Women with thyroid disorders must consult their physician before supplementation.
Other supplements
- Iron supplements in addition to a balanced diet should only be taken after a medically diagnosed deficiency.
- Pregnant women who do not consume oily sea fish regularly are recommended to take DHA (omega 3) supplements.
- Pregnant women who rarely spend time in the sun or extensively cover their skin or use sunscreen lotions on exposure to the sun as well as women with dark skin types should use a vitamin D supplement.
Protection against Food-Borne Illnesses During Pregnancy
- Pregnant women must avoid raw, animal-based foods. In addition, they should follow the recommendations to avoid listeriosis and toxoplasmosis in the choice, storage and preparation of foods.
- Pregnant women must only eat eggs if the yolk and egg white are firm from being heated.
Exercise Before and During Pregnancy
- Women who are planning a pregnancy and pregnant women must follow the general exercise recommendations for adults.
- Women must also be physically active in everyday life during pregnancy and must limit or regularly interrupt sedentary activities.
- Pregnant women should be moderately physically active for at least 30 minutes at least 5 days a week and preferably daily. Moderately active means that conversation is still possible during sporting activity (talk test).
- Women who engage in sport can also be more intensively physically active in pregnancy.
Alcohol
- Women who are planning a pregnancy and pregnant women must avoid alcohol.
Caffeinated Beverages During Pregnancy
- Pregnant women should drink caffeinated beverages only in moderate amounts.
Medication Use in Pregnancy
- In pregnancy medications must only be taken or stopped after consulting a physician.
Nutrition in Pregnancy for the Prevention of Allergies in the Child
- Pregnant women must not exclude any foods from their diet to prevent allergies in the child. The avoidance of certain foods during pregnancy is not beneficial for the prevention of allergies in the child.
- Pregnant women are recommended to consume oily fish regularly also with respect to allergy prevention.
Oral and Dental Health
- Women who are planning a pregnancy should have a dental check-up and where necessary undergo specific treatment.
Vaccinations
- The vaccination status should be checked and vaccination gaps should be plugged in women who are planning a pregnancy.
Koletzko B et al. Diet and Lifestyle Before and During Pregnancy – Practical Recommendations of the Germany-wide Healthy Start – Young Family Network. Geburtshilfe Frauenheilkd. 2018 Dec;78(12):1262-1282