- A healthy, varied diet that contains
adequate amounts of all the nutrients needed by a mother and her growing fetus (including
sufficient iron, calcium and folate) is essential for a healthy pregnancy.
- All women of child-bearing age who may
become pregnant are advised to take daily supplements (400 micrograms) of folic acid, as this
can help to reduce the risk of the baby suffering from a neural tube defect. Pregnant
women should avoid supplements containing vitamin A.
- Pregnant women should ensure that their
intake of alcohol and caffeine does not exceed current recommendations and minimise their risk
of suffering from food poisoning (e.g. by strict use of good food hygiene practices and
avoidance of ‘high risk’ foods). Avoidance of shark, swordfish and marlin and the
consumption of no more than 2 portions of oily fish per week is advised because of the levels
of potential contaminants in these fish.
- Staying physically active during
pregnancy is important to promote general health and well-being.
- Breast-feeding is the best method of
feeding for babies. A varied diet is important whilst breast-feeding to ensure a sufficient
intake of all nutrients needed by both the mother and the baby. Breast-feeding mums are
also advised to take supplements containing 10 mcg of vitamin D each
- By 6 months of age breast or formula
milk will be insufficient to meet a baby’s nutrient needs and the process of weaning onto a
solid diet should begin.
- Non-wheat cereals, fruit, vegetables
and potatoes are suitable first weaning foods. Salt should not be added to any foods for
babies. Between 6 and 9 months the amount and variety of foods should be increased to
include meat, fish, eggs, all cereals and pulses.
From the age of 6 months, infants receiving breast milk as
their main drink should be given supplements of vitamins A, C and
A varied diet containing adequate amounts of energy and
nutrients is essential both before a woman becomes pregnant (conceives), during pregnancy and if
she breast-feeds (lactation). The mother’s diet influences the health of the baby in the short-term
and perhaps even in the long-term.
healthy body weight is important before pregnancy. Being underweight can affect fertility, making
it more difficult to conceive. It can also increase the chance of the baby having a low birth
weight, which can increase the risk of ill health in early and later life. Being
also affect fertility and increases the risk of complications such as high blood pressure,
infections and diabetes during pregnancy.
particularly important before conception and during the first twelve weeks of pregnancy. Extra
folate at this time reduces the risk of having a baby with a neural tube defect, such as spina
All women of child bearing age who may become pregnant are
advised to take daily supplements (400 micrograms) of folic acid (the manufactured form of folate),
as it is difficult to achieve the extra folate needed through diet alone. This is because the
vitamin is important at a time when many women do not realise that they are pregnant. A woman who
has already had a baby with a neural tube defect may be advised by her doctor to take a larger
supplement (for example 5 mg/day). It is also important to consume foods that are naturally
good sources of folate e.g. green vegetables, oranges, and foods that have been fortified with
folic acid e.g. some breads and breakfast cereals.
Women who are
trying to become pregnant should drink no more than one to two units of
alcohol once or twice a week
and avoid binge drinking.
The Food Standards Agency has advised pregnant women and
those women intending to become pregnant to limit their caffeine consumption (see
Standards Agency (FSA) advises women intending to become pregnant to avoid eating shark, swordfish
and marlin and not to eat more than 4 medium-sized cans of tuna or 2 fresh tuna steak a week. This
is because the mercury present in thesefish can potentially harm an
unborn child’s nervous system.
Giving up or
reducing alcohol intake is often recommended for men too. Theminerals zinc and selenium are
important in sperm production and a varied diet is important to provide adequate amounts of these
nutrients. However, there is little evidence to suggest that supplements of these nutrients will
the popular phrase ‘eating for two’, most pregnant women do not need to double their food intake.
In fact, it is only during the latter part of pregnancy that extraenergy is needed; an increase of 0.8 MJ
or 200 kcals a day in the last 3 months of pregnancy is recommended, although the needs of
individual women will vary, depending on how active they are (see below). However, an expectant
mother requires a healthy and varied diet to provide her and her growing baby with the full range
A weight gain of 12.5 kg in women of normal pre-pregnant
weight is associated with the lowest risk of complications during pregnancy and labour. In
practice, however, there is a wide range of weight gains in individual women who have normal and
healthy pregnancies, with average weight gains of between 11-16
During pregnancy a woman’s nutritional needs increase
because the diet must provide sufficient energy and
- to meet both the mother’s usual needs
and provide extra for the growth of the breasts, uterus and
- to meet the needs of the growing
- for the mother to lay down stores of
nutrients to help the growth of the fetus, and for lactation
- Nutrients and oxygen pass from the
mother’s blood to the fetus from the placenta, via the umbilical cord.
The recommendation for energy intake (an extra 0.8 MJ/day
or 200 kcals during the last 3 months) assumes that, during pregnancy, activity levels fall and
women will become more sedentary but this is not always the case. It is difficult to say how much
an individual pregnant woman should be eating – the best option is for weight gain and fetal growth
to be monitored.
Iron needs are increased during
pregnancy for the growth of the placenta and fetus. Consequently it is recommended that pregnant
women consume plenty of foods containing iron such as red meat, fortified breakfast cereals,
pulses, breads and green vegetables. However, there is also an iron saving because of the absence
of menstruation (periods) and an increase in iron absorption during pregnancy, so many pregnant
women do not need extra iron during pregnancy. But some groups of women (e.g. young women aged
15-18 years) typically have low intakes of iron before becoming pregnant, and are at risk of
developing anaemia. Iron deficiency anaemia during pregnancy can increase the risk of the baby
having a low birth weight and developing iron deficiency anaemia during the first year or two of
life. These women will be prescribed iron supplements and may also be given dietary advice to
ensure that their diets contain adequate amounts of all nutrients.
Vitamin A is essential for good health. However, large
intakes during early pregnancy have been linked to birth defects. Women who are pregnant, or who
might become pregnant, should not take vitamin A supplements unless they are advised to do so by a
health professional. Liver and liver products (e.g. paté) may contain large amounts of vitamin A,
so these should also be avoided.
Listeriosisis a rare flu-like illness caused by bacteria called Listeria monocytogenes.
Listeriosis in pregnancy may cause miscarriage, still-birth or severe illness in the newborn baby.
Although it is rare in this country, pregnant women are advised to avoid those foods where high
levels of the bacteria have occasionally been found, for example paté and blue-veined and soft
cheeses such as Brie and Camembert. There is no risk associated with hard cheeses such as Cheddar
of Cheshire, or cottage cheese, processed cheese or cheese spread. For similar reasons, it is
emphasised that pregnant women re-heat ready-cooked meals (particularly those containing poultry)
until they are piping hot and that they wash fruit and vegetables well, especially if they are to
be eaten raw (which is also the advice given to the general population).
Toxoplasmosisis an illness caused by a parasite which can be found in cat faeces. The parasite
can also be present in raw meat and occasionally goat’s milk. The illness can in rare cases be
passed to the unborn baby via its mother, resulting in a range of problems, some of them serious.
As a safeguard, pregnant women should not eat raw or undercooked meat, unpasteurised goat’s milk or
goat’s cheese, or unwashed raw fruit and vegetables. Good food hygiene practices should be followed
in the kitchen and contact with cat litter trays or soil that may have been fouled by cats should
be avoided by wearing gloves.
Salmonellapoisoning is particularly undesirable during pregnancy, although it is not likely
to have a direct adverse effect on the baby. As a precaution, pregnant women should avoid eating
raw eggs or food that contains eggs that are raw or partially cooked. Eggs should be cooked until
both the white and yolk are solid. Raw meat and chicken can also be a source of salmonella
bacteria. All meat, especially poultry, should be thoroughly cooked and it is important to avoid
contamination of other foods by washing hands after touching raw meat and by preventing raw meat
and poultry from touching or dripping onto other food (e.g. in the fridge), especially that which
is already cooked or will be eaten raw.
Drinkingalcohol during pregnancy can damage the unborn child, so pregnant women may prefer
to avoid alcohol. The Department of Health advises that to minimise the risk to the unborn child,
women who are trying to become pregnant or are at any stage of pregnancy should not drink more than
1 or 2 units of alcohol once or twice a week, and should avoid heavy drinking sessions. One unit is
a small glass of wine, a half pint of ordinary strength beer, lager or cider, or a single 25ml
(pub) measure of spirits.
The Food Standards Agency (FSA) advises pregnant women to
limit the amount of caffeine they consume to no more than 300 mg a day (around 4 cups of coffee).
High levels of caffeine can result in babies having a low birth weight, or even lead to pregnant
mothers miscarrying. Caffeine is added to some soft drinks and energy drinks, as well as occurring
naturally in foods such as coffee, tea and chocolate.
How much caffeine is there in
- 1 mug of instant coffee contains 100mg
- 1 cup of brewed coffee contains 100mg
- 1 can of ‘energy’ drink contains up to
- 1 cup of instant coffee contains 75mg
- 1 cup of tea contains 50mg
- 1 chocolate bar (50g) contains up to
- 1 can of cola contains up to 40mg
- For more information, please visit the
guideline recommendation forfish consumption is at least two portions of fish per week, one of which should
be oily fish. This recommendation on fish also applies to pregnant and breast-feeding women (but
they should limit oily fish to 1-2 servings per week). Also these groups of women should
avoid the large predatory fish marlin, swordfish and shark (because of potential methylmercury
exposure). The FSA also advises pregnant women that the amount of tuna eaten should be limited to
no more than 2 tuna steaks per week or 4 medium-size cans a week. This is again because tuna may
contain mercury, which at high levels can harm a baby’s developing nervous
nutritional basis for these recommendations is that fish consumption, particularly oily fish,
decreases the risk ofcardiovascular
disease; the effect is thought to be a result of the
long chain n-3 (omega 3)polyunsaturates present in oily
fish. Furthermore, in pregnancy and lactation, there is a demand on the mother to supply the
fetus and infant with long chain n-3 polyunsaturates, required for the development of the
central nervous system. No adverse effects of maternal n-3 supplementation have been observed
and increased maternal intakes may be of particular importance in groups with a low habitual
intake and in lower birth weight populations.
If a mother, father or sibling suffers from allergic
disease (such as eczema, asthma or hayfever) it is recommended (as a precaution) that peanuts or
foods containing peanuts are avoided during pregnancy and breast-feeding and that infants are not
given these foods until the age of 3 years. For those who do not have a strong family history
of allergy, avoiding these foods is not recommended and, in fact, can do more harm than good, as it
may be that the tiny amounts encountered via the mother are precisely the quantities required to
trigger the baby’s tolerance of the proteins in these foods responsible for allergic reactions.
Staying physically active during pregnancy is important to
promote general health and help to alleviate common complaints during pregnancy such as backache
and constipation. Useful activities include swimming, some forms of yoga, toning and
stretching, which can be done at any stage of pregnancy. Contact sports or exercise with a
risk of falling should be avoided and pregnant women must be careful not to become dehydrated,
exhausted or too hot.
The estimated average requirement for energy (EAR)
increases during the last three months of pregnancy by an average of 0.8 MJ (200 kcal) per day. At
this time a woman’s energy expenditure from physical activity is usually reduced. If a mother’s
food intake is very low at this stage and if her fat stores are low, the fetus grows more slowly
and the baby may have a low birth weight. This may increase the risk of heart disease, diabetes and
raised blood pressure many years later, in adult life.
A normal pregnancy is between 37 and 41 weeks, and
full-term babies in the UK on average weigh around 3.3 kg. On average, boys are approximately 300 g
heavier than girls. Babies who are born small for their gestational age (low birth weight) or have
a low birth weight because they are premature (i.e. their weight is appropriate for their
gestational age) may need special feeding in a special care baby
AFTER THE BABY IS
During pregnancy, while in the womb, the fetus obtains
nutrients from its mother via the placenta. Once the baby is born, energy and nutrients are
supplied by breast milk or formula milk for the first 4-6 months. The rate of growth at this age is
greater than at any other time of life.
Breastfeeding is considered to be the best method for
feeding babies. Breast milk provides all the energy, liquid and nutrients the baby needs for growth
During pregnancy, hormones cause tissues in the mother’s
breast to grow and become ready to secrete milk. After birth, the act of suckling by the baby
stimulates the action of hormones which cause milk to be produced and secreted.
energy in the form ofprotein,fat andcarbohydrate Therefore, a mother
who is breast-feeding needs extra energy and nutrients. It is important that breast-feeding
women have a well-balanced and varied diet and consume plenty offluids. Breast-feeding mums in the UK
are advised to increase theirenergy intake.
Studies have shown that in the first three months, mothers
of fully breast-fed babies produce about 800 ml of milk a day. The amount is very similar among
women all over the world. The production of this quantity of milk uses up about 2.1 MJ (500 kcals)
a day and this energy can come from:
- the diet (if the mother eats
- fat stores gained during pregnancy,
- energy saved from changes in metabolic
rate, or becoming more sedentary.
For most women, the energy comes from a mixture of these
routes and breast-feeding can help to promote the loss of excess weight gained in pregnancy. There
are also many other important reasons, including psychological and immunological factors, why women
should breast-feed. It is not advisable to either restrict food intake or to limit the
variety of foods during lactation (e.g. by the adoption of ‘faddy’ diets), as this could result in
a low intake of important nutrients.
Composition of breast
In the first 3 days after birth, a special form of breast
milk called colostrum is secreted. It contains less fat, more protein and more ‘protective’ factors
than the breast milk that is produced later. The composition of breast milk also changes as the
baby feeds. At the beginning of the feed, the consistency is more watery (called the
foremilk), whereas towards the end of the feed the fat content increases (the hindmilk)
which provides the baby with energy.
On average, 100g of human milk
- 289 kJ (69 kcal) of
- 1.3g protein
- 4.1g fat
- 7.2g carbohydrate (mainly
- 34 mg calcium
In the early weeks after birth, the baby also obtains some
nutrients (e.g. vitamin D and iron) from stores it laid down before it was
It is known that breast milk contains special proteins,
antibodies, white blood cells and nucleotides which help to protect the baby against infection. It
also contains growth factors, hormones and the long chain polyunsaturated fatty acids
(PUFA) arachidonic and docosahexanoic acids. There may also be other active substances, which
we do not yet know about. Despite the recognised benefits of breast-feeding, in the UK in 2000 only
42% of mothers were breast-feeding at 6 weeks, with this figure dropping to 21% at 6 months.
However, the incidence of breast-feeding has increased since the
Whilst breast-feeding it is important to ensure adequate
fluid intake. Breast-feeding women are also advised to take supplements containing 10
micrograms of vitamin D each day. Peanuts and peanut products do not need to be avoided while
breast-feeding unless a baby is at high risk (i.e. has a parent or sibling with allergic conditions
such as hayfever, asthma and/or eczema), in which case avoidance while breast-feeding and during
the introduction of solid foods may be sensible.
For further information, visit the Department of Health
mothers who cannot or choose not to breast-feed, an infant formula (‘baby milk’) should be used.
Most infant formulas are made from cows’ milk that has been modified to make the protein, fat and
carbohydrate similar to that of human milk. Soya formulas are based on soya and it is
recommended that they are only used following medical advice. They are sometimes used for infants
who cannot tolerate cows’ milk, although such babies may need special ‘hypoallergenic’ milks as
soya can also trigger allergy.
Unmodified cows’ milk does not provide nutrients in the particular
proportions needed by human infants. In infants under 1 year of age, cows’ milk should not be the
main drink, as it is a poor source of iron. However, it can be a component of the weaning
Most infant formulas are powders which must be mixed with
water in the correct proportions. The water must be sterilised by boiling (and then cooled), and
the bottles must be cleaned carefully and sterilised to prevent contamination by bacteria.
Vitamins, minerals and trace elements are added to infant formulas during manufacture to meet the
infant’s nutritional needs and to comply with legal requirements. Infant formula does not contain
the growth factors, hormones, antibodies and other protective factors found in breast milk, so
infections and constipation tend to be more common in bottle-fed compared to breast-fed babies.
However, some infant formulas now contain other components that occur naturally in breast milk,
such as long chain fatty acids and oligosaccharides.
The composition, ingredients, and the manufacture of infant
formulaes and baby foods is extremely strictly controlled by legislation.
Before 6 months fully breast-fed babies do not require
additional fluids (including water), unless medically indicated. Bottle-fed babies may be
offered cooled, boiled water in hot weather but this should not be given as a replacement to milk
Water from the mains tap in the kitchen should be used and
it should always be boiled and cooled for babies under 6 months. Some natural mineral waters have
high mineral contents and are not suitable for babies (some bottled waters are suitable for infant
feeding and may be labelled as such). Bottled water is not sterile so will still need to be
boiled and cooled before being offered to babies.
In hard water areas, people sometimes choose to use jug
water filters to remove some of the hardness naturally present in tap water. Although tap
water is recommended for reconstituting infant formula, some people may choose to use filtered
water; in this instance this must also be boiled and cooled.
By six months of age, milk alone no longer fulfils the
baby’s nutrient needs, particularly for iron, and the process of weaning on to a solid diet should
begin. It is a time when the body’s systems, notably the gut and kidneys, are rapidly maturing and
when neuromuscular coordination should be sufficiently developed to allow the infant to eat solids.
Until recently the Department of Health (DH) advised that weaning should begin between
4 and 6 months of age. But in line with recent World Health Organisation recommendations (that take
into consideration the needs of infants in developing countries) DH currently recommends exclusive
breast-feeding for the first six months of age. Some authorities believe this advice is not
necessary for a country such as the UK and there are ongoing discussions concerning the ideal
weaning age for both breast- and bottle-fed infants. It is currently agreed that the majority of
infants should not be given solids before four months of age and a mixed diet should be offered by
six months (COMA, 1994). However, the timing and rate of introduction of weaning should take into
consideration the wide individual variation in developmental maturity between infants. Surveys of
infant feeding in the UK suggest that in practice solids are frequently introduced before six
months and even before 4 months of age (FSA/DH link), although most babies will not benefit from
solids before 4 months.
The initial stage of weaning should aim to accustom the
baby to take food from a spoon and the food should be of a smooth consistency and relatively bland.
Non–wheat cereals, such as rice, puréed vegetables and fruit, and mashed potato (no added salt) are
suitable foods for this first stage. Salt should not be added as the infant’s kidneys are unable to
cope with too much sodium. Added sugar should be avoided except small amounts to sweeten sour
fruit. Cows’ milk products such as yogurt and custard are suitable early weaning
It is recommended that children under six months of age
should not be given wheat or other gluten-containing cereals such as barley or rye, as early
exposure to gluten may increase the risk of coeliac disease. Other potentially allergenic foods,
notably eggs and peanuts should also be avoided until 6 months of age. In children from families
with a strong history of allergic conditions such as eczema, asthma or hayfever, a longer period of
exclusion of certain foods (e.g. peanuts) may be advisable.
Gradually, different tastes including pulses and pureed
meat (which are important sources of iron) can be introduced. Different textures (minced and then
chopped) can also be introduced as the baby begins to chew. As the baby gets older and begins to
put foods in its own mouth, soft finger foods such as banana or pear or toast can be
Gradually the baby becomes less dependent on milk and by
the age of 9-12 months should have progressed to a more adult type of diet with three meals a day
containing a wide variety of different foods interspersed with two or three suitable snacks and
with milk (around 500 to 600 ml per day of breast, formula or follow-on milk). This should provide
an adequate intake of all nutrients.
Foods/drinks containing vitamin C (e.g. fruit and
vegetables, potatoes or fruit juice) should be included with meals to assist iron absorption,
particularly if the diet is meat-free. Continued use of iron-enriched infant formula or a
follow-on milk after the first year should be considered if there are concerns about the adequacy
of iron in the diet.
Eggs should be cooked until both the white and yolk are
solid. Raw eggs and food that contains raw or partially cooked eggs should be avoided because
of the risk of salmonella poisoning. Whole or chopped nuts should not be given to children under
five years old because of the risk of choking. Shark, swordfish and marlin should also be avoided
because these fish contain relatively high levels of mercury, which might affect a baby’s
developing nervous system.
Commercial baby foods can make a useful contribution to a
mixed weaning diet by complementing family foods. They offer convenience, particularly in the
intermediate stages of weaning, and many are fortified with iron, a particularly important nutrient
for rapidly developing infants.
As the baby’s teeth come through, it is important that good
dental hygiene begins. Initially teeth can be cleaned gently with a small toothbrush and no paste.
The use of toothpaste containing fluoride is important in dental caries prevention as the teeth
develop, but in babies and young children very small amounts of toothpaste should be used to avoid
excess fluoride ingestion.
Weaning onto a vegetarian or vegan
With appropriate care, varied vegetarian and vegan diets
can provide all the nutrients a baby needs for growth and development. However, such diets
can be high in fibre and this may result in low energy intake and interfere with mineral absorption
(e.g. iron, zinc, copper). Vegetarian meals should provide protein from a mixture of sources,
and vitamin C to aid iron absorption. Supplements of some nutrients (e.g. vitamin B12) may be
The Department of Health recommends that infants receiving
breast milk as their main drink after the age of 6 months should receive supplements of vitamins A,
C and D (in the form of liquid drops). Infants receiving at least 500ml of infant formula daily do
not require these vitamin drops since the vitamins are already added to the formula. If
babies are consuming infant formula or follow-on milk in smaller amounts, or they are being given
cows’ milk, supplements of vitamins A and D should be given.
It is also
recommended that between the ages of one to five years, vitamin A, C and D supplements should be
given unless adequate intake and exposure to sunlight can be assured.