Pregnancy food dilemmas solved by our nutritionist

Q: I’m a vegetarian, but should I give it up during my pregnancy?

A: There is no reason to give up your vegetarian diet, as long as you ensure it is nutritionally balanced. You should have no problems achieving your five portions of fruit and veg a day, but protein is more tricky: include plenty of pulses, eggs or vegetable protein. Dairy is also a good source of protein, as well as calcium (important in pregnancy); aim for three daily portions. Red meat provides an easily absorbed source of iron, whereas the body needs to work harder to utilise iron in veggies. You can promote iron absorption by eating iron-rich foods (pulses, green vegetable and fortified cereals) with vitamin C-rich foods like citrus fruit, kiwi, tomatoes or mango. If you avoid fish, an omega-3 supplement would also be beneficial.

Q: I’m really confused as to whether sushi is safe to eat now I’m 20 weeks pregnant. Some books say it is, others forbid it. Can you help?

A: The Food Standards Agency advises that raw shellfish should be avoided but it does not comment of other types of fish. Raw fish is problematic because of the parasites it can contain, such as tapeworm, which will strip both you and your baby of the nutrients you need. However, thorough cooking or freezing the fish at -200˚C for 24 hours before eating will destroy any parasites. Usually sushi bought ready-made from a shop will have been frozen but if a restaurant has made the sushi on-site this may not be the case. If in doubt, ask, and as in all these ambiguous situations I would recommend asking yourself if it’s worth the risk.

Q: Why are pregnant women in the UK advised not to eat Brie and Parma ham when it’s perfectly acceptable on the continent?

A: The UK Food Standards Agency recommends pregnant women avoid Brie and Parma ham due to the risk of developing Listeriosis. Because this is quite rare, I would suggest that the advice on the continent is simply less strict than here, where our approach tends to be ‘better safe than sorry’.

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Listeriosis is a bacterial infection caused by the bacterium Listeria monocytogenes. When you are pregnant, your immune system is weakened and so less able to fight bacteria. While you would simply experience flu like symptoms, the infection can be passed on to your baby through the placenta, and can cause meningitis, pneumonia or premature birth. Listeria is sometimes found in soft, mould-ripened blue and goats’ cheeses, pates, unpasteurised dairy products and in cold, pre-cooked meats – hence the UK advice. You should also be sure to wash fruit and vegetables before use and to cook all food thoroughly.

Q: I’m 12 weeks pregnant and, as a vegetarian, concerned about eating well for my baby. What’s the best way to ensure I get the right nutrients?

A: Adequate nutrient intake during pregnancy should be no more difficult for vegetarians – just ensure your diet is balanced and varied. The Vegetarian Society has adapted the traditional ‘plate model’ to show the recommended amount of each food group to achieve a nutritionally balanced diet (see www.vegsoc.org/newveg/fft/balance.html ).

Within your daily intake, ensure two or three portions of a variety of protein sources, such as pulses, eggs or textured vegetable protein, to provide all the essential amino acids that you and your baby require. As non-meat iron sources are less well absorbed by the body, a good intake is imperative. Eat plenty of leafy green vegetables, dried fruit, wholegrain cereals and pulses, and as vitamin C helps the absorption of iron, drink orange juice with an iron-rich meal.

If you avoid fish, it’s important to achieve a good omega-3 fat intake from alternative sources, such as flax or linseed oil, soya beans, pumpkin seeds, leafy green vegetables and fortified dairy products. If you restrict diary products, a mineral and multivitamin supplement would top up your B vitamins and calcium intake. However, avoid supplements with vitamin A.

Q: I haven’t been able to face fruit since getting pregnant – it makes me want to vomit! Will taking a vitamin supplement make up for all the nutrients I’m missing out on?

A: Studies have shown that the health benefits of fruit and vegetables goes beyond their vitamin and mineral content and supplements alone do not provide the same protective effect, so it’s important that you continue to achieve a minimum of 5 portions of fruit and vegetables a day.

If you can still tolerate tinned and dried fruits, these forms are just as nutritious as fresh fruit. However, if you are off all types of fruit, use vegetables to make up your 5 portions. So long as you include a variety of different coloured vegetables you’ll be getting a good variety of vitamins and minerals and also be benefiting from the fibre, fluids and as yet largely unidentified protective properties.

A portion could include one raw carrot or stick of celery, half a raw pepper, a handful of dried fruit or cherry tomatoes, a small bowl of salad, 2/3 tbsp of cooked vegetables or tinned fruit. One glass of pure fruit juice also counts as a portion.

If you are still feeling anxious, then taking a multivitamin and mineral supplement that includes a small ‘top up’ of everything would be sensible. Avoid taking high doses of any one vitamin or mineral unless advised by your doctor, and take special care not to exceed 1,500 micrograms of vitamin A in a supplement per day as this can be toxic.

Q: I’m a little confused about which seafood dishes are not advised during pregnancy. I’m going on holiday to Spain soon and would like to check whether I should be avoiding things like prawns and squid. What exactly is the risk with seafood?

A: Different types of seafood hold different risks when eaten during pregnancy and the dishes you need to avoid will depend on which fish they contain.

Firstly, shark, swordfish and marlin should be avoided completely as they contain high levels of mercury, which can damage your baby’s developing nervous system. Tuna also contains mercury, but in smaller amounts, so limiting your intake to no more than 2 tuna steaks or 4 medium cans (140g drained) per week is advisable.

Oily fish are the best source of omega-3 fatty acids, which are essential in pregnancy for the development of your baby’s brain. However, oily fish also contain dioxins and PCBs, which in high quantities may cause detrimental development changes in an unborn child. The key is to achieve a balance: at least 1 portion of oily fish per week is recommended for its health benefits, but no more than 2 portions per week is advised to avoid harmful affects.

Being pregnant impairs your immune system so you are at greater risk of food poisoning, which would be unpleasant for you and not good for your baby. However, shellfish (including prawns and squid) need not be avoided so long as they are well cooked to ensure all harmful bacteria and viruses have been destroyed.