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This project looks at the requirements for proper nutrition during human pregnancy; the reasons for such in order to avoid possible bad outcomes ; and what alternatives can be made available to allow for differing personal needs in diverse social groups. The various means by which this information can be best promoted to the advantage of the client women's group are further considered as part of a health education plan that can be implemented in contemporary Britain in a manner concordant with aims of "Health of The Nation : A Strategy for Health in England."

                                                                                        _{( D.O.H , 1992 )}

Perhaps at no other time in the human life span is a person so likely to be open to nutritional education, or more motivated by a sense of responsibility for another life as during pregnancy. A good approach can build on such a feeling of responsibility in anticipation of parenthood - to develop a more positive attitude to nutritional improvement that will carry over into the postnatal period , and then subsequently for the duration of the infancy , childhood and maturity. A policy statement by the American College of Obstetricians and Gynecologists states "A woman's nutritional status before during and after pregnancy contributes to a significant degree to the well-being of both herself and her infant. Therefore, what a woman consumes before she conceives and while she carries the fetus is of vital importance to the health of succeeding generations."

Optimum weight gain of the mother makes an important contribution to a pregnancy's successful course and outcome; and the ideal weight to be aimed for is related to the woman's Body Mass Index. BMI is calculated by dividing kg weight by height in metres² . Thus low BMI (< 19.8 ) persons are expected to gain ~ 12.5 - 18 kg ; normal (~19.8 - 26) BMI persons might gain 11.5 -16 kg ; persons of high BMI (~26 - 29) should gain 7 - 11.5 ; and the obese ( BMI > 29 ) about 7 kg. But if there are twins, weight gain will be higher ! Young adolescent and African women should aim for upper end of the ranges , while persons less than ~ 157cm height (e.g. small southeast asian women ) could aim for gains at the lower end.

                                                                                                                ( 'Institute of Medicine' ,1992 )

In early pregnancy kg gain goes mainly toward mother's tissues ( such as for placenta, amniotic fluid, uterus and expanded blood volume ) ; and in later pregnancy more toward growing fetus. In second and third trimesters a weekly weight gain of 0.3 - 0.6 kg (depending on BMI) is normal.The obese woman entering pregnancy faces increased risk of severe complications, notably hypertensive disorders and diabetes mellitus , which have adverse effects on pregnancy outcome. An excessive weight gain is associated with higher rates of perinatal mortality.                                           

( Bobak et al ,1989 )

Placentas of poorly nourished mothers may contain fewer and smaller cells less able to synthesize substances needed by the fetus , and less able to inhibit passage of the potentially harmful ones. Undernourished mothers can give birth to poorly nourished babies , small for gestational age.

It is commonly said that there are ' 5 groups of foods ' from which choices need to be made in order to achieve proper nourishment adequate in both caloric quantity and nutritional quality, and these might be delineated as follows :-

( "Cow & Gate", 1995 )

                                                                                                                                                                                                                                                                                               

# Group 1: breads, cereals and potatoes (rich in carbohydrate, fibre, minerals & vitamins )

# Group 2: fruit & vegetables ( high in vitamins, minerals and fibre ) (shown as TWO groups by USDA)

# Group 3: dairy products ( good sources of protein, + some vitamins and minerals, e.g. calcium )

# Group 4: meat, poultry, fish, eggs, pulses , nuts ( protein foods )

# Group 5: fatty/oily & sugary foods - which are not essential to health and should be limited to provide < 30% of daily calorific intake( and especially reducing the saturated fats and oils )

Also water intake of 1.5 - 2 litres daily is recommended ( including from sources such as fruit juices and milk ) , vital for exchange of nutrients and wastes across cell membranes as well as for vitality of body fluids e.g. blood and lymph. Drinks high in artificial sweeteners are best avoided , and alcohol needs to be restricted - preferably to less than ten units per week taken at intervals.

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