THE FOOD REQUIREMENTS DURING PREGNANCY
The Food-stuffs: Water; Mineral Material; Protein; Carbohydrate; Fat--
What We Do to Our Food--How Much Food Is Needed During Pregnancy?--
The Importance of Liquid Nourishment--The Choice of Food--Cravings--
The Relation Between the Mother's Diet and the Size of the Child.
There is a gain in weight during pregnancy amounting finally to about
thirty pounds; exceptionally, it is as little as ten or fifteen
pounds, and, at the other extreme, as much as forty or fifty. With
individuals inclined to be stout the increase is greater, and it is
relatively greater in later pregnancies than in the first. During the
early months of pregnancy the weight generally remains stationary or
suffers a slight loss; even in those rare instances in which the
weight begins to increase shortly after conception the gain is less
marked in the earlier months than later. For the last three months
the average monthly gain has been found to be between three and a
half and five and a half pounds.
The weight gained during pregnancy is not, as can be readily
understood, permanently retained. At the time of birth, in
consequence of the expulsion of the child, the after-birth, the
amniotic fluid, and a varying amount of blood, there is necessarily a
loss of from ten to fifteen pounds. Later, as the maternal tissues,
whose growth has been stimulated during pregnancy, return to their
original condition, a further loss in weight takes place. It is not
unusual, however, for women to remain permanently better nourished
than before they became pregnant. Under ordinary conditions the food
of the prospective mother provides not only for her own wants but
also for those of the embryo. Between the two organisms there exists
a relation which resembles that existing between a house in course of
construction and the contractor who supplies the building material.
The mother furnishes what is needed to construct the "living
edifice," as Huxley called the growing embryo, but she is not
responsible for the lines of the building. The embryo is both
architect and mechanic, designing the structure and arranging the
"organic bricks" in their proper places. The work of construction
necessitates the expenditure of an appreciable amount of energy and
the creation of waste products that must be removed, lest they
accumulate and interfere with the growing structure. These waste
products leave the embryo by way of the umbilical cord and the
placenta and return thus into the mother's circulation; ultimately
they leave the mother through the same channels that carry off her
own waste. First and last, then, the nutrition of the mother and of
the child are so bound together that it has been impossible to study
them separately. Our knowledge of food requirements during pregnancy
has been obtained by measuring the food requirements of the mother
alone; and as nutrition during gestation is fundamentally the same as
nutrition at other times, it is necessary for us first to consider in
general the food needed by the human body.
THE FOOD-STUFFS.--The waste products we throw off indicate that the
substances which compose our bodies are being constantly broken down
and reduced to a condition such that they are useless to us. In
normal persons hunger signifies that they need material to replace
what has been used up. The substances thus required, if the wants of
the body are to be satisfied correctly, are called the food-stuffs;
and they are the same during pregnancy as at other times. The
foodstuffs are usually classified according to their chemical
properties; on this basis they are placed in five groups: (1) Water,
(2) Mineral Materials, (3) Proteins, (4) Carbohydrates, (5) Fats.
In view of the different purposes which the foodstuffs serve, it is
convenient to group them in another way. Thus, the carbohydrates and
the fats may be placed together because they are the body fuel; their
value consists in the heat and energy which they yield when acted
upon in the tissues. Water and mineral matter, on the other hand, are
never a source of energy; they assist in building new tissue or in
repairing tissue that already exists. The proteins are unique, in
that they may serve either purpose. Primarily the proteins are
tissue-builders, but in the absence of sufficient fat or carbohydrate
the body burns protein to secure heat and energy.
Each food-stuff, therefore, serves a distinct purpose, and some of
them render services which the others cannot perform. A man will die
if either water or mineral matter or protein is completely withdrawn
from his diet. Fat or carbohydrate, on the other hand, or even both
of them, may be excluded for some time without causing serious
inconvenience. It is true, nevertheless, that each food-stuff
performs some task better than any of the others can perform it, and
for that reason all of them should be included in the diet of an
healthy individual.
Some of the food-stuffs, such as water and table salt, come to the
body separate from the others; but generally the different types
reach us intimately mingled in the various articles of food in common
use. Foods vary greatly, however, in the amount of the different
food-stuffs they contain. The meats, for example, have a relatively
large protein content; in the vegetables starch, which is one of the
carbohydrates, predominates. As to the choice of food and the amount
that is necessary for the average person, generally the appetite is a
safe guide; but the accurate observations of physiologists have gone
so far as to determine the exact requirements of the body. Not the
least important principle taught by these investigations is to avoid
dietary fads, for in arranging a satisfactory diet the problem to be
solved is not, What is it possible to live on? but, What serves best
as nourishment? The experience of countless generations has taught us
that we thrive best on a diet which includes all five food-stuffs.
_Water_ constitutes nearly two-thirds of the weight of the body.
As water is constantly being given up in the life process, health
demands an abundant supply of liquids to replace the waste. The
average daily loss has been found to be between two and three quarts.
Of this amount the urine constitutes nearly two-thirds; and the
remaining third is eliminated through the skin, the lungs, and the
bowels. Although the deficiency thus created is met in part by the
water in our solid food, the greater part of the loss is made up by
the liquids we drink, and we are warned, in a measure, by the
sensation of thirst that they are needed.
_Mineral material_ is of the greatest importance as a
constituent of our food. It contributes to the welfare of the body in
at least three ways; (1) it gives rigidity to the bones, (2) it
supplies an essential ingredient of the living substance in all the
tissues, (3) it is present in the blood and in the other body fluids,
where it is of service in such vital processes as the beating of the
heart, the transportation of oxygen to every portion of the body, and
the maintenance of an acid or alkaline condition of the digestive
juices according as the one or the other is necessary for the
assimilation of the food.
An animal deprived of mineral food will die as surely as one deprived
of water. In arranging our diets, however, we are not compelled to
take the minerals into account, for, with the exception of table salt
(sodium chlorid), the meat and vegetables that we eat provide the
mineral material the body requires. Iron, for example, which imparts
to the blood one of its most essential qualities, occurs in
relatively large amounts in apples, spinach, lettuce, potatoes, peas,
carrots, and meats. Only now and then does it become advisable to add
iron deliberately to the diet. Similarly lime (calcium) the material
that makes the bones hard, is present in quantities ample for the
needs of the body in the bread, milk, eggs and vegetables that we
eat. The remaining mineral constituents of the body, among which the
most conspicuous are magnesium, potassium, sulphur, and phosphorus,
occur in foods which we are naturally inclined to take, so that we
secure an abundance of them unconsciously.
_Protein_, the third food-stuff which we must eat to keep alive,
contains the chemical element nitrogen in such form that it can be
incorporated in our tissues. Although most persons derive their
protein in part from meat, milk, and eggs, it is possible to satisfy
the requirements of the body on a purely vegetarian diet. Experience
has shown, however, that it is both natural and advantageous that we
employ a mixed diet.
The property of protein to build living tissue and replace tissue
waste probably depends upon several factors; but certainly one of
them is the presence of nitrogen. So intimately associated are the
consumption of the tissue substance and the elimination of nitrogen
that we have no better way of judging the amount of tissue substance
used in the body than by determining the quantity of nitrogen that
appears in its various waste products. From such investigations it
has been found that the quantity of protein required to repair the
breaking down of the tissues is not great. The average man consumes
approximately a quarter of a pound (100 to 120 grams) of protein
daily; but this quantity is in excess of his real needs. Indeed,
Chittenden has shown that for various classes of individuals, namely,
students, athletes and soldiers, half as much is sufficient. Other
physiologists, though admitting that this is true, contend that it is
inadvisable to regulate one's diet on such a slender basis. Very good
reasons are assigned for the view that more protein is needed than
just enough to counterbalance the tissue waste. Thus, in the case of
animals, it has been found that a diet low in protein finally causes
digestive disturbances and other ailments.
Although it does not seem advisable to practise rigid economy in
arranging the protein content of the diet, it is equally important
that we should not go to the other extreme. The consumption of over-
large quantities of protein, as would be the case if we lived
exclusively upon meat, increases putrefaction in the intestines and
throws unnecessary work upon the kidneys, which are the organs
chiefly concerned in getting rid of the waste products of protein.
_Carbohydrate_ is the name given the group of foodstuffs to
which the sugars belong. The food value of cane sugar, the most
familiar member of the group, was recognized even in prehistoric days
by the natives of India. By boiling the plant we call sugar-cane they
obtained a substance to which they gave the name Sakkara, and from
this our word sugar evidently originated. The roots of this plant
were carried into Europe and cultivated during the Middle Ages.
Obviously, its value was and is appreciated, since the cultivation of
the sugar-cane and the sugar-beet has become the foundation of a
great modern industry.
There are some persons, perhaps, who do not realize that beside cane
sugar many kinds of carbohydrate occur in our food. Glucose or grape
sugar, for example, occurs not only in the fruit indicated by its
name, but also in other fruits, in corn, in onions, and in the common
vegetables. Glucose is especially suited to act as nourishing food.
In keeping with that fact our digestive juices convert most of the
sugars we eat, if not all of them, into glucose, which is regularly
present in our blood. It is unnecessary to enumerate all or even the
more important compounds included in the carbohydrate group; but
everyone should know that starch is its chief member, and that after
being thoroughly digested starch enters the body as glucose and
therefore serves the same purpose as sugar.
The value of carbohydrates as a source of heat and energy may be
accurately measured, and is technically expressed in terms of a unit,
called the calorie. As the energy which our bodies require may be
estimated in the same terms, it is possible to determine whether or
not our food is equal to our wants. Very naturally the energy
requirements of any individual are influenced by his weight and by
the work he does. But we may take as a standard the results of an
extensive study of American families which indicate that women
require four-fifths as much energy-yielding food as men. It also
seems safe to conclude that a woman weighing 130 pounds who does her
own housework requires food every day having an energy-value of 2,500
calories; smaller women and those who do no work require somewhat
less. In a mixed diet the chief source of this energy--and the source
from which it is most economically obtained--is the carbohydrates.
_Fat_ yields more energy and heat than does carbohydrate, bulk
for bulk; but fat is burned by our tissues less readily. We
instinctively avoid eating a great deal of this food-stuff; in the
course of a day the average person consumes no more than one or two
ounces. The natural aversion which many feel toward fat may possibly
depend upon the difficulty with which they assimilate it. In colder
climates, however, we know fat to be a staple article of diet; and it
is not unlikely that the very conditions which make it necessary
there explain the unusual tolerance for it.
Fat is more than fuel. Deposited in our bodies, beneath the skin for
example, it prevents the escape of heat that we generate and protects
us against the penetration of cold. This food-stuff, therefore,
contributes in several ways toward maintaining the temperature of the
body at a constant level.
Our source of fat is chiefly animal food and in a smaller measure
vegetables; but the fat our food contains is not altogether
responsible for the fat in our bodies. Carbohydrates, if in excess of
momentary needs, are partly converted into fat and stored as such. A
reserve supply of nourishment is thus provided, and is drawn upon
only when the food that we consume does not contain as much energy as
we expend.
WHAT WE DO TO OUR FOOD.--With the exception of water and mineral
substances, the food-stuffs must undergo chemical alterations before
they are capable of being absorbed into the body; this is the work of
digestion. The digestive processes, the main purpose of which is to
break up the carbohydrates, proteins, and fats into substances of
much simpler chemical structure, begin in the mouth and are not
completed until some time after the food has entered the intestine.
As the food moves through the alimentary canal, it is mixed with the
various digestive juices containing ferments, such as pepsin, which
are the active agents of digestion. Although digestive processes go
on automatically, they are, in a degree that is far from negligible,
influenced by the mind. Thus, cheerfulness promotes digestion, and
not infrequently mental depression may be the direct cause of
indigestion. Indeed, it is chiefly in regard to the state of the mind
of the prospective mother that the existence of pregnancy may be said
to have a bearing, whether favorable or unfavorable, upon her
digestion.
The digestive juices are prepared in glands which lie either within
the lining of the alimentary canal or adjacent to it. In the latter
event the glands are connected with the canal by means of tubes.
These glands must be warned when to pour out their secretion, and
their very first warning usually comes from the agreeable sensations
experienced when we see, smell, or taste inviting food. If we are
hungry, our viands attractive, and our surroundings congenial, the
stimulus excites a plentiful secretion of the digestive juices;
conversely, the opposite conditions, to some extent, check their
flow.
The sight of attractive food, as we all know, "makes the mouth
water," that is, it calls forth the saliva which contains one of the
digestive ferments. Thus, at the beginning of a meal, favorable
conditions for digestion are established. The saliva, however, acts
only upon starch; and, moreover, its action upon this carbohydrate is
weak unless the food is thoroughly chewed and mixed in the mouth.
Most of us, perhaps, overlook the importance of mastication, which
not only crushes all the food-stuffs, preparing them for efficient
digestion, but also stimulates the flow of the digestive juices.
Furthermore, by thoroughly masticating our food, we know intuitively
when we have had enough, and thus avoid overeating.
In the stomach the digestion of starch is continued for a time, but
the chief work of gastric digestion concerns the proteins. They alone
are attacked by pepsin, a ferment secreted by the mucous membrane of
the stomach. Moreover, since pepsin is able to act only when an acid
is present, the gastric mucous membrane also secretes hydrochloric
acid.
Just as the digestive glands in the neighborhood of the mouth become
more active when we are conscious that desirable food is at hand, so
do the glands in the stomach. Mastication also stimulates the flow of
the gastric juice, and this flow is greater if we enjoy what we eat.
Furthermore, it has been shown that, after entrance into the stomach,
the food itself increases the flow of the digestive juices. All
articles of food are not, however, equally efficient in producing
this effect: thus meat requires more pepsin for satisfactory
digestion than bread, and consequently meat calls forth a larger
quantity of gastric juice.
Fat in all probability is not digested in the stomach; even starch
and protein are not broken down sufficiently by the time gastric
digestion is complete to permit them to be absorbed into the body.
"The value of digestion in the stomach," as Howell says, "is not so
much in its own action as in its combined action with that which
takes place in the intestine." It is even possible for satisfactory
digestion to take place without the assistance of the stomach. This
fact has been substantiated by several cases in which men have lived
for years after the stomach was removed to eradicate a disease. It is
true, nevertheless, that intestinal digestion can be performed more
economically if it begins where gastric digestion normally leaves
off.
Of the changes wrought in the food by the various digestive
processes, those which are the most profound take place in the
intestine. While the food is being moved through this organ--some
thirty feet in length--it is reduced to simple chemical fragments,
which are absorbed by the intestinal wall. Digestion in the intestine
is carried on through the agency of a number of ferments, the more
important of which are supplied in the juice manufactured by the
pancreas. The pancreatic secretion contains three separate and
distinct ferments, which act respectively upon carbohydrate, protein,
and fat. The absorption of fat, however, is materially assisted also
by the action of the bile.
A part of what we eat always escapes digestion; the unused portion,
it has been estimated, is somewhat less than one-tenth of an ordinary
mixed diet. The residue from vegetables is notably larger than the
residue from meat. The _undigested_ portions of all the food-
stuffs collect in the lowermost portion of the intestine and form a
part of the feces. Here also are gathered the _indigestible_
material we have eaten, the products of bacterial decomposition in
the intestine, and other waste substances that the body should throw
off.
HOW MUCH FOOD IS NEEDED DURING PREGNANCY?--In connection with the
development of the child we have already referred to the difference
in the purpose of the constructive processes which go on in the
earlier months of gestation and those which take place in the later
months. In a general way the first half of pregnancy is occupied with
the formation of the embryo from relatively simple structural
elements, the second half with its growth into an infant, which
acquires ninety per cent. of its substance and weight at birth after
the fifth month of embryonic development. A similar contrast may be
observed in the nutritional processes of the mother. Often, at the
beginning of pregnancy, the appetite is poor and there is
indisposition of one kind or another, with the natural result that
there is slight if any change in the mother's weight; whereas later a
period ensues when her appetite increases, her health improves, and
she gains in weight.
Since it is natural that the weight of the mother should remain
practically stationary during the early months of pregnancy, it is
clear that a diet which has previously been ample will likewise be
sufficient for some time after conception has taken place. To most
persons, however, it is not clear that the quantity of food
ordinarily eaten will suffice also during the later months of
pregnancy. On the contrary, popular opinion holds that the
prospective mother "should eat for two." It is not unimportant to
point out the erroneous character of this superstition, because
overeating during pregnancy is much more likely to provoke discomfort
than insufficient nourishment.
In order to comprehend the nutritional needs of the prospective
mother, one must keep in mind the fact that our food always serves
two purposes. These are, as we have seen, to build or to repair
tissue and to furnish heat and energy. Since these needs of the body
during pregnancy--as at all other times--are best understood when
considered in their relation to the food-stuffs which supply them, we
shall take up these various ingredients separately.
Protein, which repairs tissue and also furnishes the substance from
which new tissue is made, is used more economically during pregnancy
than when the maternal functions are inactive. As a result of this
economy the same allowance of protein which is sufficient before
conception is sufficient also during pregnancy. This fact has been
put in the clearest light by extensive observations made upon
animals. Dogs which were not pregnant, for example, have been
carefully fed so that their food should contain just enough protein
to cover the needs of the body and keep their weight constant.
Subsequently, when these animals became pregnant precisely the same
amount of protein was fed to them. The result was that they gained in
weight, and at the same time the waste products of protein they threw
off were notably diminished. Such observations, of which there have
been a large number yielding concordant results, may be safely taken
to mean that an amount of protein previously satisfactory for the
animal is also sufficient for her during pregnancy. We are forced to
conclude that protein was used more sparingly in the latter
condition--a view which has been repeatedly confirmed with regard to
human beings as well as animals. It is found, for example, that an
amount of protein competent to meet the needs of a man of a given
weight will not only provide for the wants of a woman of equal weight
while she is pregnant, but will also leave a surplus sufficient for
the growth of the fetus.
With regard to the mineral substances, likewise investigations
indicate that the "housekeeping" of the body during pregnancy
proceeds along unusually economic lines. It is not advisable,
therefore, to make any change in the diet with regard to these
substances. Attempts have been made to cut down the amount of
minerals in the food for the purpose of softening the fetal skeleton.
The success sometimes attributed to these efforts is, however, very
doubtful, for we know that the mother's tissues will be robbed of
minerals for the embryo whenever her food fails to contain them in
sufficient amount for her own needs and those of the child.
Practically speaking, the mineral content of diet during pregnancy
requires no thought, for so long as meat and vegetables are eaten in
satisfactory quantity the mineral nutrition will take care of itself.
The food-stuffs which supply heat and energy, since the amount of
energy utilized by the body during the latter months of pregnancy is
somewhat in excess of that previously required, do not follow the
same rule as the protein and the mineral matter. It has been found
that just before the fetus becomes mature the energy requirements of
the mother are approximately one-fifth greater than in the non-
pregnant condition. It is certain, however, that no extra demand for
energy exists until the fifth or sixth month of pregnancy, and that
the excessive requirement is extremely small until the last three or
four weeks. Even then the prospective mother requires less energy-
giving food than the average man.
Since the body handles carbohydrate more readily than fat, it is
preferable that whatever additional energy pregnancy necessitates
should be supplied by carbohydrates. An increase in the daily
consumption of fatty food, over and above that previously found
agreeable, is not only unnecessary but undesirable. Every-day
experience teaches that less fat taken with the meals promotes the
comfort of the prospective mother. A glass of rich milk a little
before meal time, however, not only makes up for this omission but
also prevents "heart-burn," a very common ailment of pregnancy.
Although there is an appreciable increase in the quantity of starch
and sugar utilized toward the end of pregnancy, it is generally quite
unnecessary to increase these materials correspondingly in the diet.
Nearly everyone eats more of all the food-stuffs than the body needs.
In the case of the prospective mother the surplus ordinarily taken
meets every need incident to her additional energy requirements.
Because we eat more than we need, someone has said, with as much
truth as humor, that prospective mothers "neither want nor need to
eat for two. The fact is more likely that enough for one is too much
for two." For the average woman it is wiser to take less during
pregnancy rather than more, for over-indulgence is apt to lead to
indigestion. The moment when the appetite is satisfied should be
accepted as the stopping point, and that will be instinctively
recognized if one eats deliberately, and thoroughly masticates the
food.
Regularity in the hour of eating is always healthful, and for some
prospective mothers three meals a day prove quite satisfactory. Not a
few, however, who adhere to this habit make the mistake of eating
more than is wise; and large meals are particularly inappropriate to
pregnancy. On this account most prospective mothers will be more
comfortable if they take some simple and wholesome nourishment at
fixed times between meals. Such an arrangement modifies a ravenous
appetite, and it is, at the same time, beneficial to those who are
not inclined to eat enough at the regular meals. If small amounts of
food are taken five or six times a day, a tendency to be nauseated,
which is not uncommon in the early months of pregnancy, can often be
averted. In the latter months, too, because the capacity of the
stomach is diminished through the encroachment of the enlarged womb,
frequent meals generally contribute toward comfort and health. While
the inevitable consequences of overloading the stomach are to be
avoided at all times of the day, it is especially important to
remember the disagreeable results of a hearty meal at night. The
evening meal should be a light one and should be eaten three or four
hours before going to bed.
THE IMPORTANCE OF LIQUID NOURISHMENT.--Every prospective mother
should have brought to her attention the great importance of drinking
water at regular times and in larger quantities than was formerly her
custom. Since water constitutes two-thirds of the substance of our
bodies, it is necessary, of course, for everyone; but during
pregnancy it is especially necessary for the building of new tissue
and for safeguarding the mother's kidneys. Prospective mothers would
protect themselves against a number of ailments if they were more
careful to drink a sufficient amount of liquids. They may easily
determine whether they are doing so, for whenever the urine passed
during twenty-four hours measures less than a quart, they are not
drinking enough. Generally the daily elimination of urine fluctuates
between two and three pints; a larger amount, however, is rather a
favorable indication than the reverse.
The variations in the quantity of liquids that healthy persons drink
make it impossible to say just how much anyone should take. It may be
said with confidence, however, that women who are pregnant should
consume at least three quarts of fluid every day, and by far the
greater portion of this should be water. The rest may be taken in the
form of milk, soup, cocoa, and chocolate. Against the moderate use of
tea and coffee no valid objection can be raised; the tradition that
they may cause miscarriage is incorrect. For well-known reasons the
habitual use of strong tea or coffee is always harmful, and it is,
therefore, equally as objectionable during pregnancy as at other
times. Beverages which contain a small percentage of alcohol, such as
malt and beer, may or may not be helpful; they should be regarded as
medicine, not to be taken without consulting a physician.
THE CHOICE OF FOOD.--There is no diet specifically adapted to the
state of pregnancy; the prospective mother may usually exercise the
same freedom as anyone else in the selection of food. She should,
however, choose what will agree with her and avoid that which she
cannot digest and assimilate. Personal experience in the main must
guide everyone as to what to eat, and most women may follow the
dictates of appetite after they become pregnant as safely as they did
before.
It is true, of course, that careful scientific observations have
taught not only what the nutritional requirements of the body are,
but also how the diet may be arranged to satisfy these requirements
most conscientiously and economically. "Caloric Feeding" is the name
given the method which aims to furnish an individual the exact amount
of food, and usually to furnish it at a minimum cost. Its principles
are of great practical importance to the commissary of an army or to
the purveyor of an institution which provides for large numbers of
people; but it is neither necessary nor advisable that the diet of
any healthy individual be regulated solely with a view to satisfying
the actual requirements of his or her body. Food should possess other
qualities than fuel value: first of all it must be appetizing, for
appetizing food receives the most thorough digestion.
We all know how variable are our appetites. What appeals to one will
not appeal to another, and frequently the same person has no appetite
to-day for food that she will eat with relish to-morrow. Precise
rules, therefore, to guide healthy persons in the selection of their
food are not obtainable; neither are they desirable, for the exercise
of individual preference possesses notable advantages. In order,
however, that there may not also be disadvantages, the prospective
mother, like anyone else, must be content to choose food that is
simple, wholesome, and of such a character that it will not throw an
undue burden upon the digestive organs.
During pregnancy some uncooked food should be eaten every day. Ripe
fruit answers the purpose admirably. At all seasons of the year fruit
of one variety or another, such as apples, peaches, apricots, pears,
oranges, figs, cherries, pineapples, grapes, plums, strawberries,
raspberries, and blackberries may be obtained and should have a place
in the diet. In making a choice personal taste alone need be
consulted.
Fruit contains a large proportion of water as compared with other
articles of diet; and, therefore, is especially capable of quenching
thirst. Fruit also lessens the desire for sweets, acts as a laxative,
and furnishes mineral material which the body needs. Its laxative
effect is most pronounced when it is eaten alone, as, for example, in
the morning before breakfast or at night upon going to bed; cooked
fruit taken with the meals acts much less effectively. Fruit and
vegetable salads are wholesome, but cannot be recommended
indiscriminately during pregnancy, for not infrequently the dressing
used with them causes discomfort. Under these circumstances it is
obvious that one should do without salads.
The cereals wheat, corn, rye, oats, and barley are the most prominent
source of starch in an ordinary diet. Breakfast foods manufactured
from grain are not only nutritious in themselves, but their value is
increased by the milk or cream used with them. Bread is the staple
starch-containing food in this country, and starch is our main source
of energy, but it is necessary to eat only a small quantity of bread,
if the diet includes a relatively large amount of vegetables. It is
advantageous to use bread made from unbolted flour (Graham bread) or
from corn meal, because the coarse undigested residue which they
leave stimulates the movements of the intestine and assists in
overcoming the constipation which is generally associated with
pregnancy. Pastry must be avoided by those who suffer from
indigestion; and every prospective mother should eat pastry only
occasionally, and not very much of it at any time. The best desserts
are raw and freshly cooked fruit, preserves, gelatin, custard, ice
cream, and light puddings, such as rice and tapioca.
Vegetables should be abundant in the diet of every prospective
mother. Some of them, however, are digested with difficulty, and on
this account cabbage, cauliflower, corn, egg-plant, cucumbers, and
radishes should be eaten sparingly. Occasionally it will be necessary
to exclude them from the diet altogether. Other vegetables produce
flatulence, and for that reason parsnips and beans may cause
discomfort. The prejudice, however, which exists against onions,
asparagus, and celery should not be heeded; all of them are harmless,
and celery thoroughly cooked with milk is very wholesome. Besides
these, moreover, there are many highly nutritious and easily
digestible vegetables which can be freely recommended, such as both
sweet and white potatoes, rice, peas, lima beans, tomatoes, beets,
carrots, string beans, spinach, Brussels sprouts, and lettuce.
Vegetable food contains all the material necessary to sustain life,
and some persons prefer to adhere strictly to a vegetarian diet. Most
prospective mothers, however, find a mixed diet more agreeable, and
this is sufficient reason for using it. Furthermore, no fair
objection can be raised against the use of animal food, provided the
pregnancy is normal. It is important, nevertheless, to remember that
meat contains protein in concentrated amounts, and that meat once a
day answers every need not only of the mother but also of the growing
fetus.
The ideal animal foods are milk and eggs; they contain every
ingredient necessary to repair old and to form new tissues. But
usually the prospective mother may have any animal food she wishes:
beef, veal, lamb, poultry, game, fish, oysters, and clams. The
relatively large fat-content of pork, goose, and duck renders them
indigestible for some persons, who, of course, should not eat them.
From what we have learned about foods in general and their relation
to pregnancy it is clear that the question so often asked by
prospective mothers, "Are there any special directions regarding my
diet?" may be briefly answered as follows: Under no circumstances is
the need of food increased in the first half of pregnancy. During the
last two or three months, while the most notable growth of the fetus
is in progress, there is a perceptible increase in the amount of
energy expended by the mother, and this may be readily supplied by a
glass of milk or some equally simple nourishment between meals.
Furthermore, throughout pregnancy, most women are made most
comfortable by frequent small meals; they will almost certainly
suffer discomfort if heavy meals are eaten three times a day.
The most nearly ideal diet consists of very little meat and a
comparatively rich allowance of vegetables and fruit. The food should
be chosen with regard to individual appetite and should be varied
frequently. Thorough mastication always increases the efficiency of a
diet. Thus the food will be most perfectly mixed with saliva and
broken into fragments which can be readily attacked by the digestive
juices of the stomach and the intestines.
CRAVINGS.--There is a well-known tradition that women who are
pregnant are subject to longings for one article of diet or another,
and that unless the desire be promptly gratified the child will be
"marked." In the light of what has already been said regarding
maternal impressions, this evidently is nonsense. A prospective
mother, like anyone else, does frequently desire one article of food
more than another. So long as the object of her wish is not obviously
harmful, it should be granted; but if it is not granted no harm will
come to the child.
Remarkable instances in which disgusting substances have been craved
and eaten are often talked about and have even found their way into
popular novels. The unfortunate victims of these unnatural cravings
are not of sound mind. With reference to them a physician of
unusually broad experience wrote fifty years ago, "I have never met
with any example of this sort; which leads me to infer that these
longings are more frequent in books than in the practice of our art."
This conclusion is even more fully justified to-day than when
originally expressed.
THE RELATION BETWEEN THE MOTHER'S DIET AND THE SIZE OF THE CHILD.--
With the beginning of careful, scientific study of the nutritional
problems of pregnancy, investigators were interested to learn the
source of the material which was used to build up the child's body.
Two possibilities suggested themselves: one that the material came
from the mother's food and the other that it was derived from her own
flesh. In order to determine which of these methods was the natural
one, animal experimentation was resorted to and gave identical
results in the hands of independent observers. It was found, as I
have already stated, that the same diet which had previously kept an
animal's weight constant was sufficient to meet her requirements
during pregnancy and also to provide for the growth of her offspring.
The mother animal was actually found somewhat heavier at the
termination of pregnancy than at the beginning. It seemed fair to
conclude, therefore, that nutrition had proceeded along more economic
lines, and that under these conditions the customary diet had
furnished the material for the formation of the young. Still other
observations indicated that, if the food is not sufficient for both
mother and offspring, it is Nature's plan to protect the young and
leave the mother's wants incompletely satisfied. On the other hand,
when an unnecessarily large amount of nourishment is taken, the
excess is stored partly in the young, and partly in the mother's
body.
There can be no doubt that the results of such observations upon
animals are applicable to human beings. Everyone familiar with the
practice of obstetrics knows that women who gratify enormous
appetites during pregnancy, especially if they also fail to take
exercise, give birth to large children. On the other hand, it is said
that children born during times of famine are frequently delivered
prematurely, or, if mature, they are small and puny. A similar though
much less marked contrast exists between the babies of the working
classes and the well-to-do, and clearly indicates that the weight of
the baby varies directly with the food of the mother.
The quantity of the food is more influential than its quality, though
the latter is also a factor in determining the size of the child. An
excessive amount of starch or sugar in the mother's diet is stored as
fat in the child. On this account it is reasonable to eat sparingly
of candy, cake, and other sweets; but further attempts to reduce the
weight of the fetus by discrimination against different articles of
food are not advisable.
The various theories that have been advanced with a view to reducing
the size of the child are impracticable; some of them, rigidly
carried out, would actually jeopardize the health of both beings. All
of them are designed to make the infant's bones soft and to diminish
the fat in its body. To this end, generally about two months before
the expected date of birth, the mother's diet is arranged to consist
chiefly of meat; and as far as possible she is denied candy, sweet
desserts, soup, bread, cereals, vegetables, and water. Such a diet
overlooks, among other things, the tremendous importance of liquids
to the woman who is pregnant. Certainly its indiscriminate use would
result in far more harm than good; and no one should adopt it without
minute directions from a physician.
Attempts to make the infant's bones soft by limiting the mother to
food containing extremely small amounts of lime and other minerals
are also unnatural, for we have learned that whenever the mother's
food fails to contain the material the fetus requires the mother's
tissues are called upon to supply it. Under these conditions,
therefore, her bones will give up their lime.
It is of the very first importance that the mother's nourishment be
correct from the standpoint of her own requirements, and such
treatment will also redound most beneficially to the child. She
should never fall, however, into the error of over-eating, which will
not benefit her and will cause unnecessary growth of the fetus. On
the other hand, there can be no justification for measures that tend
to weaken her. She may be careful, in other words, to avoid over-
growth of the fetus, but should not adopt a diet so restricted as to
interfere with normal development. So long as her health is
successfully maintained, she may give herself no concern as to what
the size of the child is likely to be. That is a detail which
concerns her physician, and which will be observed by him several
weeks before the expected date of birth.