Nutritional tips for active and athletic pregnant women

Exercise is beneficial for both the mother and the baby, before conception and during pregnancy. Exercising during pregnancy is known to ease back pain and constipation, reduce the risk of gestational diabetes and pre-eclampsia, help maintain a healthy weight and aid recovery from labour (1,2,3). Exercise is also proven to have a positive effect on the mother’s mood (2,4).

The rule of thumb for expectant mothers is to exercise 150 minutes per week, over 3 days (1,2,3). This amount of exercise does not influence the recommended energy and nutritional requirements for pregnant women. However, your nutritional intake requirements increase accordingly if you are more active.

But what do you need to pay attention to if you are very active during your pregnancy? What changes should you make to your diet at different pregnancy stages?

This article will provide you with some tips on how to support your well-being throughout your pregnancy if you are active and sports play a major part in your daily life.

Why it is important to pay attention to your diet when you are athletic

Being extremely active may cause some worry for the baby’s well-being and development, especially during the later stages of pregnancy. High-intensity and long-lasting exercising in particular can have an effect on the baby’s weight at birth (3). The baby may have less fat and therefore weigh less. Fortunately, some recent studies have shown that the pregnancies, births, and babies of training top athletes have not had any abnormalities (3). However, active exercising and training increase the nutritional and fluid intake needs of the mother to ensure the baby is developing well.

Learn more: Maternity Physio's Top Tips To Stay Fit During Pregnancy

As your body changes during pregnancy, you may experience different types of aches and symptoms. Unless you experience unusual symptoms such as anaemia, placenta previa, slow development of the foetus, severe nausea, or severe pelvic pain, you may continue to exercise as normal for your preferred sport (1,3). It is important to listen to your own body and limits. If you feel unsure, you should discuss your activity levels and the special requirements of your sport with your doctor. To ensure that you meet your nutritional goals, you may also want to contact a registered dietician.

Getting enough energy from your food

For the health of both you and the baby, the key thing is to focus on getting enough energy from your diet. Pregnancy in itself increases energy requirements, which is increased even further if you continue to exercise actively.

The requirement for extra energy varies by the stage of the pregnancy. During the first 14 weeks, the need for extra energy is quite low and can be fulfilled by eating one large piece of fruit or 200 millilitres of fat-free yoghurt per day (5,6). During the second trimester, the need for extra energy is slightly more substantial and is equivalent to a full-rounded snack such as a sandwich, fruit, and a handful of nuts. The energy requirements reach their highest point during the last trimester when the baby is growing in weight and the mum’s body is storing fat in preparation for breastfeeding. During this later stage, the extra energy can be obtained from one larger or several smaller portions of snacks (5,6).

If the expectant mother is highly active, the need for extra energy can increase substantially. The energy needs are influenced by the sport being played, its intensity, the regularity of training, and the length of each training session (7). The energy use of an athlete varies depending on the sport and the training regimen by approximately 2500–8000 kcal per day, even without the pregnancy involved (8). Your energy intake from food should reflect your energy use of the day or exceed it slightly so that your immune system and recovery would be optimal, and the baby would develop normally. Insufficient energy intake may decrease performance and increase the risk of illness, overtraining syndrome, and injuries.

Tips for pregnant athletes for getting sufficient energy (8):

• Eat regularly every three hours, approximately seven times a day.
• Keep all the main meals (breakfast, lunch, dinner) balanced so that they contain carbohydrates, protein, and healthy fats.
• Add two to four snack breaks. Eating snacks will improve your performance and recovery.
• Avoid eating “too healthy”. While highly nutritious choices such as whole meal grains and vegetables are generally recommended, eating too much of them might make you feel full and therefore decrease your overall energy intake. Do not worry about adding fast-absorbing carbohydrates and healthy fats to your diet.
• Sometimes it can be easier to get extra energy from liquids such as dairy and juices.
• Add healthy fats to your diet by using high-fat spread, oil-based salad dressings, and nuts.

Estimating a sufficient energy intake for a pregnant athlete can be challenging. For athletes who are not pregnant, sufficient energy intake can be observed from general well-being, tiredness levels, recovery, normal continuation of periods, and maintaining a certain weight (8). Pregnancy in itself can influence all these, so it can be quite difficult to determine if you are getting enough energy from your diet. You can get a good idea by listening to your body and checking your weight gain. An expectant mother of normal body weight should gain weight during pregnancy (for a total of approximately 13 kg), especially from the second trimester onwards and gain most of the weight during the last trimester (5). If your weight does not increase during pregnancy, it can be a warning sign of insufficient energy intake. Healthcare professionals also help to monitor the baby’s growth.

Energy-rich foods

So what are great sources of energy and how much should you eat when actively engaging in sports during your pregnancy?

Energy-rich foods, also known as macronutrients, are carbohydrates, proteins, and fats. Under normal circumstances, calculating your macronutrient intake is not supportive of a flexible and positive relationship with food, but for athletes, it may be important at times—especially during pregnancy.

Carbohydrates

Carbohydrates are considered to be the most important source of energy, both to support activity levels and pregnancy. A growing baby uses mostly carbohydrates, which also enhances its role as the most important energy source (5). For sports, carbohydrates are the primary energy source during training and sufficient intake prevents muscle catabolism, i.e. using protein as energy (9).

In most cases, 175 grams of carbohydrates per day fulfils the glucose needs of both the mother and the baby (5). However, for sporty mums, the need may be significantly larger. They should aim to obtain at least 6 grams of carbohydrates per kilogram of their weight per day (9). However, some endurance sports such as running and cycling, as well as the number, length, and intensity of training sessions may even double the carbohydrate requirements.

It is also important to consider the quality of gained carbohydrates. They can be categorised to slow and fast-releasing types. A sporty mother should include both of these in her diet. Slow-releasing carbohydrates also contain other important nutrients, such as fibre, vitamins, and minerals, which are invaluable for sports and pregnancy. However, focusing too much on slow-releasing carbohydrates may make it difficult to obtain enough energy. Fast-releasing carbohydrates are preferable during intense training, as they improve recovery (9).

To reach the best possible performance, it is important to ensure that your body has enough carbohydrates to use (9). Especially during training that lasts for over an hour, it is recommended to get extra carbohydrates e.g. through drinks. Eating carbohydrates after training is important for recovery. You should aim to eat a carbohydrate and protein-rich snack after training and follow it up with a more balanced meal approximately an hour later.

Protein

Recommended protein intake for athletes is about 1.4 to 2 grams per kilogram a day. Therefore, under normal circumstances, a person weighing 60 kg requires 84 to 120 g of protein a day.

Pregnancy slightly increases the need as the body uses it to grow the baby as well as tissues such as the womb and the placenta (5). Sufficient intake of protein is important to ensure the baby is born at a normal weight. The need for extra protein is 1.2 g/day during the first trimester, 6.1 g/day during the second trimester, and 10.7 g/day during the third trimester. Getting too much protein is not advisable for either the sport or the pregnancy.

You can obtain protein from animal or vegetable sources. If you are eating solely vegetable-based products, it is important to combine different sources such as pulses, whole meal products, and nuts for each main meal. Below are some examples of how much protein certain foods contain (6,9).

Fat

The need for essential fatty acids increases during pregnancy, especially during the first trimester (10). Sufficient intake is important for the development of the baby’s nervous system and eyesight, for absorbing fat-soluble vitamins, and for tissue regeneration (5,10). For sports, fat from your diet is important for sufficient energy intake, hormone balance, immune system, and normal metabolism. Athletes require approximately one to two grams of fat per kilogram a day (9).

Especially while pregnant, it is important to focus on getting enough polyunsaturated fats. Intake of essential fatty acids such as linoleic acid and alfa-linolenic acid should be slightly increased during pregnancy. Great sources of essential fatty acids include fish, vegetable oils (especially rapeseed and flaxseed), and nuts (especially walnuts).

Should athletic mums use food supplements?

Sporty mums should first and foremost focus on a balanced and sufficient diet. This in itself can fulfil the vitamin and mineral needs (12). Both active exercising and pregnancy can increase the need for certain vitamins and minerals, so sometimes food supplements can be recommended (5,10,11).

The most important vitamins and minerals for sports include vitamins C and D, iron, calcium, and magnesium (11). For pregnancy, it is important to ensure sufficient intake of folic acid, vitamin D, iron, iodine, and calcium (5). Food supplements have only proved to mildly improve performance when compared to a well-balanced diet (12). But when it comes to the combination of intense training and pregnancy, certain food supplements can be required.

Pregnancy can pose a challenge for a sporty mum’s iron levels. The main role of iron is to play a part in red cell formation and the transfer of oxygen from the lungs to other tissues (11). Regularly checking haemoglobin and stored iron levels are very important for sporty mothers, as iron deficiency decreases performance and can make it easier to run out of breath, which can have a negative impact on the baby.

Food supplements for pregnant athletes:

• Folic acid
• Vitamin D

Possible extra food supplements when taking the diet and other circumstances into consideration:

• Iron
• Iodine
• Calcium

An expectant athlete can also consider using energy, carbohydrate, or protein supplements if obtaining enough through diet is difficult. It is especially important during pregnancy to check the background and safety of any food supplements before use (12).

Learn more: Are You Getting Enough Iron? How To Treat Anaemia During Pregnancy

Accepting any changes to your body is important for a healthy body relationship and recovery

Athletes and highly active people are often more drawn to keep checking their diet and body changes, which can be a risk factor for developing eating disorders. Pregnancy comes with many body changes, which can raise different kinds of feelings. It is important to work through these feelings to maintain a healthy relationship with your body and your diet. If the changes cause you to feel sad or anxious, it’s recommended you have a chat with a professional. This is especially true if you find these thoughts alter the way you eat. Food should be much more than just fuel. It is important to take the time to recover after childbirth, and during that time it is advisable to take care of yourself with nutritious and tasty food!

Sources

(1) ACOG, The American College of Obstetricians and Gynecologists (2022). Exercise During Pregnancy – Frequently Asked Questions. 2022. https://www.acog.org/womens-health/faqs/exercise-during-pregnancy (Accessed 21.4.2022)

(2) UKK-instituutti (2022). Hyvää oloa odotusaikaan. Viikoittainen liikkumisen suositus raskaana oleville (normaali raskaus). UKK-instituutti, 2021. https://ukkinstituutti.fi/liikkuminen/liikkumisen-suositukset/liikkumisen-suositus-raskauden-aikana/ (Accessed 21.4.2022)

(3) Tiitinen A (2021). Raskaus ja liikunta. Lääkärikirja Duodecim 2021. https://www.terveyskirjasto.fi/dlk01034#s1 (Accessed 21.4.2022)

(4) Alapappila A (2020). Liikunta raskaus- ja imetysaikana. Sydän.fi 2020. https://sydan.fi/fakta/liikunta-raskaus-ja-imetysaikana/ (Accessed 21.4.2022)

(5) Laitinen K (2021). Raskauden ja imetyksen aikainen ravitsemus. Kirjassa: Mutanen M, Niinikoski H, Schwab U, Uusitupa M. Ravitsemustiede. Helsinki: Kustannus Oy Duodecim 2021, s. 326-332.

(6) Fineli®. Elintarvikkeiden koostumustietopankki. Helsinki: Terveyden ja hyvinvoinnin laitos. https://fineli.fi/fineli/fi/index (Accessed 22.4.2022)

(7) Santos-Rocha R (2019). Exercise and Sporting Activity During Pregnancy. Kirjassa: Silva MR G, Doñate B R, Carballo K N C. Nutritional Requirements for the Pregnant Exerciser and Athlete. Springer International Publishing AG 2019. https://doi.org/10.1007/978-3-319-91032-1_11 (Accessed 21.4.2022)

(8) Terve urheilija -ohjelma. Ravitsemus – Energiansaanti ja ateriarytmi. Tampereen urheilulääkäriasema. https://terveurheilija.fi/urheilijan-ravitsemus/energiansaanti-ja-ateriarytmi/ (Accessed 21.4.2022)

(9) Terve urheilija -ohjelma. Ravitsemus – Energiaravintoaineet. Tampereen urheilulääkäriasema. https://terveurheilija.fi/urheilijan-ravitsemus/ravintoaineet/ (Accessed 22.4.2022)

(10) Sariola AP, Nuutila M, Sainio S, Saisto T, Tiitinen A (2014). Odottavan äidin käsikirja – Raskausajan ravitsemus. Helsinki: Kustannus Oy Duodecim 2014, s. 103-119.

(11) Terve urheilija -ohjelma. Ravitsemus – Vitamiinit ja kivennäisaineet. Tampereen urheilulääkäriasema. https://terveurheilija.fi/urheilijan-ravitsemus/vitamiinit-ja-kivennaisaineet/ (Accessed 22.4.2022)

(12) Terve urheilija -ohjelma. Ravitsemus – Ravintolisät. Tampereen urheilulääkäriasema. https://terveurheilija.fi/urheilijan-ravitsemus/ravintolisat/ (Accessed 22.4.2022)