Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Founder & medical director of siahmsr wellness.in

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Reviewed by SIAHMSR medical team.

Dietary needs of women of reproductive age

Overview

       According to data from UNICEF a quarter of women of reproductive age in India are undernourished, with a body mass index (BMI) of less than 18.5 kg/m. Women  have special nutrient needs, during each stage of a woman's life, these needs change with adolescence ,pregnancy, lactation and menopause[1].

 It is a fact that an undernourished mother inevitably gives birth to an undernourished baby, and it will continue through generations if not addressed properly.

     In many underdeveloped countries and developing countries nutritional status of women is a grave concern. The health of baby and mother is not dependent only on the diet and nutrition during period of pregnancy. The nutritional status of women much before pregnancy is crucial.

    Short intervals between pregnancies and having frequent pregnancies with many children, can exacerbate nutrition deficits, which are then passed on to their children.   Fetal growth stunting is often the outcome of the mother’s inadequate nutrition before conception and in the first trimester [first three months of pregnancy].     

What women of reproductive age should eat?

The diet should include whole grains, fruits, vegetables, healthy fats and lean protein.

Iron is important to good health of women. Foods that provide iron include red meat, chicken,  pork, fish, kale, spinach, beans, lentils and some fortified ready-to-eat cereals.

Plant-based sources of iron are more easily absorbed by your body when eaten with vitamin C-rich foods.

Folate or folic acid plays an important role in decreasing the risk of birth defects. The requirement of folates for women who are not pregnant is 400 micrograms (mcg) per day.

Folic acid is very important to produce healthy red blood cells and is critical during periods of rapid growth, such as during pregnancy and fetal development.

 Folic acid is very important for early fetal development, particularly neural tube and spinal cord in foetus.It is crucial in the formation of DNA and RNA .Folate is also involved in protein metabolism [2].

What are the foods rich in folic acid?

•     Dark green leafy vegetables

•     Turnip greens, spinach, romaine lettuce, asparagus, Brussels sprouts, broccoli,  black-eyed peas, mustard greens, green peas,

•     Kidney beans

•     Canned tomato juice

•     Fresh fruits-Oranges, Grapefruit, Papaya,Banana,Avocado

•     Cantaloupe

•     Beans

•     Peanuts

•     Sunflower seeds

•     Whole grains

•     Liver

•     Seafood

•     Eggs

•     Fortified foods and supplements

•     Dungeness crab

•     hard-boiled egg

•     beef liver

RDA [The Recommended Dietary Allowance for folate]

Men                                              400 mcg DFE

Women                                        400 mcg DFE

Alcoholics                                   600 mcg DFE

Pregnant & lactating women    600mcgDFE &500mcg DFE respectively

Inclusion into your diet the natural sources of folates, such as oranges, leafy green vegetables, beans and peas etc. will help increase your intake of this B vitamin.

There are many foods that are fortified with folic acid, such as breakfast cereals, some rice and breads. 

A dietary supplement with folic acid also may be necessary for women who are pregnant or breastfeeding, since their daily need for folate is higher, 600 mcg and 500 mcg per day, respectively. Take folic acid supplements under the direction of a physician.

Folic acid is advised to take as supplements before planning pregnancy to avoid the risk of neural tube defect in the fetus.

Why calcium and vitamin D are very essential for women ?

      Women need to eat a variety of calcium-rich foods every day. Calcium keeps bones strong and helps to reduce the risk for osteoporosis, a bone disease in which the bones become weak and break easily.

Some calcium-rich foods include low-fat or fat-free milk, yogurt and cheese, sardines, tofu, tempeh, soy beans, sesame seeds, green leafy vegetables and calcium-fortified foods and beverages.

  Vitamin D also is important for proper absorption of calcium.  The calcium and vitamin D requirement increases with growing age. Excellent sources of vitamin D include fatty fish, such as salmon, eggs and fortified foods and beverages, like milk products, yogurts etc.

How does  vitamin E protect against ROS [ reactive oxygen species free radicals] impact on  pregnancy and implantation of embryo?

   Vitamin E is important for reproductive health.It is known as anti-sterility vitamin. Some vitamin E-containing foods include wheat, rice bran, barley, oat, coconut, palm and annatto. Other sources of vitamin E are rye, amaranth, walnut, hazelnut, poppy, safflower, maize and the seeds of grape and pumpkins [3].

   In the female reproductive system, ROS can impair cellular functions and subsequently interrupt intracellular homeostasis or balance and furthermore lead to cell damages.The presence of excess ROS can influence early embryonic development through modification of the key transcription factors that modify gene expressions [4].

   High concentrations of ROS in the female reproductive tract could also negatively affect the fertilization of oocytes and cause inhibition of embryonic implantation [5].

Additionally, earlier studies reported that Oxygen species free radicals are involved in defective and retarded embryonic development due to OS-induced cell-membrane damage, DNA damage, and apoptosis .

Vitamin E is a great antioxidant against reactive oxygen species [ROS] causing oxidative stress and damage to our body. Reproductive system also is attacked by these oxygen species and affects fertility.

Why vitamin B12 intake  is very important  during pregnancy ?

Vitamin B12 intake must be enough during pregnancy for the healthy growth of foetus and its nervous system especially during the first trimester of pregnancy. Both vitamin B12 and folic acid intake is essential for mothers to prevent miscarriage and neural tube defect in the baby.

Researchers conclude the fact that vitamin B12 deficiency is associated with a significantly increased risk for neural tube defects.

The recommendations for vitamin B12 intake before becoming pregnant is >300 ng/L.

Sources of vitamin B12

•     Milk

•     Cheese

•     Yogurt

•     Meat 

•     Fish-salmon, trout

•     Eggs

•     Clams

•     Shiitake mushroom

What kinds of foods women should avoid for better reproductive health? 

•   Avoid added Sugars, Saturated Fats and Alcohol

Increase in sugars and fat food make women predisposed to obesity,insulin resistance, polycystic ovarian syndrome ,metabolic syndrome, cardiovascular diseases like heart attacks & strokes. Choose for low-fat or fat-free dairy products and lean proteins instead of red meat .

•   In women muscle mass is less when compared to that of men, body fat is more. They need fewer calories to maintain a healthy body weight. Women who are more physically active may require more calories. Adjust your calories intake according to physical activity.Physical activity is an important part of a woman's health. Regular physical activity helps with muscle strength, balance, flexibility and stress management.

ROLE OF NUTRIENTS IN REPRODUCTIVE HEALTH

 Along with the most important vitamins cited above women of reproductive age group require healthy carbohydrates, proteins and other vitamins and minerals in the adequate values for their better health.

Our knowledge about the significance of interactions between micronutrients in relation to pregnancy outcome is limited. Pregnancy related physiological changes, cause excessive demand for nutrients and deficiency is exaggerated then, causing complications. 

Micronutrient deficiency during pregnancy can lead to anaemia, hypertension, and complications of labour and even maternal death. The deficiency may also cause fetal growth failure .

Iron supplements are routinely used during pregnancy in order to prevent anaemia; however, the potentially harmful effects of excess iron intake through supplements in women with sufficient iron stores are posing questions.

    Recent studies have approved the effective role of copper in neuro-behavioral and neuro-cognitive development during the last two-third period of pregnancy [7]. Copper deficiency in the human diet affects the foetal development. Fortunately copper deficiency is extremely rare. The richest dietary copper sources include shellfish, seeds and nuts, organ meats, wheat-bran cereals, whole-grain products, and chocolate.Zinc plays an important role in pregnancy and lactation, including foetal development and milk secretion. 2-4 mg of excessive zinc is required during pregnancy to meet the physiological needs.

Severe zinc deficiency is associated with long-term labour, teratogenicity and foetal or embryonic mortality .The best source of zinc is oysters, but it’s also plentiful in red meat and poultry. Other good sources are beans, nuts, crab, lobster, whole grains, breakfast cereals, and dairy products. Zinc deficiency is also rare. 

 It is suggested that women of reproductive age group should take a well balanced diet rich in fruits,legumes,lentils cereals,fish,meat, nut and seeds with adequate intae of water for better reproductive and general health.Supplements are to be taken only under the directions from a physician or health care provider.

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References

1.    https://www.unicef.org/india/what-we-do/womens-nutrition

2.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4161975/#:~:text=Deficient%20or%20inadequate%20maternal%20vitamin,%2FL)%20before%20becoming%20pregnant .

3.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836012/

4.    https://pubmed.ncbi.nlm.nih.gov/14713346/

5.    https://pubmed.ncbi.nlm.nih.gov/15237000

6.        https://pubmed.ncbi.nlm.nih.gov/17039855/

 7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5713811/#b13

8. Park`s textbook of Preventive and Social Medicine- chapter Nutrition.