Diet, supplements and minor discomfort in pregnancy and postpartum

VIDEO 6

Symptoms of discomfort due to pregnancy vary from woman to woman. Nausea, vomiting, fatigue, hemorrhoids, varicose veins, indigestion, bleeding gums, pica, fluid retention, backache, skin changes, stretch marks and constipation are the most reported. Dietary modifications can prevent or attenuate many of these. Common postpartum minor discomfort includes afterpains, perineal pain, constipation, urinary distention and lactation problems. Immediate and effective care during and after birth for these problems can ameliorate postpartum adaptation.

Pregnancy and the postpartum period involve significant physiological changes that can cause minor discomfort, affecting maternal and neonatal wellbeing. Proper nutrition during these stages is crucial for maternal and infant health and may prevent or attenuate common causes of discomfort. While high-quality evidence on their efficacy is limited, dietary modifications are recommended as first-line interventions.

Nausea and vomiting

Nausea and vomiting in pregnancy result from elevated hormonal levels stimulating the brain's vomiting center and altering gastric motility. Dietary modifications are often sufficient for managing mild or moderate symptoms. Small, frequent meals can help stabilize blood glucose and reduce gastric discomfort. Protein-rich meals can stabilize blood sugar and prolong satiety. Avoiding spicy foods and consuming electrolyte-containing fluids between meals may also alleviate symptoms. Among supplements, ginger (1 g/day) and vitamin B6 (10–25 mg) are most effective. Iron supplements may exacerbate nausea, therefore, intermittent iron supplementation may be a feasible alternative for non-anemic women with adequate antenatal care.

Constipation and hemorrhoids

Constipation results from progesterone slowing intestinal motility and the growing uterus increasing pressure on the gut. Hemorrhoids result from increased pelvic blood vessel pressure and constipation. Increasing fiber and fluid intake can help soften stools and promote regularity. Fiber supplementation is effective in increasing stool frequency and consistency. Psyllium fiber (6.4–10 g/day) improves constipation and may offer metabolic benefits. Probiotics may regulate bowel function and improve stool frequency and consistency. Switching to intermittent iron supplementation (for non-anemic women with adequate antenatal care) may decrease constipation. Addressing constipation may prevent hemorrhoid exacerbation, though the benefit of these strategies for hemorrhoid relief requires further study. Recommendations for postpartum constipation are the same as those during pregnancy.

Heartburn and indigestion

Heartburn and indigestion are primarily caused by progesterone and relaxin relaxing the lower esophageal sphincter, along with the growing uterus exerting pressure on the stomach. Eating small, frequent meals could avoid stomach overload and reduce pressure on the sphincter. Avoiding trigger foods such as spicy or fatty meals, chocolate, caffeine, and citrus fruits could help, as these can relax the sphincter or increase stomach acid production. Preventing constipation may indirectly reduce stomach pressure. Drinking fluids between meals reduces stomach volume. Maintaining an upright position prevents acid reflux. Calcium carbonate supplements quickly neutralize stomach acid and relieve heartburn. Ginger may support gastric emptying and reduce indigestion, though its effect on heartburn remains uncertain. Probiotics may help improve digestion and lessen heartburn and indigestion, but further research is needed.

Pica

Pica during pregnancy involves craving non-food substances (e.g. clay, ice, starch) and is associated with mineral deficiencies, particularly iron and zinc, as well as an increased risk for anemia. It is more common among women in rural areas and those with a family history of the condition. Early identification of nutritional deficiencies, particularly iron and zinc, should be part of routine care. A diverse and nutrient-rich diet can prevent the deficiencies that contribute to pica. When iron-deficiency anemia is present, iron supplementation should be initiated. Zinc, calcium and folic acid supplementation may benefit if deficiencies are suspected.

Fatigue

Fatigue during pregnancy results from hormonal changes, increased metabolic demands and physiological adjustments. A sufficient intake of energy, healthy carbohydrates, protein and proper hydration, could be beneficial. Nutrients are important, since magnesium deficiency can cause weakness and fatigue; vitamin D addresses low mood and muscle weakness, both of which contribute to tiredness. Vitamin C and other antioxidants help reduce oxidative stress and improve energy levels. Omega-3 fatty acids are linked to improved mental energy and mood. Iron deficiency is a major cause of anemia-related fatigue, necessitating iron supplementation. Addressing folate and vitamin B12 deficiencies is also essential, as they contribute to other forms of anemia.

Varicose veins and leg edema

Increased blood volume, hormonal changes, and the expanding uterus place significant strain on leg veins contributing to venous issues. Avoiding constipation can reduce pelvic pressure. Proper hydration helps minimize fluid retention by eliminating excess sodium and waste, while a low-sodium diet may alleviate swelling and discomfort. Adequate protein intake prevents hypoalbuminemia, a potential cause of edema. Potassium and magnesium support fluid balance, and flavonoids, along with vitamins C and E and omega-3 support vascular health and reduce oxidative stress.

Bleeding gums

Hormonal changes during pregnancy increase gum sensitivity and inflammation, which can be exacerbated by nutritional deficiencies. Vitamin C supports collagen production and reduces inflammation, while calcium and vitamin D are vital for bone and gum health. Vitamin D and folate help lower gum tissue inflammation, and antioxidants combat oxidative stress. Omega-3 fatty acids, with their anti-inflammatory properties, may also reduce gum bleeding.

Back pain

Back pain in pregnancy is caused by the effects of relaxin, which increases spinal and sacroiliac joint instability, along with the shifting center of gravity due to the expanding uterus. A healthy dietary pattern promoting appropriate weight gain can help prevent exacerbating back pain. Anti-inflammatory nutrients, such as omega-3 fatty acids and vitamin D, may support musculoskeletal health, though direct evidence in pregnancy is limited.

Skin changes and stretch marks

Skin changes and stretch marks often cause emotional distress despite posing no health risks. Hydration is advised to improve skin elasticity. Vitamin E and carotenoids, with their antioxidant properties, may support skin integrity, while zinc, omega-3 fatty acids and vitamin C contribute to skin health and provide anti-inflammatory benefits. The Mediterranean diet and low-glycemic-index diets, linked to reduced acne severity in non-pregnant adults, may also be beneficial during pregnancy.

Postpartum perineal pain

Postpartum perineal pain is common and can affect an individual’s ability to care for themselves and their infants. The Mediterranean diet with strong evidence for reducing inflammation, could improve pain. Adequate protein intake supports wound healing and can ease discomfort. Omega-3 fatty acids have anti-inflammatory effects, and evidence, albeit limited, suggests that increased intake may reduce postpartum pain and inflammation. Sufficient vitamin D levels are linked to lower pain perception. Magnesium may aid in muscle relaxation, while curcumin offers notable anti-inflammatory benefits. Vitamin C and zinc, essential for collagen synthesis and tissue repair, support wound healing. Probiotics may help modulate inflammation and pain.

Postpartum urinary retention

While no specific dietary approach exists, certain dietary components may benefit general bladder health. Adequate hydration is essential for proper bladder function. Omega-3, vitamin D, turmeric and ginger, with anti-inflammatory effects, may reduce pelvic inflammation. Avoiding bladder irritants (caffeine, alcohol, carbonated beverages) could be beneficial. Probiotics may maintain gut and urinary microbiota balance, lowering urinary-tract-infection risk, a common complication linked to urinary retention.

Lactation problems

Maternal nutrition can influence lactation. Adequate intake of energy, vitamins and minerals is essential for maintaining maternal health. Vitamin D is vital for the wellbeing of both mother and infant, calcium aids milk production, and iron helps prevent postpartum anemia, which can impact lactation. Staying hydrated is recommended to support milk volume, while protein, omega-3, vitamin B12, and folate contribute to milk quality, production and maternal recovery. Galactagogues show inconsistent results in increasing milk production and require further research. Multiple-micronutrient supplementation during breastfeeding remains debated. In lower-income settings, multiple supplementation addresses nutritional deficiencies effectively; in developed countries, supplementation often focuses on omega-3 for neonatal health, though evidence on preventing postnatal depression is insufficient. Probiotics have shown benefits in treating and preventing mastitis.

CONCLUSION

Most women experience minor discomforts during pregnancy and postpartum. While common, these issues can impact maternal and neonatal wellbeing. Validating symptoms and establishing treatment options are essential. Dietary and lifestyle interventions should be recommended as first-line strategies. Pregnant and lactating women should be encouraged to adopt a nutrient-rich diet. Supplementation may benefit certain conditions, for example, ginger and vitamin B6 for nausea, fiber for constipation and iron for anemia. Although high-quality research is limited, modifying the diet is a practical and low-risk approach, which is fundamental to maternal care.

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