Dr Girija Wagh, Obstetrician, Gynecologist, IVF expertMD, FICOG, DIP ENDO, FICS
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It’s been six months of confirming now, reassuring and settling with the wonderful life growing within. It’s moving, making its presence felt and many a times kicking, to tell you, it’s happy and doing well. Your own bundle of love, created by you. A lot of hope is attached to it and you now want all to be just right.
Let’s see today how best we can tackle this final sector of the last three months through proper nutrition.
The beginning of the third trimester is marked by some important changing perceptions. Suddenly you feel like making a comfortable home, which is similar to what the birds do for their little ones and is called as ‘nesting’. You become more tolerant, positive and the world looks bright and beautiful. On the other hand, you no more bother to pick up the piece of paper or any something lying on the floor and walk off. The now well-rounded baby bump is much prominent and makes you feel a little physically challenged with some drag on the back muscles, leading to the typical back ache.
As the 28 weeks end, the postural giddiness reduces and you are much more stable. Now the baby’s demands have increased and it needs too; but one still should be very disciplined with food intake. Sudden weight gain at this juncture is commonly observed and the stretch marks start appearing which can be avoided to a much extent.
The growing uterus now occupies the abdomen and this also pushes the diaphragm ( partitioning structure between the chest ( thorax ) and the tummy ( abdomen ) through which the oesophagus ( the pipe connecting the stomach [ that part of the digestive system where the food is mixed with acids to make it easy to be absorbed through the intestines when it reaches there ] to the throat travels ). This, therefore, makes the mother feel full even on eating moderate amounts and excessive amounts can cause some discomfort. Additionally, the emptying of the stomach is slowed, therefore the food mixing with acids and retention there is longer. Due to this the food can come back into the esophagus and sometimes the throat and cause a burning sensation in the chest. This is called as retrosternal burning. This can further get exaggerated by lying down immediately after meals.
Taking small meals often so that they are digested easily and assimilated well. Overeating and forced eating should be avoided. This can cause excess workload on the digestive system mechanisms causing the symptoms of gases and acidity. Easily digestible food admixed with a lot of fibres, help. Water intake with food should be minimal and can be taken about 15-30 minutes after food. Increasing fermented foods and yogurts and buttermilk can help. Light walks after meals help. Do not lie down immediately after meals.
Yes, both you and your baby need more substrates to accommodate the growth. The baby grows and has increased needs and your bodily adaptations to pregnancy need more substrates. It is important that food is adequate in its caloric content and the calories are sourced from complex carbohydrates encompassing 40 % of the diet intake. Proteins too should be equivalent to your weight and this you can read from my previous articles. Increased fluid intake is important. The iron requirement daily is now about 9.5 to 10 mg per day and therefore you must ensure that you are taking the supplements prescribed to you properly.
Supplements are prescribed because your need of micronutrients may not be fulfilled through the diet you are consuming and this has been now studied and proved. It is important that you share this with your doctor and ask for a change of the formulations or practice the right methods of consumption to avoid these side effects. The doctor can suggest alternatives either through other modes of treatment ( e.g iron can be taken via an injection ) or through diet fortification or dietary alterations.
Yes, as the skin stretches to accommodate the growing womb with the baby, it causes microscopic break down. It starts as a red stria and then turn to white or be just white and sometimes are darkly pigmented. These changes and the types are dependent on the individual skin structure and the tenacity. Sudden weight gain is the commonest cause and therefore one should ensure gradual weight gain through smart eating. Also use of moisturisers help. Women with obesity, hypothyroidism, diabetes have an increased tendency to develop dark stretch marks. This is due to release of a pigmenting hormone in addition to excess weight gain.
First and foremost, get it confirmed by your doctor who will guide you about it more. Many a times, the reduced liquor can be a result of less consumption of fluid. It is observed that women who fast or have restricted meals, have this issue and proper nutrition and hydration is known to help. Sometimes it can be pathological needing interventions as it can be mark of reduced perfusion to the baby through the placenta and reduced urinary output of the baby.
Regular clinical evaluations done by the doctor based on clinical assessment and your weight gain help in assessing optimum growth.Therefore regular checkups as recommended by the doctor are important. Sometimes, the doctor may choose to order for a sonographic evaluation if necessary and that can guide better in assessing the baby’s well being.
It’s the last few months and weeks now and you must look forwards to a healthy outcome. Keep a watch on baby movements and report to the doc if you see any difference. Have the right attitude and do not worry or panic unnecessarily. All is going to be well and trust yourself. Wish you all the best for a healthy outcome and in the next
Wish you all the best for a healthy outcome and in the next blog we will write about
‘Am I in Labor ? And how do I know this ? ‘
Dr. Girija Wagh, MD (Obstetrics & Gynaecology), FICOG, FICP, Diploma (Endoscopy, Infertility), Fellowship of Indian College of Ob-Gynec, Women health care specialist, Academician, Acclaimed Orator & Researcher, B. J. Medical 1990-1992, Topper University Of Pune 1992
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