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        Nutrition in pregnancy significantly affects maternal health and infant size and well-being. Pregnant women should have nutrition counselling early in pre-natal care and access to supplementary food programmes if neccesary, according to Dr S Sathyanaraynan, attached to Sri Chakra Hospital Medical Education & Research Centre, Nanganallur near Chennai.

        Counselling should stress abstention from alchohol, smoking and recreational drugs. Caffeine and artificial sweeteners should be used to the minimum. 'Empty calories' should be avoided and the diet should contain the following foods: protein foods of animal and vegetable origin, milk and milk products, whole-grain cereals and bread and fruits and vegetables - especially green leafy vegetables.

        Weight gain in pregnancy should be 20-40 lb, which includes the added weight of the fetus, placenta and amniotic fluid and of maternal reproductive tissues, fluid, blood, increased fate stores and increased lean body mass.

        Maternal fat stores are a caloric reserve for pregnancy and lactation: weight restriction in pregnancy to avoid developing such fat stores may affect the development of other fetal and maternal tissues and is not advisable. Obese women can have normal infants with less weight gain (15-20 lb) but should be encouraged to eat high-quality food, he opines.

        Normally, a pregnant woman gains 2-5 lb in the first three months and slightly less than 1 lb/wk thereafter. She needs approximately an extra 200-300 kcal/d (depending on energy output) and 30g/d of additional protein for a total protein intake of about 75 g/d.

        Appropriate caloric intake in pregnancy helps prevent the problems associated with low birth weight.

        Rigid salt restriction is not necessary. While consumption of highly salted snack foods and prepared foods is not desirable, 2-3 g/d of sodium is permissible. The increased calcium needs of pregnancy (1200 mg/d) can be met with milk, milk products, green vegetables, soyabean roducts, corn tortillas and calcium carbonate supplements.

        The increased need for iron and folic acid should be met from foods as well as vitamin and mineral supplements. Megavitmins should not be taken in pregnancy, as they may result in fetal malformation or disturbed metabolism. However, a balanced prenatal supplement containing 30-60 mg of elemental iron, 0.5-0.8 mg of folate and the recommended daily allowances of various vitamins and minerals is widely used in US and is probably beneficial to many women with marginal diets. There is evidence that periconceptional folic acid supplements can decrease the risk of neural tube defects in the fetus. For this reason, it is recommended that the consumption of 0.4 mg of folic acid per day for all pregnant women. Women with a prior pregnancy complicated by neural tube defect may require higher supplemental doses as determined by their providers. Lacto-vegetarians and ovolacto-vegetarians do well in pregnancy; vegetarian women who eat neither eggs nor milk products should have their diets assessed for adequate calories and protein and should take oral vitamin B12 supplements during pregnancy and lactation.

        Travel and immunisations during pregnancy: During an otherwise normal low-risk pregnancy, travel can be planned most safely between the 18th and 32nd weeks. Commercial flying in pressurised cabins does not pose a threat to the fetus. An aisle seat will allow frequent walks. Adequate fluids should be taken during the flight.

        Ideally, all immunisations should precede pregnancy. Live virus products are contra-indicated (measles, rubella, yellow fever), including small-pox. Inactivated polio vaccine ( Salk) can be used instead of the oral vaccine. Vaccines against pneumo-coccal pneumonia, meningococal meningitis and hepatitis-A can be used as indicated. Influenza vaccine is indicated in all pregnant women who will be in their second or third trimester during 'flu season'.

        Pooled immune globulin to prevent hepatitis-A is safe and does not carry a risk of HIV transmission. Hepatitis-A vaccine contains formalin-inactivated virus but can be given in pregnancy when needed. Chloroquine can be used for malaria prophylaxis in pregnancy and proguanil is also safe, advises the doctor.