There are many food taboos or restrictions during pregnancy, and every Malaysian will surely have a story or two about them. While some of these can be backed by science, many of these taboos are old wives’ tales or traditional beliefs that have been passed from one generation to another. We talked to Dato’ Dr Siti Zaliha, consultant obstetrician & gynaecologist in order to learn more about the facts and myths regarding food and pregnancy in Malaysia.

1.

Pregnant women should eat twice their usual amount of food

 

 

Eating healthily is very important when you are pregnant.1 But, ‘eating for two’ does not mean eating double or a lot more than you did before.1-3 In the first trimester, you need an extra 80 kcal/day from the normal recommended energy intake of 1,840 kcal/day.4 During the second and third trimester, your energy needs increased by 280 and 470 kcal/day, respectively.4 You can achieve these extra energy requirements by consuming nutrient-dense food, i.e. foods that are rich in essential nutrients such as carbohydrate, protein, calcium and vitamin that are important for both you and your developing baby.3,5 In cases where you are pregnant with twins (or multiples), your nutritional demands will be magnified as the presence of multiple foetuses causes a rapid depletion of your nutritional reserves.6 The American College of Obstetricians and Gynecologists recommended a daily intake of 3,500 kcal/day calories for twin gestations; more than 1,000 kcal/day additional calories as compared with singleton pregnancy.4,6

2.

Pregnant women should not consume cooling foods such as watermelon and pineapple as it is harmful during pregnancy

 

 

Pineapple and other cold foods such as watermelon, cabbage and cucumber are among the food taboos among pregnant Malaysian women.7 This may be due to the fear of miscarriage, excessive bleeding during labour or that the child may be born with deformities.7-9 Generally, pineapple is safe to be consumed during pregnancy.10 Besides, fruits such as pineapple and watermelon are high in fibre and contains important nutrients such as vitamins (A, B1, B12 and C), copper and manganese.10,11

3.

Eating liver contributes to foetal eyesight development

 

 

Eating liver can potentially harm the foetus as it contains a lot of vitamin A.12,13 Therefore, pregnant women should avoid taking excessive liver or products containing liver (e.g. liver pâté, liver sausage or haggis) as excessive intake may result in toxic effect for the mother and foetus.12,13

4.

Eating nuts during pregnancy will give your child nut allergy

 

 

In a recent study, it was revealed that children whose mothers had the highest consumption of peanuts (more than 5 times a week) during pregnancy, had the lowest risk of peanuts allergy.14 This was especially true among pregnant mothers who are non-allergenic (no allergic reaction to peanuts).12,14 Therefore, unless you are allergic to peanuts or your doctor advises you not to, it should be safe to eat peanuts or food containing peanuts (such as peanut butter) during pregnancy.12

5.

Pregnant women should avoid raw or partially cooked foods e.g. raw meat, fish and eggs

 

 

Eating raw and undercooked meat may expose pregnant women to toxoplasmosis; an infection caused by Toxoplasma parasite commonly found in raw and undercooked meat, untreated water and cat’s stool.12,15,16 On the other hand, it is safe for pregnant women to eat raw or lightly cooked fish, provided that  any raw wild fish used to make it has been frozen beforehand.12 Freezing kills the small parasitic worms that are normally found in wild fish.12 Raw or partially cooked eggs may contain Salmonella bacteria which may cause food poisoning that typically present with symptoms such as diarrhoea, nausea and vomiting.12,15,17

6.

Pregnant women should avoid dairy products made from unpasteurised milk such as some types of ice creams and cheese

 

 

Unpasturised milk may contain Listeria bacteria which is associated with abortion or premature delivery.15-17 It is fine to eat commercially manufactured ice creams as they are made with pasteurised milk and eggs, therefore eliminating the risk of bacterial food poisoning.12,15 However, try to steer clear of soft serve ice creams as there is a high chance of bacterial (Listeria) contamination due to poor hygiene and cleaning of the soft serve dispensing machines.18 Try to opt for hard frozen ice cream or gelato as they are usually stored frozen, stopping any bacterial growth.18 You should also avoid soft cheeses such as Feta, Brie and Camembert; however processed cheese slices and hard cheeses (for example cheddar cheese) are acceptable.15,16

7.

Drinking coffee is harmful

 

 

Caffeine is commonly found in coffee and other beverages such as tea, chocolate, soft drinks and energy drinks.12 According to the United Kingdom National Health Services and American Pregnancy Association, pregnant women should limit their caffeine intake to ≤ 200 mg per day (about one mug of filter coffee plus one can of cola).12,15 Too much caffeine can result in miscarriage and an increased risk of low birthweight.12,15 In addition, polyphenolic compounds found in coffee are responsible for poor iron absorption from the diet which may lead to iron deficiency.19 You can cut down your caffeine intake by switching your coffee to decaffeinated coffee and tea, mineral water, milk or fruit juices.12,15 

8.

Eat plenty of vegetables but do not touch salad

 

 

Fruits and vegetables are essential during pregnancy.15 However, it is important to make sure that fruits and vegetables that are normally eaten raw such as lettuce and carrots are properly washed to remove soil and dirt that could expose you to toxoplasmosis.15,16 You should stay away from pre-prepared salads or salads from salad bars in restaurants, delis and supermarkets.20 These chilled, ready-to-eat salads may be contaminated with Listeria bacteria due to the multiple handling involved in their preparation.20,21 Furthermore, Listeria can continue to grow even in refrigerated foods. 20Therefore, if you really craved for salads, try your best  to only eat salads that have been thoroughly washed and freshly prepared.20 The United States Food and Drug Administration (FDA) has alerted pregnant mothers about the risk of eating raw sprouts of any kind (for example alfalfa, snow pea, clover, radish and mung bean).21-23 The sprout seeds are often contaminated with harmful bacteria such as Salmonella, Listeria and E. coli that are impossible to wash out and could lead to foodborne illness upon consumption.21-23

9.

Eating soybean and avoiding dark-coloured food will give my child fair skin

 

 

According to traditional taboo, it is believed that eating dark-coloured foods (such as kicap (soy sauce), chocolate, coffee and cola) is associated with having a child with dark skin.8 On the other hand, eating more tofu and soybean products is thought to be related with having a child with fair skin.24,25 This is in fact an old wives' tale because no food can alter your child's genetic make-up.24-26 Skin colour is a genetic trait (inherited from the ancestors) and is affected by the amount and distribution of melanin pigments in the skin.26 For example, people with darker skin have more melanin pigments compared to those with lighter skin, and the melanin pigments in Africans are more dispersed than us; Asians.26

10.

Eating street/hawker food

 

 

During pregnancy, you are more susceptible to food poisoning as a result of hormonal changes that lower your immune system.17,27 Listed below are some precautions that you could take while still enjoying your favourite hawker foods.

 
  • Choose foods that are prepared fresh or foods that are cooked only after you have placed your order.28 You should also opt for piping hot foods (60°C and above) and foods that are well-cooked such as well-done meat and deep-fried foods.27,29  Pre-cooked foods such as rojak, pisang goreng, pre-made sandwich or steamed chicken rice are normally left out for some time a room temperature, sitting uncovered, allowed to cool, or contaminated by other people; hence increacing the risk of food poisoning.27-29
  • Avoid dishes with raw ingredients such as raw fruits and vegetables or uncooked meat to prevent food poisoning or water-borne infections as these dishes may harbour dirt, bacteria, insects or residues from sprays.27,29,30
  • It is best to avoid foods with sauces or condiments that have been left out at room temperature for a long time to eliminate the risk of foodborne illnesses such as listeriosis.28,29
  • Try to stay away from eating ais kacang during pregnancy as the ice used may not actually have been made from safe drinking water and sometimes the vendors use bare hands when shaving the ice.31
  • Street foods are normally loaded with mono sodium glutamate, cheap oil and food colourings which are known to cause headache, allergy and water retention. It is best that you limit your street food intake during pregnancy.30

11.

Eating spicy food triggers labour

 

 

There is no scientific proof that eating spicy food can trigger labour or have any impact on your pregnancy and your developing baby.32,33 However, you may experience heartburn and digestion problems if you consume too much spicy foods, especially in the third trimester.33 During this time, your growing foetus may cause acid reflux (backward flow of stomach acid into the oesophagus) and consumption of spicy foods could worsen this situation.33

12.

Drinking more water increases amniotic fluid

 

 

The volume of amniotic fluid is influenced by the status of maternal hydration.34,35 Several studies have been conducted on pregnant mothers who consumed 1.5 to 2 litre of water 2 to 6 hours before their amniotic fluid volume was measured. The results demonstrated significant increase of amniotic fluid volume by 16 to 30%.34-36 

 

Article contributed by Dato’ Dr Siti Zaliha, Consultant Obstetrician & Gynaecologist

 

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