A woman can gain enough weight during pregnancy and still remain nutritionally depleted. Much of the conversation around prenatal nutrition still focuses on restrictions, what to avoid, what to cut back on, what might be risky, rather than whether the body is actually receiving what it needs.
That matters because many women enter pregnancy with nutrient stores that are already low or borderline, particularly for iron and iodine, long before symptoms become obvious. In many Asian households, meals are often centred around staples such as rice, noodles, soups, and home-cooked dishes. While these meals can be comforting and filling, nutritional adequacy isn’t always as straightforward as simply eating enough. Meals may feel satisfying while still falling short of key nutrients needed to support pregnancy.
Pregnancy increases biological demand in ways appetite alone doesn’t fully reflect, and the gap between what’s consumed and what’s required is where many nutritional challenges begin.
Why “eating well” is not the same as meeting pregnancy demands
A more accurate way to understand prenatal nutrition is through three layers: supply, absorption, and demand. Most guidance focuses on what’s eaten, but not enough on what the body can absorb or what pregnancy actually requires at different stages.
In early pregnancy, nutrients like folate and iodine take on critical roles, often before pregnancy is even confirmed. As pregnancy progresses, demands shift towards iron, calcium, protein, and omega-3 fatty acids to support blood expansion, skeletal growth, and neurological development. What’s often overlooked is the tendency to focus on isolated nutrients or “superfoods”, rather than recognising that nutritional needs change throughout pregnancy and that balance matters more than excess.
Pregnancy can increase nutritional demand faster than eating habits adjust to meet it. When intake doesn’t keep pace with demand, the body adapts, but not always efficiently. This is often when fatigue, reduced stamina, appetite changes, or difficulty concentrating begin to appear.
From a clinical nutrition perspective, nutritional priorities during pregnancy shift across each trimester, yet many of the most important aspects are either misunderstood or overemphasised. As Dr Rouf, a Certified Prenatal Dietitian, notes, pregnancy nutrition centres on meeting specific nutrient needs at the right time, rather than simply increasing overall intake.
In the first trimester, folate and iodine take precedence. Folate is essential for the development of the neural tube, which forms the baby’s brain and spinal cord. It also supports cell division, red blood cell formation, and DNA synthesis. Folic acid supplementation plays a key role in reducing the risk of neural tube defects. Prenatal supplements typically provide around 400–600 µg, aligning with the 600 µg daily intake recommended by RANZCOG through a combination of food and supplementation.
However, requirements aren’t uniform. Women with higher risk factors, including those with higher BMI, diabetes, a history of bariatric surgery, or malabsorptive conditions such as inflammatory bowel disease or coeliac disease, may require higher intake. Those taking anticonvulsant medication or with an MTHFR genetic mutation may also need alternative forms such as methylfolate or folinic acid, which are more readily utilised by the body.
Iodine is equally critical in early pregnancy. It supports thyroid hormone production, which is essential for the baby’s brain development, particularly in the first three months when the baby relies entirely on maternal thyroid hormones. A daily supplement of 150 µg is recommended. As Dr Rouf highlights, what’s often overlooked is the importance of assessing thyroid function before conception and in early pregnancy. Existing thyroid conditions may require adjustments in supplementation or medication, whether due to an underactive thyroid, often linked to Hashimoto’s disease, or an overactive thyroid, commonly associated with Graves’ disease.
As pregnancy progresses into the second and third trimesters, attention shifts towards iron, choline, and omega-3 fatty acids. Iron supports the expansion of maternal blood volume, placental development, and overall foetal growth. It’s important to recognise that haem and non-haem iron absorption differs significantly. Haem iron, found in animal products, is more readily absorbed, while non-haem iron from plant-based sources is less efficiently utilised. As a result, vegetarians and vegans may require up to 1.8 times more iron to meet their needs.
Choline plays a central role in brain development and supports nutrient transport across the placenta. Despite its importance, choline is often under-consumed, partly because high doses are difficult to include in prenatal supplements due to its physical properties.
Omega-3 fatty acids, particularly DHA is critical for brain and eye development. Adequate intake has also been associated with a reduced risk of preterm birth. While plant-based sources provide ALA, the more biologically active forms, EPA and DHA, are primarily found in animal sources. For those following vegetarian or vegan diets, algae-based supplements are the appropriate alternative.
Nutrition in pregnancy isn’t only about individual nutrients. One of the most persistent misconceptions remains the idea of “eating for two”. Energy needs don’t increase in the first trimester. In the second and third trimesters, requirements rise modestly by approximately 340 kcal and 452 kcal per day respectively. The emphasis should remain on nutrient quality rather than quantity. This means prioritising whole, nutrient-dense foods, adequate fibre, and consistent hydration, rather than simply increasing portion sizes.
Taken together, pregnancy nutrition is less about broad generalisations and more about precision, timing, and individualisation.
Where assumptions about nutrition do not match biological demand
Several widely held assumptions sound reasonable but don’t fully reflect how the body works. Eating more doesn’t automatically mean meeting nutrient needs, and supplements aren’t a replacement for a balanced diet. Feeling “fine” is also not a reliable sign that nutritional needs are being met.
Iron deficiency remains one of the most common nutritional concerns during pregnancy, alongside low levels of vitamin D, iodine, and vitamin B12. When iron levels are low, the body has to work harder to deliver oxygen throughout the body. This is why climbing stairs, carrying groceries, or even walking moderate distances can suddenly feel far more exhausting than expected.
Left unaddressed, these gaps contribute to persistent fatigue, increase the risk of anaemia, and can affect foetal growth and brain development. The challenge is that these changes often develop slowly, making them easier to normalise or dismiss.
By the time these patterns are recognised, fatigue and reduced stamina may already be affecting everyday routines, work, or eating habits.
Many women enter pregnancy with underlying nutrient gaps, and some of the most common aren’t always immediately obvious. Iron and vitamin D deficiencies are frequently seen in early pregnancy, and both play a critical role in maternal health and foetal development.
Vitamin D, a fat-soluble vitamin, supports calcium absorption and is essential for the development of the baby’s bones. It also plays a role in placental function, insulin regulation, and immune health. When levels are insufficient, it has been associated with an increased risk of pre-eclampsia, gestational diabetes, preterm birth, and low birth weight. Adequate supplementation has been linked to a reduced risk of complications such as miscarriage and adverse neonatal outcomes, as well as potential longer-term effects including neurodevelopmental conditions such as ADHD and ASD.
Risk isn’t evenly distributed. Women with darker skin tones, those who wear more covered clothing, or those with limited sun exposure may require closer monitoring and higher intake to maintain adequate levels.
Iron requirements increase progressively throughout pregnancy, as iron is needed to support the expansion of maternal blood volume, placental development, and overall foetal growth. Iron deficiency has been associated with both low and high birth weight, reflecting its broader impact on pregnancy outcomes.
There’s no increased iron requirement in the first trimester, which can make it a practical window to begin supplementation if levels are suboptimal. However, this is also the stage when many women experience nausea, and iron supplements may worsen gastrointestinal symptoms such as constipation, making adherence more challenging.
It's also important to recognise that iron absorption varies significantly by source. Non-haem iron from plant-based foods is less efficiently absorbed than haem iron from animal sources. As a result, vegetarians and vegans may require up to 1.8 times more iron to meet their needs.
These deficiencies are often a reflection of pre-existing nutritional gaps, with direct implications for both maternal health and early foetal development.
Why everyday routines undermine nutritional intake
In urban settings across APAC, pregnancy is often navigated alongside work, long commutes, caregiving responsibilities, and packed daily schedules that don’t necessarily slow down. Daily eating patterns reflect this reality. Some women rely on plain crackers or bread throughout the day because nausea makes other foods difficult to tolerate. Others skip meals between meetings, depend heavily on caffeine to stay functional, or avoid foods like fish, eggs, or meat because smell sensitivity suddenly makes them unappealing.
These behaviours are understandable. But over time, they can reduce intake of key nutrients such as protein, iron, iodine, and omega-3 fats.
When nausea, fatigue, time constraints, or food aversions narrow food choices further, meals can gradually become repetitive, making it harder to maintain adequate intake of protein, iron, and other key nutrients across the course of pregnancy.
In many Asian households, diets are shaped by staples such as rice, noodles, soups, and largely home-cooked meals. Optimising nutrition during pregnancy doesn’t require a departure from these familiar patterns, but a more considered approach to balance within them.
Food is deeply tied to culture and identity. It provides comfort, shapes routines, and plays a central role in social and family life. Removing these foods entirely is neither necessary nor sustainable, and may also affect emotional wellbeing, especially during a period of significant change.
While many Asian dishes are rich in flavour, they can sometimes be more carbohydrate-heavy. A practical way to optimise meals is to balance each plate with protein and fibre. This can be achieved by incorporating lean protein sources and aiming for at least three colours of vegetables at main meals. Staples such as rice, noodles, or soups can still be included, but pairing them with protein and fibre supports satiety and more stable energy levels.
Ultimately, there’s no need to restrict familiar foods. The focus should be on how meals are composed, rather than eliminating what is culturally meaningful. With a few adjustments, traditional eating patterns can continue to support both maternal health and nutritional needs throughout pregnancy.
Not everything is “just pregnancy”
Fatigue, dizziness, breathlessness, and reduced concentration are commonly associated with pregnancy. But context matters.
Needing to sit down after short walks, becoming breathless after climbing one flight of stairs, feeling unusually weak during routine tasks, or struggling to stay alert despite adequate sleep may reflect more than expected pregnancy changes.
In some cases, these patterns are linked to nutritional gaps, particularly iron or vitamin B12 deficiency. The overlap with expected pregnancy symptoms is exactly what makes these issues easy to miss, especially when the changes appear gradually over weeks or months.
How you describe symptoms matters
General statements rarely lead to deeper assessment. Saying “I feel tired” may not communicate how much symptoms are affecting daily life.
More specific descriptions are often more useful:
“I feel exhausted even after resting.”
“I get dizzy when I stand up.”
“I feel breathless doing simple things.”
“I’m struggling to finish meals because of nausea.”
These details help doctors decide whether further evaluation is needed. Depending on the situation, they may assess haemoglobin levels, ferritin (iron stores), vitamin B12, thyroid function, or other nutritional markers.
Key nutrients such as iron, folate, iodine, calcium and DHA are frequently highlighted during pregnancy, but their role extends beyond simply increasing intake. As Dr Rouf points out, the function, timing, and balance of these nutrients become particularly important during this stage, and more isn’t always better.
There’s evidence to suggest that targeted supplementation can be beneficial and may reduce the risk of certain conditions during pregnancy. For example:
- Vitamin B6 may help reduce nausea in the first trimester.
- Vitamin D may lower the risk of pre-eclampsia, miscarriage, foetal or neonatal mortality, as well as ADHD and ASD in childhood.
- Calcium may be recommended for women at risk of pre-eclampsia or those with high blood pressure.
- Iron is typically introduced based on blood test results around 24–28 weeks.
- Omega-3 may reduce the risk of premature birth.
However, supplementation needs to be individualised. Taking higher doses doesn’t necessarily confer additional benefit and, in some cases, may cause harm. High doses of certain nutrients can exceed safe limits. For instance, excessive vitamin B6 intake has been associated with nerve damage and may lead to adverse pregnancy outcomes, particularly in early pregnancy. All nutrients have an upper limit, and exceeding these thresholds, whether through a single supplement or multiple overlapping products, can result in nutrient toxicity and unnecessary financial cost. This is why unsupervised supplement use isn’t recommended.
Dosage and timing also influence effectiveness. Some nutrients are better absorbed in smaller amounts and may need to be spaced apart. Calcium and iron, for example, should be taken at different times to optimise absorption. Iron absorption can also be reduced when taken alongside tea or coffee due to the presence of tannins.
The form of the nutrient matters as well. Different formulations vary in bioavailability and side effect profiles. Common forms such as ferrous fumarate and ferrous sulfate are more likely to cause gastrointestinal side effects, including constipation and nausea. For those already experiencing these symptoms, gentler forms such as iron bisglycinate may be better tolerated.
When tradition supports nutrition and when it starts to limit it
Across many households, pregnancy eating habits are influenced by family advice, cultural beliefs, and long-standing food practices. Some encourage rest, hydration, and home-cooked meals. Others may lead to unnecessary restriction of foods that provide important nutrients during pregnancy.
In some cases, foods such as eggs, seafood, or certain meats may be reduced because they’re believed to generate “heat”, worsen symptoms, or affect the pregnancy in some way. When nausea and food aversions are already limiting intake, these additional restrictions can narrow food choices even further.
The challenge is often not tradition itself, but whether nutritional needs continue to be met when diets become increasingly limited over time.
When these changes deserve a closer look
Persistent fatigue that doesn’t improve with rest, noticeable appetite changes, recurrent dizziness, difficulty tolerating supplements, or significant dietary restrictions should be assessed more closely.
This is particularly important for women following vegetarian or vegan diets, those with significant nausea and vomiting, or those struggling to maintain regular meals. In these situations, more tailored support from a doctor or dietitian may help identify nutritional gaps before they become more difficult to correct.
Why consistency matters more than eating perfectly
Prenatal nutrition is shaped less by occasional healthy meals and more by what happens consistently over time. Missing meals regularly, relying on the same low-variety foods, or struggling to eat adequately for weeks at a time can gradually affect nutrient intake in ways that aren’t always obvious early on.
Pregnancy increases nutritional demand over months, not days. This is why regular eating patterns, dietary variety, and adequate intake often matter more than trying to eat “perfectly”.
These demands don’t suddenly end after delivery. For some women, nutritional strain becomes more noticeable after birth, when recovery, breastfeeding, sleep disruption, and irregular meals begin to overlap.
Nutrition during pregnancy doesn’t only influence outcomes during those nine months. It also shapes how a woman recovers after birth, including her energy levels, nutrient stores, and the ability to meet the demands of breastfeeding. As Dr Rouf highlights, many women are unaware that requirements for several nutrients are higher during postpartum and lactation than during pregnancy.
For example, choline requirements increase from 440 mg/day during pregnancy to 550 mg/day during lactation, reflecting its ongoing role in supporting both maternal health and infant development.
Entering the postpartum period with existing nutrient depletion can affect breastfeeding experience and maternal mental health. It may affect breastfeeding outcomes and has been associated with an increased risk of postpartum depression. A 2020 systematic review found a significant association between perinatal depression and dietary intake across multiple studies, with patterns that included fruit, vegetables, fibre, yoghurt, and seafood appearing to have a protective effect.
Energy demands also rise during breastfeeding. Caloric needs increase to support milk production and maintain maternal energy levels. When intake is insufficient leading into the postpartum period, it may affect both milk supply and overall recovery.
What becomes clear is that nutrition doesn’t begin at birth, nor does it end at delivery. As Dr Rouf emphasises, it’s a continuum that starts before pregnancy, carries through pregnancy, and extends into postpartum recovery. Supporting health during preconception can influence pregnancy experience, and dietary patterns during pregnancy can shape recovery after birth.
Healthy eating isn’t about perfection. It’s about doing the best you can on any given day, and that will look different for everyone.
Prenatal nutrition is about meeting demand, not eating more
Pregnancy is a period of continuous physical change, and nutritional demands don’t suddenly stop after delivery. Nutrient stores built during pregnancy continue to influence recovery, energy levels, healing, and the demands of breastfeeding long after birth.
For many women, nutritional strain becomes most noticeable only after the pregnancy itself is over, when exhaustion, disrupted sleep, recovery, and feeding demands begin to overlap while regular meals become harder to maintain.
Prenatal nutrition isn’t simply about eating more. It’s about whether the body can consistently meet the demands of pregnancy over time.
Because by the time the body starts showing the effects of nutritional strain, the gap may have already been there for months.
Dr Anika Rouf, PhD
Certified Prenatal Dietitian
Appetite by Anika, Australia
Instagram @appetitebyanika
This article was produced by Healthful For You. The views and opinions expressed throughout are those of the authors and do not necessarily reflect those of the Expert Contributor. The Expert Contributor has provided input solely for the EXPERT INSIGHT and TIP segments, based on their professional expertise. These comments are intended to offer general guidance and may not apply to all individuals. Any interpretations or conclusions beyond that section are those of Healthful For You. This article is not a substitute for personalised medical advice, diagnosis, or treatment. Please consult your doctor or a healthcare professional regarding your specific health needs.
We hope you found this article informative. Healthful For You welcomes contributions from healthcare professionals, patients, and community members. If you have a story, research, or a perspective that can enrich our dialogue, please get in touch with us at [email protected].