Diet Related Taboos During Pregnancy – A Narrative Review

: Maternal nutrition has a huge impact on the health of the mother and the fetus. Pregnancy imposes the need for considerable extra calorie and nutrient requirements. A food taboo is a prohibition against consuming certain foods are embedded into the cultural and religious threads. The restrictions imposed on people forces them to abstain from certain food and drinking items as these things. Food taboos in this community are deep rooted. Avoidance of nutritive food was common in both the religion. Many misconceptions are prevalent which do not have scientific basis. Maternal nutrition needs to be prioritized at community level among family members and front line workers. Anganwadi workers need to be sensitized regarding different beliefs about food consumption during pregnancy and lactation.

Pregnancy is a period when physiological nutrient demands are considerably increased. It imposes the need for considerable extra calorie and nutrient requirements. Therefore, a balanced and adequate diet is of utmost importance during pregnancy and lactation to meet the increased needs of the mother and to prevent "nutritional stress" (1).
However, dietary restrictions due to misconceptions or food taboos during the critical period of pregnancy may compromise the pregnant woman's ability to meet the increased demands of the extra calories and nutrients, hence putting the woman at an increased risk of adverse pregnancy outcomes (2).
Pregnant women have faced dietary deficiency due to food taboo. Some pregnant women, who live in rural area, are obliged to have food taboo that restrain calorie and specific nutrients [3]. Although in the real scenario pregnancy requires more calorie, some food items are considered to be good or bad by the community during pregnancy [4]. Food taboos among pregnant women are varying from culture to culture and community to community especially in rural settings. Pregnant women who were practicing food taboos had significance on lower body weight and unhealthier babies [5,6].
Food taboos are closely related to dietary intakes of pregnant women underscoring the need for assessing food taboos and related misconceptions during pregnancy. Food taboo is abstaining people from food and/or beverage consuming due to religious and cultural reasons [7]. It can be permanent or temporary. Permanent food taboos are avoiding food and drinks throughout their life, while some foods are avoided for certain periods of time. These restrictions often apply to women and are related to the reproduction cycle (during pregnancy, birth, and lactation periods) [8].

Discussion
The practice of food taboo is widespread in developing countries, even though there is a variation in the type of food considered as taboo and the reasons attached to it vary from society to society. For example, in a study in Cape town, South Africa, the most commonly avoided foods were meat products, potatoes, fruits, beans, eggs, butternut and pumpkin, which are rich in essential micronutrients, protein and carbohydrates and the reasons for avoidance of the foods were associated with pregnancy outcome, labor and to avoid an undesirable body form for the baby(9). In a study in Ethiopia, food items avoided were, linseed, honey, milk, fatty meat, eggs, fruits and vegetables and reasons mentioned for avoidance of this food item were plastered on the fetal head, makes fatty baby, fear of abortion, fetal abnormality(10). Similar in a study in Central Ethiopia, the most common taboos were related to the consumption of green leafy vegetables, yogurt, cheese, sugar cane, and green pepper(11). While adequate dietary intake during pregnancy could be affected by many factors including affordability and accessibility, food taboo has been recognized as one of the factors contributing to maternal under-nutrition in pregnancy; especially in rural settings (12,13).
Food taboos have influence on pregnancy even though they need about 300 extra calories per day, especially during the later pregnancy period. When a baby grows quickly, additional calories should come from nutritious foods, so they can contribute to baby's growth and development [14]. The major problem of food taboos is preventing pregnant women from accessing a wellbalanced diet, resulting in high prevalence of low birth weight and harm to mother and baby. Seven percent of disability particularly sight loss and limb malformation is believed to be caused by broken food taboo [15] Food taboos have an effect on nutritional status of children and women. The health sector is better to increase its effort to enhance good nutritional practice through health education, treatment of extremely malnourished children, and provision of micronutrients to mother and children.
Any country in the world has food taboo due to different factors like culture, norm, and religion. The food taboo is also differing from place to place and time to time. Each religion has its own food taboo [16]. Food taboos during pregnancy are influenced by different factors like dietary counselling, whether attending antenatal care (ANC) clinic or not, younger age, less educational status, and multiparous and pregnant women. Culture and belief also influence maternal eating pattern during pregnancy [17].
The foods items most commonly avoided during pregnancy were dairy products like milk, cheese, and yogurt, fruits such as banana, Avocado, eggs, vegetables like cabbage, pumpkin, Taro and sugarcane. Findings from the current study support others in which food taboos during pregnancy were found to be more elaborate, nutritionally significant and differ only in the type and reasons attached to avoidance of the food type (18,19).
A study in Accra Ghana also showed that pregnant women were restricted from consuming certain foods to check their health, control the weight of the expectant mother and unborn child and ensure there is a safe delivery (20).
A study revealed that sugarcane is commonly restricted during pregnancy as it is believed to causes excessive weight gain and difficult deliveries. A similar finding was reported from a study in Arsi Zone, where the discussants considered consumption of sugarcane to be associated with having bigger babies, which is believed to lead to a difficult delivery(21). Similarly a study in Ghana showed that consumption of sugary foods make fetus large (19).
A study further revealed the community belies the fact that if pregnant women consume fruits like banana or avocado and vegetables such as pumpkin and taro particularly towards the last weeks of her pregnancy, it passes to the fetus in the womb and plastered onto the head of the fetus. This finding is supported by the report from Ghana and East Gojam, Ethiopia in which consumption of banana during pregnancy is believed to be attached to the head of the fetus (19).
Another type food considered as taboo in the study area was the consumption of Eggs during pregnancy as it is believed that it makes the fetus large, contributing to a difficult delivery. This finding is again supported by the findings from the study in Ghana and Kenya that showed consumption of Eggs make the fetus large ( 19). The difference supports literature that indicates there is no single reason but several reasons for the belief and adherence to food taboos (22).
Consumption of milk and milk products during pregnancy were also considered as taboo in the study area. The reasons for the restriction of the food type is that it passes to the fetus and gets plastered on to the head of the fetus and makes the baby big. A study in Ethiopia also identified that consumption of milk and yoghurt is considered as taboo and the reason attached to the food held as taboo was to prevent the fetus from getting large and reduce the risk of a long labor (18).

Conclusion
The dietary quality of the pregnant women remains as low as, or sometimes lower than the pre-pregnancy state, partly because of the limited access of fruits, and vegetables. This, along with the prevailing food taboos and misperception towards weight-gain during pregnancy could lead to adverse pregnancy outcomes. The most common foods prohibited as taboo are milk and milk products and eggs, some vegetables like cabbage and pumpkin, taro, banana from fruits and sugarcane. Omitting those food staff from the requirement during pregnancy will have a long term impact on the mother and fetus making maternal and child that is, for the mother and fetus.
The food and drink items, which were avoided during pregnancy, were linseed, cabbage, banana, sugarcane, pumpkin, nug, tea, coffee, porridge, coca drink, groundnut, pimento, and salty diets. Reasons which avoid food were plastered on the fetal head, fatty baby, fear of abortion, and fetal abnormality. Age of the mother, income, and previous ANC attendance had significant association with food taboos.