Deficiencies Common in Second Trimester

The second trimester, spanning weeks 13 to 26 of pregnancy, is often called the "golden period" because morning sickness typically subsides and energy levels improve. However, this trimester also marks a significant increase in the baby's growth rate and nutritional demands. The baby's organs continue to mature, bones begin to harden, the brain undergoes rapid development, and the baby gains weight more noticeably. All of these processes require a steady supply of vitamins and minerals from the mother.

During this period, the mother's blood volume increases substantially, rising by approximately 40 to 50 percent by the end of pregnancy. This expansion begins in earnest during the second trimester and creates a surge in demand for iron, folate, and vitamin B12 to produce the additional red blood cells needed. Nutrient stores that were adequate in the first trimester may become depleted if dietary intake and supplementation do not keep pace.

Iron deficiency is the most common nutritional deficiency that becomes clinically apparent during the second trimester. As blood volume expands rapidly, the body needs significantly more iron to produce hemoglobin for the new red blood cells. Women who entered pregnancy with low iron stores or who have not been consistent with iron supplementation often develop overt anemia during this period.

Symptoms of iron-deficiency anemia include fatigue, weakness, pale skin and nail beds, dizziness, and shortness of breath with mild exertion. A hemoglobin test is typically performed around weeks 24 to 28 as part of standard antenatal care. In India, where the prevalence of anemia among pregnant women exceeds 50 percent, second-trimester iron screening is essential. If your hemoglobin drops below 11 g/dL, your doctor will likely adjust your iron supplementation.

The second trimester is when the baby's skeleton begins to calcify significantly, creating a sharp increase in calcium demand. If dietary calcium intake is insufficient, the mother's body will mobilize calcium from her own bones to supply the baby, potentially weakening her skeletal health. Many pregnant women in Visakhapatnam and across India do not consume enough dairy or other calcium-rich foods to meet the recommended 1,000 mg per day.

Vitamin D deficiency compounds the calcium problem because vitamin D is essential for calcium absorption in the intestines. Without adequate vitamin D, even a calcium-rich diet may not be fully utilized. Symptoms of calcium and vitamin D deficiency during the second trimester can include leg cramps, especially at night, back pain, and a general sense of muscle weakness. Your doctor may recommend a vitamin D blood test and calcium supplementation during this period.

Zinc deficiency can emerge during the second trimester as the baby's growth accelerates. Zinc is essential for cell division, immune function, and the development of the baby's organs. Symptoms may include poor appetite, altered taste sensation, slow wound healing, and increased susceptibility to colds and infections. Good sources include pumpkin seeds, chickpeas, cashews, and whole grains.

Magnesium is another mineral that can become deficient during this period. It works alongside calcium in muscle and nerve function and is needed for hundreds of enzymatic reactions in the body. Second-trimester symptoms of magnesium deficiency include leg cramps, muscle twitches, difficulty sleeping, and irritability. Dark green vegetables, bananas, nuts, and seeds are good dietary sources.

Omega-3 fatty acids, particularly DHA, are in high demand during the second trimester as the baby's brain and eyes undergo rapid development. Women who do not regularly consume fish or omega-3 supplements may not be meeting the recommended intake for optimal fetal brain development.

With morning sickness usually behind you, the second trimester is an excellent time to focus on improving dietary quality and diversity. Aim to include foods from all major food groups at each meal. A typical South Indian thali that includes rice or roti, dal, a vegetable sabzi, curd, and a small serving of pickle or chutney provides a good foundation that can be enhanced with additional protein, dairy, and fruit.

Increase your intake of iron-rich foods such as green leafy vegetables, lentils, fortified cereals, and (for non-vegetarians) fish and chicken. Pair these with vitamin C-rich foods to boost absorption. Add a daily serving of dairy (milk, curd, or paneer) or a calcium supplement if you do not consume dairy. Include a handful of nuts and seeds daily for zinc, magnesium, and healthy fats.

The second trimester is when your calorie needs increase by approximately 300 to 350 kcal per day compared to your pre-pregnancy intake. Focus on nutrient-dense calories rather than empty calories. A boiled egg, a fruit smoothie with curd, or a portion of chana chat provides both calories and essential nutrients, while fried snacks and sugary drinks provide calories without nutritional benefit.

Your second-trimester antenatal visits are an important opportunity to assess your nutritional status and make any necessary adjustments to your diet and supplements. If you experience persistent fatigue, leg cramps that disrupt your sleep, unusual food cravings for non-food items (pica), or any symptoms of concern, bring these up with your obstetrician promptly.

Around weeks 24 to 28, you will typically undergo blood tests including hemoglobin, blood sugar screening for gestational diabetes, and possibly other tests as recommended by your doctor. This is a good time to request additional nutritional markers if you have concerns. At Heamac Healthcare in Visakhapatnam, your prenatal care team can provide comprehensive second-trimester nutritional assessment and guidance tailored to your individual needs.