January 26, 2011
Congratulations! For most moms-to-be, the news of a pregnancy is filled with excitement, anxiety, and a frantic rush to figure out how to do all the right things for the next nine months so that ultimately a healthy baby is born. As you know, what you eat plays a big role in your health and that of your pregnancy and your growing baby.
Eating for 1.15?
They say when you’re pregnant you’re eating for two. But really your calorie needs increase by less than 15 percent. You need about an extra 300 calories to support your developing baby – a little less in the first trimester and more in the third. So while you should definitely let hunger be your guide in determining how much to eat, also keep an eye on the scale to prevent excessive weight gain. A normal weight woman (BMI 18.5-25) should gain 25-35 pounds during pregnancy. An underweight woman should gain more (28-40 pounds) and an overweight woman should gain less (11-20 pounds). If you think you’re gaining too little or too much, talk with your doctor. Remember that dieting is never healthy during pregnancy.
A Healthy Pregnancy Plan
A healthy nutrition plan in pregnancy begins with eating small, frequent meals. Three “square meals” are best replaced by five small meals per day including breakfast, lunch, an afternoon snack, dinner, and a bedtime snack. Try to avoid fasting (>13 hours) and always eat breakfast to prevent ketosis, an increased acidity of the blood which can lead to a heightened risk of preterm delivery. An abundance of fruits, vegetables, whole grains, and high-calcium foods are important throughout pregnancy and lactation (check out the MyPyramid Plan for Pregnancy and Breastfeeding).
For many women, the hormonal flux in early pregnancy leads to several weeks of nausea, vomiting, fatigue, stress and other discomforts. First trimester weight loss is not uncommon and a major nutritional goal is to try to eat as balanced of a diet as is tolerable. For the baby, the first trimester is the most critical period for future health.
A prenatal vitamin with at least 400mcg of folic acid is great insurance to prevent neural tube defects (improperly formed spinal cord). Generous consumption of dark green, leafy vegetables; fortified cereals; and fruits like oranges and strawberries may provide enough folate, but a prenatal vitamin eliminates the guesswork and assures sufficient intake.
Often known as the “honeymoon” of pregnancy, the second trimester is the most comfortable part of pregnancy for most women. For the baby, the second trimester is a period of rapid fetal growth leading to increased maternal calorie and protein needs. Protein is especially important to help in the development and growth of the fetus’ vital organs. Try to meet increased nutritional needs through a varied diet high in nutrient-dense foods such as fruits, vegetables, whole grains, and lean proteins but leave a little room to satisfy your cravings. The second trimester also may be a good time to begin to focus on omega 3 fatty acid intake either from foods (such as salmon or other fatty fishes) or a DHA supplement. Some research suggests that fish oils may enhance pregnancy duration and improve the baby’s later cognitive, visual, and cardiovascular development. It’s recommended that pregnant women eat low-mercury fatty fish twice per week.
The third trimester is devoted to putting on weight in the growing fetus, and subsequently you might also see your most rapid weight gain in the final weeks of pregnancy. During this trimester it is especially important to consume carbohydrates regularly throughout the day to provide an adequate supply of glucose to the fetus.
If you have decided to breastfeed your baby, your nutrition choices are especially critical not only to optimize your health and return to your pre-pregnancy weight but also to provide complete sustenance to your baby. Aim to drink about a glass of water each feeding to keep your milk supply up and commit to making the healthful nutritional changes that were initiated during pregnancy such as increased fruit, vegetable, and whole grain intake and smoking cessation permanent. Try to avoid breastfeeding within three hours of drinking any alcohol. A diet rich in fish and taking a DHA supplement may help enhance brain development in your breastfeeding newborn.
What Not to Eat
No article on nutrition in pregnancy would be complete without the obligatory long list of foods that you aren’t supposed to eat. Because alcohol-induced problems such as mental retardation, learning disabilities, and fetal alcohol syndrome and its associated birth defects are entirely preventable, and it is unknown at what amount of alcohol intake damage occurs, alcohol is best avoided throughout pregnancy. Caffeine is also a potentially dangerous substance during pregnancy, particularly at high doses. Caffeine readily crosses the placenta (which develops at the end of the first trimester) and can affect fetal heart rate and breathing. Caffeine also may increase risk of miscarriage, low birth weight, sudden infant death syndrome, and possibly congenital anomalies or birth defects at very high doses. It is best to aim for <100mg of caffeine per day (equivalent to about one cup of coffee).
Many foods can be dangerous due to possible contamination with organisms like listeria and toxoplasma or the metal mercury. While an occasional turkey sandwich, feta cheese crumble, or grilled tuna steak is unlikely to do much harm, try to avoid the following foods whenever possible:
- raw or undercooked meat, poultry, fish or shellfish (sushi or sashimi)
- swordfish, tilefish, king mackerel, and shark
- refrigerated smoked seafood like whitefish, salmon, and mackerel
- refrigerated pâtés or meat spreads
- hotdogs and luncheon meats – unless you reheat them to steaming hot
- soft cheeses like feta, brie, camembert, “blue-veined cheeses,” “queso blanco”, “queso fresco,” and Panela unless the label says they are pasteurized or made from pasteurized milk
- raw or unpasteurized milk or eat foods that contain unpasteurized milk
- unwashed fruits and vegetables
By Natalie Digate Muth
Natalie Digate Muth, MD, MPH, RD, FAAPNatalie Digate Muth, MD, MPH, RD, FAAP is the Healthcare Solutions Director for the American Council on Exercise, a board-certified pediatrician and Fellow of the American Academy of Pediatrics, a Diplomat of the American Board of Obesity Medicine, registered dietitian and board-certified specialist in sports dietetics, and ACE-certified health coach. She is the author of "Eat Your Vegetables" and Other Mistakes Parents Make: Redefining How to Raise Healthy Eaters" and the upcoming textbook "Sports Nutrition for Health Professionals". She has been ACE certified since 1998.