Paying particular attention to nutrition before, during, and after pregnancy has many benefits. Firstly, good nutrition improves fertility, eases the side effects of pregnancy, and makes for an easier labor. Secondly, having good eating habits before and during pregnancy helps model healthy behaviors to your child even in utero.
Let’s take a moment to summate the weight of your baby, extra fluids, breast enlargement, etc. Your baby weighs on average 7.5 pounds. Then there’s extra stored protein, fat and other nutrients to support your baby. That makes up for another 7 pounds. You also have about 4 pounds of extra blood, and 4 more pounds of extra bodily fluids. Your breasts and uterus both enlarge by 2 pounds. The placenta weighs 1.5 pounds and also contains 2 pounds of amniotic fluid surrounding the baby. The point of this illustration is to reassure any insecurities about gaining weight in pregnancy. It is important for the mom’s body to prepare for carrying and delivering the baby. If the mom isn’t gaining weight, it is very likely that neither her nor the baby have the right amount of nutrients. Not gaining enough weight puts babies at risk for premature birth, and/or dysfunctions of the lungs and heart.
So now that we know how common and essential it is to gain weight during pregnancy, let’s talk about how that transfers to calories. Women in their second or third trimester account for 300 extra calories per day for the baby. It’s important to consider nutritional calories like fruits and veggies versus empty calories like dessert or soda. If the baby only gets 300 calories from you, make them count!
Should I eat what my body craves? Better yet, what are cravings?
Cravings, an interesting topic, are common among many pregnant women. Usually, cravings are strongest in the beginning of pregnancy, and let up after three months. Some typical food cravings include: chocolate, spicy foods, fruits and comfort foods. There is debate and speculation that a woman craves a food in that her body is deficient. For example, if a mom is craving apples, she might be low in vitamins. Although this idea makes sense, evidence shows no link between cravings and nutritional requirements. There’s another hypothesis that pregnancy changes hormones, specifically those of smell and taste, therefore, a woman craves different foods. Although this idea also makes sense, no one knows for sure. The evidence is anecdotal.
So… what should you do if you’re experiencing cravings? Pay attention to aversions as well as cravings as they might be a signal to avoid potentially harmful foods such as diet soda, coffee or alcohol. Cynthia Belew, a midwife and herbalist in San Francisco suggests taking a fish oil or flax oil supplement as these sometimes ease the cravings. (Be sure to talk with your doctor before taking any supplements.) Beyond that, allow yourself to give in to the healthy cravings such as apples, peanut butter, pickles, etc. and avoid the unhealthy ones like ice cream or cake. You can also find substitute foods for the unhealthy cravings. Substitute frozen Greek yogurt for ice cream. An article on BabyCenter website says “humor your cravings rather than fight them.” If you can trick your body into thinking the craving is satisfied, then you’ll feel more freedom to eat healthily.
Lastly, if you feel that the cravings are controlling you, the article suggests never skip breakfast, take time to exercise, and get lots of emotional support.
There is another type of craving known as pica, where women crave non-food items such as clay or cornstarch. These should never be indulged in, and you should always bring up these cravings with your doctor.7 He or she can guide you through some ways of coping with the cravings and possibly find underlying contributions to your cravings.
What medications are safe?
There is a confusion that sometimes exists during pregnancy about which medications (specifically over-the-counter medications) are safe to use. The bottom line is: never take over-the-counter medication before talking it through with your primary care provider/obstetrician/midwife. This includes vitamins, herbal remedies and supplements. There are certain risks that come with each medicine, so it’s best to research and communicate before taking anything. With all that being said, the following is a list of common medicines with the reputation of being ‘safe’ to use during pregnancy: Benadryl, Claritin, Tylenol, Saline nasal drops or spray, warm salt/water gargle, Colace, Metamucil, bacitracin, Johnson & Johnson first aid cream, Neosporin, Benadryl cream, caladryl lotion, hydrocortisone cream, and oatmeal baths.
The Pregnancy Diet
Eating for two doesn’t necessarily mean eating twice as much as you would before pregnancy. Your body needs nutrients to function normally and to healthily carry a child. The baby also needs nutrients to grow and develop. It is important to know which nutrients you and your baby need and how much. The next sections are broken up into subcategories for fast-look-up and grouped subject information.
You may have heard or read about the importance of getting enough folic acid during pregnancy. “Enough” for pregnant mamas ranges from 400mg9 to 800mg10. Folic acid is essential for blood and protein production and effective enzyme function. Secondly, folic acid prevents neural tube defects in the developing fetus. Folic acid is especially important before and in the early stages of your pregnancy. An article called “Eating During Pregnancy” from the source Family Doctor says to supplement folic acid in the first 28 days to be extremely certain you have enough. There are great sources of folic acid in food, too! Green leafy vegetables, fruits and other vegetables, beans, peas and nuts all are excellent choices for meeting your folic acid goal.
Protein is a staple in the pregnancy diet as it has essential amino acids that aid in cell growth and blood production.12 The baby’s brain, the breasts, and uterine tissue grow dramatically during your 9-month term. The recommendation is to consume 75 to 100 grams per day. This equates to 2-3 servings of meat (size of card deck) or ½ cup legumes.13 Some other protein examples include lean meat, fish, poultry, egg whites, beans, peanut butter, and tofu. 14
Fish, rich in omega-3 fatty acids, low in saturated fat, and high in quality protein is an excellent component of your diet. “Eating During Pregnancy” article recommends 12 ounces per week of low mercury fish. The potential danger with fish is that it’s sometimes high in amounts of mercury, an element that can impair the developing nervous system of the baby. Fish that are low in mercury include salmon, shrimp, clams, Pollock, catfish, and tilapia. Canned tuna may be a convenient choice; however, some nutritionists suggest to avoid it altogether. If you do plan to eat canned tuna, the FDA recommendation is no more than 6oz of canned light tuna per week. 15
It’s important to mention food-borne illnesses while talking about preparing meats and fish. To stay clear of food-borne illnesses, the following is a list of foods to avoid.
- Soft, unpasteurized cheeses (feta, goat, brie, camembert, blue cheese)
- Unpasteurized milk, juice or apple cider vinegar (check labels)
- Raw eggs or food with raw eggs (mousse and tiramisu)
- Raw or uncooked meats, fish, or shellfish
- Processed meats (hot dogs and deli meats)
- Fish high in mercury (shark, swordfish, king mackerel or tilefish)
Up to 30% of your diet is from fat, and it stores energy for moments of fatigue while carrying and delivering your baby.16 Fat also builds fetal organs and the placenta.17 Some good sources of fats are meat, whole-milk dairy products, nuts, peanut butter, margarine, and vegetable oils.18
Both your body and your baby’s body need calcium for strong bones and teeth. In addition, calcium assists muscle contractions and nerve function.19 Calcium helps develop a healthy heart, normal heart rhythm and blot-clotting abilities. Lastly, another benefit of calcium is it reduces the risk of hypertension and preeclampsia. 20
Calcium is a vital mineral to either supplement or include in the diet because your baby will draw calcium from your bones if he or she is deficient. For women under the age of eighteen, the recommendation is 1,300mg per day before, during, and after pregnancy. For women nineteen and older, the recommendation is 1,000mg per day before, during and after pregnancy. Keep in mind that the body only absorbs 500mg at one time, so it’s best to supplement or eat calcium throughout the day. Vitamin D aids in absorption of calcium, so be sure it’s either supplemented or included in your prenatal vitamins. 21
The recommendations roughly translate to three cups per day of high quality calcium.22 Sources of calcium include low-fat yogurt, mozzarella cheese, sardines, nonfat milk, calcium-fortified soy milk, whole milk, canned pink salmon with bones and liquid, cottage cheese, vanilla frozen yogurt, raw kale, turnip greens, and white bread. 23
Excess of calcium (over 2,500mg or 3,000mg if under 18) can cause constipation, increase risk of kidney stones, and hider the body’s absorption of iron and zinc. 24
Fiber is important for your diet to ease constipation and hemorrhoids.25 Fiber can be found in fresh fruits and vegetables, whole-grain breads, cereals, and muffins. There are fiber tablets and drinks, however there is less known about these products, so be sure to talk with your doctor before trying these products. Benefits of fiber come from 20 to 30 grams per day.26
Carbohydrates make up your daily energy production. Some examples of good carbohydrates include breads, cereal, rice, potatoes, pasta, fruits and vegetables.27
|A||Healthy skin, good eyesight, growing bones||Carrots, dark leafy vegetables, sweet potatoes|
|C||Healthy gums, teeth, and bones, assistance with iron absorption||Citrus, broccoli, tomatoes, fortified fruit juices|
|B6||Red blood cell formation, effective use of protein, fat and carbs||Pork, ham, whole-grain, cereals, bananas|
|B12||Formation of red blood cells, maintaining nervous system health||Meat, fish, poultry, milk (supplements)|
|D||Healthy bones and teeth, absorption of calcium||Fortified milk, dairy, cereal and bread|
Iron is important for carrying oxygen for organs and tissues. The recommendation is to eat/supplement 27mg per day. Foods rich in iron include: lean red meat, poultry, fish, dried beans, peas, and prune juice. Vitamin C aids in the absorption of iron.
A Note for Vegans and Vegetarians
There are healthy babies, mamas and pregnancies from a vegan or vegetarian mother. However, nutritional sources and requirements may vary. It is important that you tell your doctor about your diet. Your doctor may suggest vitamin B12 or vitamin D supplements as these are commonly lacking in a vegetarian’s or vegan’s diet. 29
Okay, now I know what to eat… How about what I should and shouldn’t drink?
Water has so many benefits for you and your baby. First of all, water carries nutrients and helps you stay hydrated. Hydration decreases the amount of water you retain in your feet and ankles30 as well as dilates your urine, which decreases your risk of urinary or bladder infections.31 Secondly, hydration eases some of the symptoms of pregnancy such as constipation and hemorrhoids.32In addition, there is a decreased chance and intensity of stretch marks for a woman who is hydrated. Lastly, drinking water replenishes amniotic fluid. You can replenish ½ cup of baby’s fluids every hour, and you do so by drinking lots of water!33
More benefits of drinking water are clearly understood when we look at a mother who is dehydrated. Dehydration increases headaches, nausea, and fatigue. Additionally, dehydration can prompt early contractions, which can lead to preterm labor.
A standard recommendation for water consumption during pregnancy is eight 8oz glasses per day or 64oz in total.34 A useful tip is to designate a glass or container for water drinking. Fill that glass every half hour- regardless if you finished it or not. This does a couple things: It helps you keep track of how much water you drink; it helps you stay on track in order to meet your goal; and it gets you up and moving at least twice per hour! Another tip is cut out all other beverages until you meet your water goal. Keep in mind the source of your water. For example, tap water sometimes has excess amounts of chloride or fluoride in comparison to bottled water.35
No amount of alcohol is safe during pregnancy. It is best to avoid all types of alcohol during pregnancy and breast-feeding. Sometimes there are hidden amounts of alcohol in herbal tinctures, vitamins or kombucha, so either read labels or check with your primary care provider.
Coffee (even decaf), espresso, tea, soft drinks, energy drinks, chocolate and coffee ice cream all contain caffeine.36 Some nutritionist say that one or two 6 to 8oz cups of coffee, tea or soda per day is a safe amount. However, others say no amount is safe. The risk with caffeine is miscarriage and other birthing problems, but there is research that suggests the risk increases as consumption increases.37
Decaf coffee and espresso may be a tempting choice to indulge in your favorite morning time ritual because decaf has very small amounts of caffeine. The danger with decaf coffee is the process of decaffeinating the beans. Sometimes the beans go through a chemical bath, and other times the beans are decaffeinated through a series of washing them with water. This process is called water process and is the safest form of decaf coffee. Ask your local coffee shop or roaster if they carry water-process decaf and enjoy!
Planning for Meals
Now that you have all the information, it may seem intimidating to translate the information into action. The U.S. department of Agriculture has a resource called Daily Food Plan for Moms. It provides tips and diagrams for healthy eating. Some of the tips include:38
- Top your cereal with fruit
- Try barley or brown rice in soups or casseroles
- Include veggies as a pizza topping
- Try exotic fruits and vegetables such as apricots, sweet potatoes, and winter squash
- Drink the milk in your cereal bowl
Another great resource comes from www.choosemyplate.gov. On this website you can personalize a profile under “SuperTracker.” It tells you how much to eat of each of the five main food groups based on trimester, height, pre-pregnancy weight, due date and activity levels.39 If you have access to a computer and want to personalize your diet, this website is a great tool for you!
What are the Best Foods for Pregnancy? And What are the Worst?
There are some foods that are considered “super-foods” for pregnant women. Below is a table of those foods.
|Eggs||Contain more than 12 vitamins and minerals, lots of protein and choline, low in saturated fat|
|Salmon||High-quality protein, high in omega-3 fatty acids, may boost mood, low amounts of mercury|
|Beans: navy, light, black, pinto and chickpeas||High in fiber, protein, folate, iron, calcium and zinc|
|Sweet potatoes||Contain vitamin A and carotenoids, which convert to vitamin A only as the body needs it, contain vitamin C, folate, and fiber|
|Whole Grains: popcorn, oats, barley and quinoa||High in fiber, vitamin E, selenium and phytonutrients that protect cells|
|Walnuts||High in omega-3, protein and fiber|
|Greek Yogurt||Greek yogurt has twice as much protein than regular and contains high amounts of calcium|
|Dark green, leafy vegetables: spinach, kale, swiss chard||Contain vitamin A, C, K and folate which promote eye health|
|Lean Meats||High in protein and vitamin B12; best if 95-98% fat free|
The following is a list of the worst foods for pregnancy: undercooked meat; tobacco, drugs and alcohol; raw or undercooked fish or shellfish; dry, uncooked meats (salami and pepperoni); raw eggs; unpasteurized soft cheese; buffet or picnic foods sitting out longer than 2 hours; raw sprouts; unwashed produce; alcoholic beverages, unpasteurized milk, fresh squeezed juice from a store; and more than 200mg of caffeine.41
Side Effects of Pregnancy can be Linked to Nutrition
A common side effect of pregnancy is nausea. Sometimes nausea is caused from your prenatal vitamins. To avoid this feeling after taking your vitamin, make sure you don’t have an empty stomach. You could also try taking the vitamin before bed so you don’t experience the nausea. Secondly, you could eat smaller portions of meals throughout the day. It’s especially effective if you eat bland foods such as toast or crackers. Lastly, if you’re suffering with nausea, suck on hard candies as they have a reputation of easing nausea. Bonus points if you suck on ginger hard candies.42
Another common side effect of pregnancy that is linked to nutrition is heartburn. If you are experiencing a burning feeling in your throat and chest, cut back on broccoli, spinach, cauliflower, fried foods and carbonated drinks as these have a reputation for flaring up heartburn. 43
Complementary and Alternative therapies are becoming more understood and popular in society. Luckily there are alternative therapies that focus on easing the side effects of pregnancy and labor. For nausea, try acupuncture, acupressure, ginger root and vitamin B6. For backache, make an appointment with a chiropractor or massage therapist. (Ask if they have training in prenatal precautions, and only visit accredited practitioners.) For pain relief in labor, there is evidence that warm baths, relaxation and breathing techniques, emotional support, self-hypnosis and acupuncture all support the relief of pain and tension during contractions and delivery. For turning a breech baby, try exercise and hypnosis. 44
Essential oils are commonly used in pregnancy, labor and postpartum care of the newborn. Although essential oils are great, there are some that have potential harm. The essential oils to avoid include: calamus, mugwort, pennyroyal, sage, wintergreen, basil, hyssop, myrrh, marjoram and thyme. 45
Pregnancy is a very special time for you to bond with your child. You are his greatest influence of health, and if you follow the above guidelines, you will feel confidence and empowerment towards caring for yourself, your newborn, and your family.
In conclusion, there are numerous outside sources such as websites, books, and parent circles to support you on your journey. Secondly, alternative and complementary modalities have techniques for aiding side effects during pregnancy and also during labor.
Next, remember what you drink counts as much as what you eat. Do your best to avoid coffee and alcohol, and be sure you drink enough water!
Vitamins, calcium, iron, carbohydrates, fats, protein and folic acid are the staples of the pregnancy diet. Make an intention to improve your habits with these main food groups, and you’ll be right on your way to a healthy diet.
Lastly, humor your cravings by choosing the healthy alternative.
Becoming a mom is about learning to make choices. Here is your first shot to prove to your baby that you’re going to make the right ones. Not only will you be a happier mama with good nutrition, but the baby will also understand the importance of good eating habits.
Ben-Joseph, Elana P., MD, “Eating During Pregnancy,” May 2013. Family Doctor. Web. 4 July 2016.
“Food Cravings and What They Mean | BabyCenter.” BabyCenter. N.p., May 2016. Web. 24 July 2016.
“Calcium in Your Pregnancy Diet | BabyCenter.” BabyCenter. N.p., June 2016. Web. 24 July 2016.
Johnson, Traci C., MD. “Taking Medicine During Pregnancy.” Web MD. 4 August 2014. Web. July 18 2016.
“Diet During Pregnancy: Healthy Eating While Pregnant.” American Pregnancy Association. N.p., 24 July 2015. Web. 24 July 2016.
“Women’s Health Care Physicians.” Nutrition During Pregnancy. N.p., Apr. 2015. Web. 24 July 2016.
Redfern, Julie. “How much water should I drink while I’m Pregnant?” Baby Center. Web. 18 July 2016.
“Water Intake During Pregnancy.” Pregnancy Water Intake. N.p., n.d. Web. 24 July 2016.
“The 10 Best Foods for Pregnancy – Photo Gallery | BabyCenter.” BabyCenter. N.p., n.d. Web. 24 July 2016.
“12 Worst Foods for Pregnancy | BabyCenter.” BabyCenter. N.p., n.d. Web. 24 July 2016.
“Pregnancy Week by Week.” Pregnancy Nutrition: Healthy-eating Basics. N.p., 28 Feb. 2014. Web. 24 July 2016.
Lifestyle Medicine ITP 3800
19 July 2016