Prenatal Nutrition
Pregnancy can be one of the most rewarding times in a woman's life. It can be one of the most confusing times, too. With a vast array of resources to investigate, you may find yourself wishing you owned a pregnancy instruction manual, including simple answers to all your pregnancy questions.
Perhaps one of the most discussed topics in pregnancy revolves around what to eat. Certainly, pregnancy represents an opportune time to focus on nourishing yourself and your baby well. The old saying, "You are what you eat," takes new meaning as you carry around your new bundle of love. For, every effort you put forth in proper nourishment can make a world of difference to the health of your baby.
As we all know, nutritional needs shift during pregnancy. And, while pickles and ice cream may be on your grocery list, hopefully some other good things are, too!
However, depending on how you navigate food cravings and aversions, your motivation to whip up well-balanced homemade concoctions may be fairly low.
A good place to start is the plan for a healthy pregnancy. Ideally, pre-pregnancy, a woman should take the proper dietary supplements, such as a prenatal multivitamin, containing proper dosages of essential micronutrients. Folic acid, one of the essential B vitamins for pregnancy, taken before and during pregnancy, helps to ensure a baby does not develop neural tube defects (birth defects of a baby's developing brain and spinal cord). You can get folic acid and folate (the food version of folic acid) from certain foods like enriched grains, beans and lentils, peas, nuts and seeds, orange juice, spinach, soymilk and wheat germ. However, to ensure you get enough of the bioavailable version (the one our bodies absorb and use the best), you should take at least 400-800 micrograms within a prenatal supplement. Some women need higher dosages, including women who have already had babies with neural tube defects and women with conditions like celiac disease. Discuss with your obstetrician to be sure of your personal needs. Also check your vitamin label to make sure it has the USP label (US Pharmacopeia) to ensure product safety and purity.
Dietary supplementation with a prenatal multivitamin should continue through pregnancy and during lactation, if you plan to breastfeed. Additional supplements may be necessary, too. It is often recommended that women take an omega-3 fatty acid supplement daily through pregnancy and lactation. This will benefit a baby's brain and vision development and possibly help reduce the risk of premature delivery and postpartum depression. The NIH recommends 300mg of DHA daily as the Adequate Intake. A great vegetarian supplement source of DHA is made by Spectrum Organics.
DHA, one of the most well researched omega-3 fatty acids, can naturally be found in fatty fish, certain marine algae and fortified foods like DHA fortified eggs, Horizon Organic DHA Omega 3 milks and Silk Plus Bone Health soymilk. Caution should be taken when consuming fish and fish oil supplements to avoid sources of potentially high concentrations of mercury and other contaminants.
The other supplement to discuss with your obstetrician is vitamin D. Consider having your levels checked since many women are vitamin D deficient. You need this vitamin for proper bone health, immune and neuromuscular function and also to help prevent inflammation. Newer research points to vitamin D's role in cancer prevention. You can get vitamin D from sun exposure – likely about 10-15 minutes on several days per week may suffice. Certain foods contain vitamin D, such as milk, yogurt, certain fish, egg yolks as well as fortified orange juice, grains and margarine. In addition to a sun exposure and a balanced diet, you will likely need at least 400IU of vitamin D in supplement form.
When it comes to weight gain, recommendations are also individualized. Women entering pregnancy at normal weight should gain about 25 to 35 pounds. This translates to about 2 to 4 pounds gained in the first trimester. In the second and third trimesters, usually an additional 200 to 300 calories daily will provide the needed weight gain for a normal weight woman. Underweight women are usually recommended to gain between 28 and 40 pounds. Overweight women may need to gain anywhere between 15 and 25 pounds. Obese women may need to gain less. Ranges are adjusted for multiple pregnancies, women shorter than 62" and teenagers.
While a woman needs extra nutrients during pregnancy, it is important to note that certain foods should be avoided, too. In general, caffeine in pregnancy should be limited to no more than 200-300mg daily.
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Soda: 35 to 75mg caffeine
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Shot of espresso: 100mg caffeine
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Strongly brewed 8oz cup of coffee: 150-250mg caffeine
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8oz of decaf coffee: 0-10mg caffeine
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8oz of iced black tea: 50mg caffeine
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1oz of chocolate: 5-25mg caffeine
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Herbal tea: 0mg caffeine
Caffeine can increase fetal heart rate, breathing rate and the risk of having a low-birth-weight baby.
As far as sugar substitutes, aim to avoid them completely. If you have to use them, choose sucralose and stevia over aspartame, acesulfame potassium and saccharin. However, even if you have diabetes, you can have a well balanced diet and successfully avoid sugar substitutes – as long as you limit added sugar, too!
When it comes to herbal supplements, use extreme caution. Research is lacking on the safety of most of these products in pregnancy. Talk to your doctor for specifics. One that appears safe and possibly beneficial for nausea in pregnancy is ginger. Try herbal ginger tea if you have morning sickness.
Alcohol should be avoided in pregnancy. If lactating, know it takes about 2 hours to metabolize one alcoholic beverage (5oz wine, 12oz beer or 1.5oz of distilled spirits), so do not nurse if you still have alcohol in your body. Recommendations for alcohol in pregnancy vary widely. Years ago, doctors recommended pregnant women have a glass of red wine every day to settle their nerves. Some doctors now say a glass of red wine every now and then is fine. Of course, fetal alcohol syndrome and other forms of mental retardation can result if a mother drinks excessively in pregnancy. However, recent research has shown negative effects of small amounts of alcohol on fetal growth. For one, alcohol does nothing positive for a baby. It may negatively impact the baby's growth, IQ, aggressiveness and attentiveness as well as increase the risk of infection soon after birth. Also know there is no defined "safe" amount for pregnancy.
A woman's immune function changes during pregnancy, making her at greater risk for food-borne illness – which can be especially dangerous to a developing fetus. All pregnant and lactating women should avoid foods at risk for Listeria bacteria contamination. This means no hot dogs or deli meats, unless they are reheated until steaming hot; no smoked seafood, unless in a cooked dish; no raw or unpasteurized milk; and, no unpasteurized soft cheeses.
To prevent other food borne illness, follow these rules:
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Cook animal proteins like poultry, eggs and ground beef thoroughly. Watch out for homemade Caesar dressing, meringues and mousse – they often contain raw eggs;
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It's ok to eat a medium done steak, but your burgers should always be cooked well (no pink);
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Seafood usually needs to be cooked thoroughly (so raw sushi is off the list!);
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Avoid all raw sprouts;
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Avoid unpasteurized juices;
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Practice proper hand washing and food preparation to avoid the spread of bacteria.
And, here is the big one – fish safety. The FDA recommends pregnant and lactating women, children and women who may become pregnant to avoid shark, tilefish, swordfish and King mackerel. Fish common in local area grocery stores and at local restaurants commonly containing high levels of mercury include Chilean sea bass, grouper, orange roughy. Other ones with medium to high levels include halibut, tuna (ahi, bigeye, bluefin, yellowfin and canned white albacore) and lobster. Of course, to make matters more confusing, you have to worry about PCB's (carcinogenic contaminants) in fish. Watch out for farm raised salmon – since it often contains PCB's…choose wild salmon or organic farm raised salmon to limit your exposure to PCB's. Most salmon at restaurants is farm raised.
You may be thinking, "Geez! What next?" Well, the fish issue is probably the most difficult to navigate. You may simply prefer to know which foods to actually eat. So, the following are some favorite recommendations for foods to include regularly in pregnancy:
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Eat a variety of lean protein sources to meet your protein needs without overloading on unhealthy fats. Ideas include beans and lentils, whole grains like quinoa, wild salmon, anchovies, sardines, white fish like flounder, sole and tilapia, any lower mercury fish (visit the websites above), organic poultry and lean meats, organic and/or local eggs, organic tofu, tempeh and soymilk and organic dairy products.
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Consume plenty of brightly colored fruits and vegetables to provide you and your baby with vitamins, minerals, phytonutrients and fiber.
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Choose whole grains over refined ones to help meet nutrient needs, prevent constipation and manage blood sugars.
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Opt for unsaturated fats from plants (i.e. nuts, seeds, avocados, olive/canola oils) and fish over saturated or trans fats (from animals or processed foods).
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Drink plenty of water! Pregnancy increases your fluid needs, so drink at least 10 cups of fluids daily.
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Include eggs! Eggs contain choline – a dietary component necessary for brain and neural tube development. The Institute of Medicine deems 450mg of choline daily as an adequate level in pregnancy (550mg for lactation). Eggs are one of the best food sources of choline – containing about 251mg choline per egg.
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Eating three to four daily servings of dairy (preferably organic) helps especially to meet calcium, vitamin D and protein needs. It also provides you with a whole host of nutritious vitamins and minerals. If you are lactose intolerant or have a milk allergy, choose milk alternatives. Almond, rice, hemp and coconut milks are nutritious, but do not provide the same vitamins, minerals and protein as milk or soymilk.
Most importantly, enjoy your pregnancy and try your best in meeting your nutrient needs. Plenty of things like morning (or all day!) sickness or fatigue may get in your way, but remember you will soon have a wonderful baby and knowing you did your best to give him or her a healthy life will be the best gift of all.