Eating by Trimester

Your doctor advises you to eat healthfully during pregnancy, but you might find it difficult, given that your tastes change dramatically throughout the nine months. Eating well can be a challenge, since your pregnant palate is much altered.

In recent years, we have learned a great deal about what constitutes a healthy pregnancy diet for both mother and baby. Several nutrients have been shown to prevent birth defects, to enhance the baby’s brain development, and to generally improve the future health of both mother and child. You should avoid some foods at this time, and eat others in moderation. In addition, the eating-for-two myth has been debunked, so pregnancy is now far from a license to indulge too freely.

Weight Worry

Many women entering pregnancy today are older, as well as overweight. The Institute of Medicine Recommended Weight Gain guidelines (see chart below) were updated recently to reflect today’s women, and help to ensure that you will not be left with a tremendous amount of weight to lose postpartum. The recommended weight gain during pregnancy for a normal-weight woman is 25 to 35 pounds, and there is only a 200- to 300-calorie increase daily in a pregnant woman’s dietary needs.

In addition to clarifying weight gain for expectant moms, the guidelines help ensure that the baby will gain the appropriate amount of weight. Of concern today is the increased number of babies growing too large in utero, especially in light of the epidemic of obesity among women of childbearing age. There are health risks later in life associated with a high birth weight — being overweight or obese, developing diabetes and having heart disease. You should stay within the guidelines for weight gain to maximize your health, as well as the future health of your baby.

Elevated glucose levels in your bloodstream contribute to fetal weight gain, and your carbohydrate intake affects these levels. Carbohydrates are broken down in your body into glucose, and higher glucose levels can make for a bigger baby. You can keep your glucose levels in your bloodstream at a lower, steadier range by eating unrefined carbohydrates instead of refined starches, which are broken down more slowly by the body. Eating plenty of unrefined carbohydrates helps prevent the spike in glucose in the bloodstream that follows a carbohydrate-rich meal. For example, eat whole-wheat bread instead of white bread, choose brown rice instead of white rice, and have whole-grain cereals instead of sugar-laden, high-carb cereals.

 

Prenatal Vitamins

Prenatal vitamins are available over the counter (OTC) and by prescription. You might wonder which is best for you. Consider the following:

1. Prescription prenatal vitamins are not better than OTC prenatal vitamins.

2. There are no national standards for the ingredients of a prenatal vitamin, since the FDA does not regulate what goes into vitamin and mineral supplements.

3. Many doctors prescribe prenatal vitamins not because the prescription vitamin is better, but because the co-pay is cheaper than the OTC cost.

All prenatal vitamins contain a greater amount of folic acid (folate), iron and calcium than regular vitamins. Choose one of the newer prenatal vitamins that also contains iodine from potassium iodine, 200 mg (rather than kelp, which can be more erratic in its absorption) and one that contains docosahexaenoic acid (DHA), 200 mg. Iodine is found in salt, but many people use designer sea salts today, so iodine deficiencies are growing. There are many brands, available OTC or by prescription. Check with your insurance company for the most affordable.

Brain Boosters

The baby’s brain continues to develop and =grow rapidly throughout pregnancy. Some recent studies suggest that growth and development can be boosted by a diet rich in DHA. The richest sources of omega-3 fatty acids are found in fatty fish.

However, many of the fish that are rich in fatty acids are also high in mercury, which can be harmful to the baby’s developing nervous system. Salmon and anchovies are good choices low in mercury yet high in DHA.

If you are not fond of fish, taking omega-3 supplements or a prenatal vitamin with DHA is another way to consume all three essential fatty acids, without the worry of mercury contamination. Some experts are now recommending that women who are trying to become pregnant, who are already pregnant or who are breastfeeding take an omega-3 supplement containing 200 micrograms of DHA. Some prenatal vitamins now contain DHA for this reason.

First-Trimester Tips

Some women experience nausea during pregnancy. Here are ways you can help minimize such discomforts, while remaining healthy:

• Fill up/graze. Keep your stomach filled partially by not going too long between meals or snacks. Refined carbohydrates, which are easily digested, are often the best tolerated. Although the healthiest carbohydrates are unrefined, at this time in pregnancy sometimes only a white diet — consisting of pasta, rice, crackers, potatoes and white breads — will do. Grazing, which is eating a little bit all of the time, will help minimize nausea. Whenever possible, eat well-balanced meals with lots of fruits, vegetables and carbohydrates.

• Rest. The fatigue in the first trimester can be overwhelming. Sleep as much as you can.

• Move it. When you’re feeling a bit better, exercising gently will stimulate your energy.

Take in folic acid. When consumed in early pregnancy, 400 micrograms of this B-vitamin can reduce the risk of birth defects by as much as half. Folate is found in rich amounts in spinach, Swiss chard, asparagus, broccoli, citrus fruits, enriched breads and cereals, or in a multivitamin or a prenatal vitamin. Despite their nausea, many women find they can tolerate fruits during this time.

An easy, soothing way to get folate is to make smoothies using frozen strawberries, banana, yogurt and orange juice.

RICH SOURCES OF FOLATE/FOLIC ACID

Asparagus • Beans • Breakfast Cereals Lentils • Orange Juice • Spinach Strawberries • Sunflower Seeds

Handling Second-Trimester Cravings

The second trimester usually brings relief from nausea. Your energy and appetite return, and the cravings begin, especially for fresh fruit, salt and chocolate. Eating a variety of fresh fruit gets you an array of nutrients. Instead of potato chips to fill that salt craving, try a salty yet nutritious meal, such as chicken or fish with a crispy, salty crust. Satisfy your craving for chocolate with a decadent yet healthy treat like chocolate-dipped strawberries. Make it dark chocolate, since the antioxidants can reduce the risk of heart disease and many cancers.

There is evidence that foods you consume during pregnancy may alter the “flavor” of your amniotic fluid, which your baby is drinking. Delight your palate with some new flavors, which can enhance your baby’s taste buds, making your child more apt to accept a broad array of foods later.

Calcium Counts in the Third Trimester

The third trimester is a time when iron and calcium requirements are maximal. Vitamin C boosts your body’s absorption of iron: Combine tomatoes with iron-rich leafy green vegetables or beef. Try Swiss chard and tomatoes tossed into pasta, or beef brisket braised in tomatoes.

The baby’s skeleton begins to form around the end of the first trimester, and the maximum fetal uptake of calcium for the formation of the fetal skeleton takes place in the third trimester. Thus, calcium is particularly important in the third trimester. Good sources of calcium are almonds, bok choy, cheese, orange juice (fortified with calcium), skim milk (the calcium content of whole and skim milk is the same), tofu and yogurt.

Constipation can be a problem throughout pregnancy, especially in the third trimester. The hormone progesterone slows down the motility of the intestine, an effect that is compounded by your iron-containing prenatal vitamin. The best defense is to drink plenty of fluids (six to eight glasses a day), and to boost the fiber content of your diet, by eating plenty of fruits and vegetables, beans, brown rice and whole-wheat breads.

 

The Lowdown on Listeria

Listeria is a food borne bacterial contaminant, and infections during pregnancy can lead to miscarriage, stillbirth and premature delivery. Pregnant women are advised to avoid unpasteurized soft cheese that might contain it, such as Brie, blue-veined cheese, Camembert, goat cheese and feta cheese. Hot dogs and lunch meats should be reheated until they are hot and steaming inside, since Listeria is killed by pasteurization and cooking.

With a bit of advance planning and knowledge of what is good for you and your baby, you can enjoy eating for two in pregnancy. Indulge in a varied and whole-foods based diet, so that eating in pregnancy is a joy and a pleasure.

Hope Ricciotti, M.D., is an ob/gyn at Beth Israel Deaconess Medical Center, Boston, MA, and an Associate Professor of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School. She is the author of I’m Pregnant — Now What Do I Eat? (DK Publishing 2007), as well as numerous other health-related cookbooks, along with her chef/husband Vincent Connelly. She has a reproductive health blog on www.bewell.com.