The Pregnant Palate

Your doctor tells you to eat healthfully during pregnancy. But this can be 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, and to enhance the future health of both mother and child. Some foods should be avoided entirely, some eaten in moderation. The eating-for-two myth has been debunked, so pregnancy is far from a license to indulge too freely.

The Weight Issue

There is only a 200- to 300-calorie increase in a pregnant woman’s dietary needs. The recommended weight gain during pregnancy is between 25 and 35 pounds for normal-weight women (see box at right). These guidelines help ensure that you are not left with a tremendous amount of weight to lose postpartum, and will also help your baby to gain the appropriate amount of weight. There is a growing concern over the increased number of babies that grow too large in utero, especially in light of the epidemic of obesity among women of childbearing age. Th ere 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 for 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 aff ects 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 unrefi ned carbohydrates helps prevent the spike in glucose in the bloodstream that follows a carbohydrate-rich meal. For example, eat whole-wheat instead of white bread, brown instead of white rice, and whole-grain rather than sugar-laden, high-carb cereals.

First Trimester

Here are tips for minimizing small discomforts and having a healthy first trimester.

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 — pasta, rice, crackers, potatoes and white breads — will do. Grazing, eating a little bit, all of the time, will help minimize nausea. Whenever possible, have 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 are feeling a bit better, gentle exercise will stimulate your energy again.

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 can be taken in a multivitamin or prenatal vitamin. Despite their nausea, many women can tolerate fruits during this time. Smoothies, using frozen strawberries, banana, yogurt and orange juice, can be a soothing, easy way to get folate.

Second Trimester

Th e second trimester usually brings relief from nausea. Energy and appetite return, and the cravings begin, especially for fresh fruit, salt and chocolate. Eating a variety of fresh fruits gets you a wide array of nutrients. Instead of potato chips to fi ll that salt craving, try a salty yet nutritious meal, such as a chicken or fi sh dish with a crispy, salty crust. Satisfy chocolate cravings with a decadent yet healthy treat like chocolate-dipped strawberries or dried fruits. The antioxidants in dark chocolate 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 fl uid, 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 in life.

Third Trimester

The third trimester is a time when iron and calcium requirements are maximal. Take advantage of the principle that vitamin C boosts your body’s absorption of iron by combining tomatoes with iron-rich leafy green vegetables or beef. Try Swiss chard and tomatoes tossed into pasta, or beef brisket braised in tomatoes.

There is a growth spurt in the fetal brain during the last trimester of pregnancy.

New scientific evidence suggests that during this time of rapid growth, dietary omega-3 fatty acids can maximize the development of the fetal brain and nervous system, and decrease the chances of prematurity and low-birth-weight babies. According to some experts, pregnant and nursing mothers should take 200 milligrams per day of a form of omega-3 fatty acids called docosahexaenoic acid (DHA). DHA intake has been linked to brain and eye development. Good sources of omega-3 fatty acids are salmon (especially wild salmon), anchovies, walnuts, canola oil, omega-3 enriched eggs and flaxseed (grind it so your body absorbs it). It can also be found in supplements, and in some prenatal vitamins.

The baby’s skeleton begins to form around the end of the fi rst 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 is the same between whole and skim milk), 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 compounded by your iron-containing prenatal vitamin. Th e 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 foodborne 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.

Facts on Fish Consumption
Fish and shellfi sh are an important part of a healthy diet, but may contain trace amounts of mercury, so pregnant women should avoid seafood known to be high in mercury (shark, swordfi sh). Fetal exposure to mercury during pregnancy may affect the development of the brain and nervous system. You should limit your total seafood intake to 12 ounces per week. Consumption of fish has many benefits, and it is important that pregnant women not be overly restrictive in their fi sh intake. Indeed, a recent study found that the health benefits eating fish during pregnancy outweighs any risks associated with trace contamination.

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

Hope Ricciotti, MD, 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.

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