You’re Pregnant – What Should You Eat?

Enhance Your Baby’s Development with Healthful Food Choices

In recent years, we have learned a great deal about what constitutes a healthy diet during pregnancy. Several nutrients have been shown to prevent birth defects, and to help ensure the health of both mother and baby, during pregnancy and beyond.

Dietary needs – as well as an expectant mother’s taste for different foods – change by trimester. There can be an increased need of 300 to 500 calories during pregnancy. For women of normal weight, the recommended weight gain is 25 to 35 pounds. Overweight women could safely limit weight gain to 15 pounds, while women who are underweight or expecting twins should gain up to 40 pounds.

Folic Acid: A Basic Nutrient

The first trimester can be a difficult time to obtain good nutrition, since many women are nauseated. Ideally, women contemplating pregnancy should increase their intake of folic acid before becoming pregnant, since birth defects commonly associated with folate deficiency (such as neural tube defects) are formed at the very beginning of embryonic life. Nevertheless, it’s also important to take in enough folic acid during the first trimester. When consumed in early pregnancy, 400 micrograms of folic acid (a B-vitamin) – from enriched breads and cereals, a vitamin or natural folate – can reduce the risk of birth defects by as much as half. Rich amounts of folate are found in spinach, Swiss chard, asparagus, broccoli and many fruits. Many women experiencing nausea find they can tolerate fruits. Smoothies consisting of frozen strawberries, banana, yogurt and orange juice can be a soothing way to get folate.

EASY SOURCES OF FOLATE/FOLIC ACID

• ASPARAGUS
• BEANS
• BREAKFAST
• CEREALS
• LENTILS
• ORANGE JUICE
• SPINACH
• STRAWBERRIES
• SUNFLOWER SEEDS

Simple Solutions to Small Discomforts

Nausea usually starts at about seven weeks of pregnancy and peaks between weeks eight and ten. For most women, simple dietary measures will help keep nausea at bay. In early pregnancy many women do not have much of an appetite in the morning. Waking up your appetite with a simple breakfast can often make the rest of the day go better. In addition to smoothies or some fruit, try whole-grain cereal, whole wheat toast or yogurt. Or a couple of cheese cubes and some crackers. You don’t have to limit yourself to traditional breakfast foods. Any nutritious food is fine if it appeals to you, even some leftover pizza.

A Matter of Taste

An ideal time to delight your palate with new favors, the second trimester often brings relief from many of the discomforts of early pregnancy. Craving chocolate? Go ahead and indulge. Make it dark chocolate, since the antioxidants can reduce the risk of heart disease and many cancers.

Easing Heartburn

For most women, the second trimester is a honeymoon period. They feel more energetic. Some women start feeling heartburn, or reflux, toward the end of the second trimester. This is due to the hormone progesterone relaxing the lower esophageal sphincter, which allows stomach acid to back up, causing discomfort. It gets worse as the uterus gets bigger, pushing up the stomach. Eating smaller meals can help. Contrary to popular belief, spicy foods do not make this worse, though peppermints might.

Building a Smart Baby

There is a growth spurt in the fetal brain during the last trimester of pregnancy (Pediatrics. 2003; 111: 39-44). During this time of rapid growth, dietary omega-3 fatty acids can maximize the development of the fetal brain and nervous system. Good sources of omega-3 fatty acids are salmon (especially wild salmon), walnuts, canola oil, omega-3 enriched eggs and flaxseed (ground, so your body absorbs it).

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

FISH STORY: WHAT TO SKIP, WHAT TO MONITOR

Avoid shark, swordfish, king mackerel and tile fish.

Limit tuna – canned albacore, sushi containing tuna and tuna steak – to once a week.

Fiber, Fluids and Flax

The discomforts of pregnancy may take center stage in the third trimester. Your gastrointestinal system moves more slowly in pregnancy due to the relaxant effect of the hormone progesterone, which slows down the natural motility of the bowel. In addition, your growing uterus mechanically impairs the motility of your bowels. Add to this mix the prenatal vitamin, and the result is that almost 90 percent of pregnant women develop constipation, most commonly in the third trimester.

Dietary fiber is a good way to combat constipation. Drink plenty of fluids, and enrich your diet with fiber-rich foods such as fruits, vegetables, flaxseed and whole grains. The fiber content of foods is the same whether they are cooked or raw.

Foods to Avoid

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 such as Brie, blue cheese, Camembert, goat cheese and feta. Hot dogs and lunch meats should be reheated until hot and steaming inside, since Listeria is killed by pasteurization and cooking.

Although fish and shellfish are an important part of a healthy diet, they contain trace amounts of mercury, so pregnant women should avoid seafood known to be high in mercury. 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 fish intake. Indeed, a recent study found that the health benefits of eating fish during pregnancy outweigh any risks associated with trace contamination.

Ensuring Your Baby’s Future

With each food choice you make, you have the opportunity to get your baby started on the road to good health. Common adult disorders such as obesity, diabetes and cardiovascular disease may begin as early as life in utero. If your diet is high in saturated fat, you might increase your baby’s risk for cardiovascular disease later in life. Choose heart-healthy fats such as olive, canola and safflower oils instead of unhealthy saturated and trans fats. Limit beef and full-fat dairy products, which are high in saturated fats, and margarine and processed baked goods, which are high in trans fats.

There are increasing concerns about babies growing too large in utero, especially in light of the epidemic of obesity among women of childbearing age. A high birth weight is associated with health risks later in life such as being overweight, obesity, diabetes and heart disease. Stay within the guidelines for weight gain to minimize this risk. In addition, increased maternal glucose levels – affected by your carbohydrate intake – contribute to fetal weight gain. Higher glucose levels can make for a bigger baby. Keep your glucose levels in your bloodstream at a lower, steadier range by eating unrefined carbohydrates instead of refined starches – whole-wheat instead of white bread, brown instead of white rice, and whole-grain cereals.

Eating right in pregnancy is worth the extra time and effort. With a bit of planning and with a well-stocked fridge and pantry, cooking can be as easy as it is to pick up takeout meals. It is always more delicious and less expensive, and you’ll reap dividends for the future. Eating is a joy and a pleasure, so do it well.

THE DOs AND DON’Ts OF POSTPARTUM EATING

It’s essential to restore your body’s stock of nutrients after you give birth. You have just lost up to about 12 pounds: 7 pounds of baby, 2 pounds of placenta and 3 pounds of blood and amniotic fluid. Now is not the time to severely limit your calories in the hopes of rapid weight loss. If you take in too few calories, you’ll be exhausted.

Remember to:

• Enjoy whole-grain breads and cereals, which will give you the energy you need.
• Include a protein source such as beef, chicken, fish, dairy, beans or nuts in all three meals, since protein is essential for wound healing. Whether you’ve had a cesarean or normal birth, your body is healing.
• Be certain to continue drinking fluids and eating water-rich fruits to stay hydrated.

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 co-author, with chef/husband Vincent Connelly, of I’m Pregnant Now What Do I Eat? (DK Publishing, 2007), and other health-related cookbooks.