When it comes to prenatal nutrition, local experts’ guidelines are straightforward: Eat plenty of protein, fruits and veggies, and whole grains. Don’t overdo the carbs, avoid refined sugar and processed stuff. Get plenty of water, take it easy on the caffeine, and definitely do not drink alcohol.
And, along with your prenatal vitamin, take one more piece of advice: Don’t stress.
“A healthy prenatal diet looks very similar to a healthy diet of any other individual,” says Katherine Karbel, a registered dietician who practices at Nutrition Works in Portland. Although pregnant women have important additional considerations, “minimizing stress is important for fetal health. Some days are easier than others. Be kind to yourself,” Karbel suggests.
According to Karbel, “The first step in becoming a parent is learning that anything you put in your mouth could also affect your child. In some ways that’s intimidating and scary but it’s also empowering. There’s a lot in pregnancy you don’t have control over. This is something you have control over.
“The one thing you can do is try to get adequate nutrition for yourself and your child,” she says.
Karbel says a prenatal diet should emphasize variety “to make sure you’re building a healthy baby.”
That variety includes “lots of fruits and vegetables, whole grains, lean meat, and calcium,” says Karbel.
Protein is key, says Jen Gilbert, a certified midwife with Portland’s Back Cove Midwives. A pregnant woman should consume 66 grams of protein daily, she says. Meat, cheese, Greek yogurt, peanuts and peanut butter are all good sources, she says, and protein powder added to a smoothie provides protein for vegetarians or those women who eat little meat. If women go that route, she adds, they should be mindful of the sugar content of the powder, and also be sure it doesn’t contain potentially unsafe herbs.
Dr. Toby Fitzgerald, an obstetrician/gynocologist who practices at All About Women in Portland, says adequate protein early in the pregnancy is also “beneficial with nausea and vomiting.”
“Good nutrition in pregnancy comes from a healthy lifestyle beforehand,” she says. “It’s all about the status of the mom before getting pregnant, especially diet and exercise.”
A prenatal vitamin is essential, experts say. In fact, Karbel suggests that all women of childbearing age take a multivitamin containing folic acid. Folic acid helps ensure healthy neural tube development, which takes place early in pregnancy, Karbel says.
Prenatal vitamins also serve to “fill any potential gaps in nutrition status” presented by such issues as morning sickness or food sensitivities, Karbel says.
All three practitioners also emphasize the importance of iron and calcium, ideally obtained through food sources. Iron is readily available in red meat, but Gilbert acknowledges that vegetarians – and women who simply want other options – can find iron in a variety of other food sources. Legumes and kale are two examples.
“Just Google high-iron foods,” says Gilbert. “There are things on that list you can eat.”
Iron levels are tested at the beginning of pregnancy and again at the beginning of the third trimester, experts say. Anemia among pregnant women is not uncommon, and because women lose iron-carrying capacity to both the development of the placenta and in childbirth, Gilbert says, iron supplements may be necessary.
Calcium is also readily available through food sources, experts say. Even women with milk-protein allergies can find calcium-enriched alternatives such as almond, soy and coconut milk, Karbel says.
With respect to calcium, Gilbert says, “your baby is going to get what it needs but you have bones and teeth, as well, and these are the years you need calcium the most.”
Pregnant women may also want to consider taking omega-3 fatty acids. Prenatal vitamins often come in combination with DHA, says Fitzgerald.
“They (omega-3’s) are heart-healthy, they help with mood and with constipation,” says Gilbert.
Equally significant, she says, there is evidence that omega-3’s play a role in developing baby’s brain health.
“It doesn’t hurt to take them,” says Gilbert.
Women should also drink between 90 to 100 ounces of water a day, Gilbert says. Soda (even diet soda), doesn’t count because the caffeine it contains is a diuretic. Women should also be mindful that many beverages have added sugar. The best choice, she says, is water, even if a woman needs to flavor it with a little lemon, or commercially made drops.
What to avoid
While experts encourage a varied and nutrient-dense prenatal diet, they do issue caveats. First, pregnant women should drink no alcohol whatsoever, they say.
“The stance of the medical community has always been that there’s no known safe amount of alcohol during pregnancy,” says Karbel.
Fetal alcohol syndrome is the greatest risk, and is usually associated with higher levels of alcohol consumption, says Fitzgerald.
“There’s no acceptable level of alcohol that hasn’t been associated with potentially poor outcomes,” she says. “It’s just a risk not worth taking.”
Food safety concerns also extend to other substances. The risk of listeria, a rare, food-borne illness, means pregnant women should avoid deli meats, soft cheeses, as well as any unpasteurized products, Fitzgerald says. Women should also avoid raw fish, she says.
Gilbert says pregnant women are also wise to avoid foods that have been frequently handled, such as those processed lunch meats and even pre-cut fruits and veggies. Cooking foods like pastrami and hot dogs to the steaming point will kill any listeria bacteria, she says.
Mercury levels in fish are also a safety concern. According to Karbel, women should not eat swordfish, tile fish, king mackerel and shark. Tuna fish should be limited to 6 ounces per week, she says, and women should not eat more than 12 ounces of fish per week in total.
Caffeine in large amounts can also pose risks, experts say. Fitzgerald says that although recommendations “kind of go back and forth,” one cup of coffee or tea per day is “totally acceptable.” Caffeine in very high amounts has been associated with miscarriage, preterm delivery and small babies, she says.
“Caffeine is a tough one to give up,” says Gilbert. “But there’s zero risk with 200 mgs of caffeine a day.”
Fitzgerald suggests women also avoid “a lot of refined sugar, soda, and all those kinds of processed foods.”
“It doesn’t add anything to mom’s nutrition or the baby’s nutrition,” she says. “It also can affect teeth, and dental hygiene is really important in pregnancy.”
Studies indicate that periodontal disease, cavities and a “high bacterial load” can increase poor outcomes like preterm labor, she says.
Fitzgerald says that when it comes to food aversions, she and her fellow practitioners at All About Women “always tell patients, ‘Don’t beat yourself up. If first trimester all you want is bread and pasta, that’s OK.’”
“It’s really common to have food aversions. It’s OK to give yourself a break. You’ll get there,” she says. “Aversions to eggs, meat, coffee, you can get those nutrients other places. Just listen to your body.”
Similarly, “cravings within limits are OK to do,” says Fitzgerald. “Just don’t overdo it.”
Gilbert cautions that women should heed whether their cravings are interfering with adequate nutritional intake. The questions to ask, she says, are, “what is it, how much are you eating, and is it interfering with your ability to get other nutrition in?”
Women do need to be mindful of weight gain during pregnancy, experts say.
Specific recommendations about weight gain depend on a women’s size prior to conception. For a woman with average body mass index (BMI) – between 18 and 24.9 – recommended weight gain is between 25 and 35 pounds, Karbel says. Suggested weight gain for a woman with a BMI under 18 is 28 to 40 pounds, she says, and a woman whose BMI is over 25 is recommended to gain between 15 to 25 pounds, she says. A BMI over 30 means recommended weight gain is 11 to 20 pounds.
Excessive weight gain is a medical concern, Karbel says. Research through the last 10 years indicates that gaining too much weight influences the presence of gestational diabetes, bigger babies, a higher risk of childhood obesity, pre-eclampsia and cesarean delivery, she says.
“To be told you’ve gained too much weight can be difficult,” Karbel acknowledges. “But it really is for the best interest of the child and yourself to try to moderate weight gain.”
Most women these days are aware, Gilbert says, that the adage of “eating for two” is a fallacy. Limiting sugar and carbohydrates throughout the pregnancy is important, she says.
“Don’t give yourself permission to eat cakes and cookies and ice cream and doughnuts just because you’re pregnant,” she says.
At the same time, Gilbert says, “women gain weight so differently during pregnancy.” A woman may gain 20 pounds during the first half of her pregnancy and “still keep consistent” with recommendations. The truth is, Gilbert adds, most women gain 40 to 42 pounds during pregnancy “and they’re still OK. Just be aware if you go overboard. Just be aware of what you are putting in your mouth.”
Practitioners are certainly sensitive to body image disturbance in pregnant women, Gilbert adds.
Fitzgerald says that women generally need about 300 to 400 extra calories per day during pregnancy. Those calories are best obtained through higher fat, higher protein foods like full fat milk and yogurt, and nuts, she says.
Poor maternal weight gain can also pose problems in small women, Fitzgerald cautions, including smaller babies and a higher risk of preterm labor.
Don’t forget exercise
Good prenatal nutrition should be complemented with healthy activity, the experts say. Pregnant women can continue whatever exercise regimen they participated in prior to pregnancy (assuming there is no risk of abdominal injury, like snowboarding, Fitzgerald says), and all women, regardless of their pre-pregnancy activity level, can safety begin a walking program, the experts say.
Women should always check with their physician before beginning an exercise program, Karbel says.
Pregnant women should aim for 30 minutes of exercise daily, Gilbert suggests, “or at least three to five days weekly. It could just be a walk – not a stroll – something to get the heart rate up. That will do amazing things for her.”