Eating for Two

Dr. Carrie Swartz

Obstetrics and Gynecology

Boulder Medical Center

303-938-4710

Eating right can be one of the best things you can do for yourself and your baby before and during your pregnancy. The foods you eat are the main source of nutrients for your growing baby.

If you are planning a pregnancy, see your doctor. She or he will discuss with you your diet, any vitamin supplements you might need (folic acid, for instance) as well as your overall health and how that might affect or be affected by a pregnancy.

A healthy diet is important even before you become pregnant. This helps you and your baby start out with the nutrients you will both need. There’s no magical formula for pregnancy nutrition. The basics of a well-balanced diet with plenty of whole-grains, fresh fruits and vegetables, and lean sources of protein remain the same. Of course, you also want to drink plenty of water – two to three liters a day!

You do need to eat more calories in pregnancy, but it may be less than you think. The number of calories recommended for a non-pregnant woman in 2000 a day. There is no recommended increase in the first trimester (up to about 12 weeks) and only about 300-350 calories more in the second trimester (12-26 weeks). This is equivalent to about a cup of yogurt and a small apple. In the third trimester (after about 26 weeks), the recommendation is about 400 extra calories a day.

Pregnant women also require more folic acid and iron. Folic acid helps prevent birth defects, preterm birth, and growth problems in the baby and iron prevents anemia in the mother. Fortified cereals are a great source of folic acid. Leafy green vegetables, citrus fruits, and dried beans and peas are also all good sources of folic acid. The recommended amount of folic acid in pregnancy is 800-1000mcg. A woman trying for pregnancy should start taking a prenatal vitamin or extra folic acid 3-6 months before she is ready to get pregnant. Some women with certain medical problems or a history of a baby with a birth defect may need more folic acid, so ask your provider if you are unsure.

Another important mineral is calcium, with a goal of 1200-1500mg a day. This is important to help build healthy bones in your growing baby as well to keep your bones strong during pregnancy and breastfeeding. Some studies suggest it might also help reduce the risk of other medical problems in pregnancy, like pre-eclampsia.

Prenatal vitamins are usually good sources of folic acid, iron, calcium, and other important vitamins and minerals, but check the labels and check with your doctor. Also, it’s best to avoid prenatal vitamins or formulations that include things like herbs or extracts since there is little evidence of the safety of these compounds and some have even been shown to cause cramping or problems in pregnancy (even ones that are “pregnancy” herbs!) Of course, the best place to get your vitamins and minerals is in your food.

DHA is an important supplement to help with healthy brain and eye development both in pregnancy and while nursing. DHA is one of the Omega 3 fatty acids and the best way to get enough is with a DHA supplement specifically designed for pregnancy. It’s best to avoid flaxseed oil (due to rare, but documented pregnancy complications) or fish sources (due to concerns about mercury levels).

Weight gain is to be expected in pregnancy, but how much you should gain depends on how much you weigh before you get pregnant. Women of a healthy weight should gain 25-35 pounds while women who are overweight should gain 15-25 pounds. Underweight women usually gain about 25-40 pounds in pregnancy. This increase in weight is needed for many components of your changing body and growing baby. As an example:

Baby                                        7 ½ pounds

Breast growth                         2 pounds

Maternal nutrition stores         7 pounds

Placenta                                   1 ½ pounds

Uterus growth                         2 pounds

Amniotic fluid                                    2 pounds

Increase in blood volume        4 pounds

Increase in body fluids           4 pounds

A few special concerns:

Vegetarianism

If you are a vegetarian, it is safe to continue your diet in pregnancy. Some women choose to add lean meats or fish to help get enough protein and iron, but this is not strictly necessary if you can get enough of these in your diet or with the help of vitamins. Sometimes vegetarians need to take extra iron, vitamin B12, and vitamin D.

Drinks

You should avoid alcohol in pregnancy because frequent use can cause birth defects and mental retardation. A few drinks before you knew you were pregnant rarely cause any problems.

Moderate caffeine intake is probably OK (1-2 cups of coffee, sodas, or teas). More than that has been shown to increase the risk of miscarriage. Caffeine also crosses the placenta.

Diet drinks and other foods with NutraSweet or Splenda is OK 1-2 servings a day. There is little data about the safety of these, and so it is probably best to reduce your exposure.

Avoid unpasteurized juices.

Read the labels on herbal teas. Many of the herbs used for teas, when taken in large or medicinal amounts, can potentially stimulate the uterus and induce miscarriage. These include anise, catnip, chamomile, comfrey, ephedra (or ma huang), European mistletoe, hibiscus, horehound, Labrador, lemongrass, licorice root, mugwort, pennyroyal, raspberry leaf, rosemary, sage, sassafras, stinging nettle leaf, vetiver, and yarrow. Also avoid Coca (or mate de coca), kava root, skullcap, valerian, woodruff, and lobelia. Mate tea can contain as much caffeine as coffee.

Meats

Do not eat any raw meats. This includes sushi! The nori (seaweed) that sushi is wrapped in can also contain high levels of mercury, so avoid even vegetarian or cooked sushi.

Deli meats are probably OK as long as they are fresh. If they’ve been in the refrigerator for more than a few days, either throw them out or reheat them to steaming.

Cheese

Do not eat unpasteurized or “raw” cheeses (this may include some imported, soft cheeses) – check the labels! Pasteurized soft cheeses are OK.

Fish

Fish (including shellfish) is OK 1-2 servings a week. Avoid shark, swordfish, king mackerel, and tilefish. This is again due to the concern for mercury which is a neurotoxin in developing babies.