The fetus growing inside you has many nutritional needs—needs you must fulfill through the foods you eat. A pregnant woman who eats a healthful diet during pregnancy is much more likely to give birth to a healthy baby. Eating well reduces the risk of complications and limits some pregnancy side effects.
You can meet most nutritional needs by eating a well-balanced, varied diet. The quality of your calories is extremely important—if a food grows in the ground or on trees, it’s better for you nutritionally than if it comes from a can or a box.
You may have heard the adage “a pregnant woman is eating for two.” Many women take this to mean they can eat twice as much. Not true! The saying really means you must be concerned about getting the best nutrition for yourself and for your growing baby. You need to eat twice as smart!
Some women have the false idea they can eat all they want during pregnancy. Don’t fall into this trap. Don’t gain more weight than your healthcare provider recommends during your pregnancy—it can make you uncomfortable and it may be harder to lose the extra pounds after baby is born.
If your weight is normal before pregnancy, your caloric intake should average about 2200 calories a day during the first trimester of pregnancy. You need to add up to 300 calories to that number during the remainder of your pregnancy, depending on your prepregnancy weight. (See the discussion of weight management during pregnancy that begins on page 191.)
Extra calories are the foundation of tissue growth in you and your baby. Your baby uses the energy from your calories to create and to store protein, fat and carbohydrates, and to provide energy for its body processes to function. You use the extra calories to support the changes your body goes through during pregnancy. Your uterus increases in size many times, your breasts increase in size and your blood volume increases by 50%, among other changes.
Calories aren’t interchangeable. You can’t eat whatever you want and expect to get the best nutrition for you and your baby; eating right takes care and attention. Where the calories come from is as important as the number you consume. You need to eat foods high in vitamins and minerals, especially iron, calcium, magnesium, folic acid and zinc. Fiber and fluids are also essential because pregnancy can cause constipation problems. Eating a wide variety of foods each day can supply you with the nutrients you need. Choose from dairy products, protein foods, fruits and vegetables, and breads and cereals. Avoid junk food, a lot of processed foods and foods loaded with empty calories.
During pregnancy, eat 6 to 7 ounces of protein every day to cover the growth of the embryo/fetus, placenta, uterus and breasts. There is no recommended dietary allowance (RDA) for daily carbohydrate intake during pregnancy. Most experts believe carbohydrates should make up about 60% of the total number of calories in your diet. If you’re eating 2200 calories a day, you would consume about 1320 carbohydrate calories.
You probably don’t need to worry about inadequate fat intake; in the North American diet, fat intake is usually excessive. There is no recommended daily amount for fat intake during pregnancy. Don’t avoid all fats, but use them sparingly. Measure how much you use of each, and read labels.
Be good to yourself and your baby. Eat the recommended number of servings from each food group every day. If you’re carrying multiples, add one more serving each of dairy products and protein each day. Discuss your nutrition plan with your healthcare provider or a registered dietitian.
Dairy products contain calcium, which is important for you and your growing baby. You need to consumer 1200mg of calcium each day. The calcium content of many packaged foods is listed on the nutrition label. Foods you might choose from this group, and their serving sizes, include the following:
If you’re watching your calorie intake, you might choose low-fat foods to help you cut back on calories. They can be a good choice, but they won’t help you if you still eat too many calories. Many people believe the kind of food they eat matters more than the amount they eat. In many cases, they eat more calories of a low-fat food than they would if they ate a higher-fat food! Don’t get caught in this trap.
•2 ounces processed cheese (such as American cheese)
•1 ounce hard cheese (such as Parmesan or Romano)
•1 cup pudding or custard
•1 8-ounce glass of milk
•1½ ounces natural cheese (such as cheddar)
•1 cup yogurt
If you want to limit the fat content of dairy products, choose skim milk, low-fat yogurt and low-fat cheese instead of whole milk and ice cream. The calcium content is unaffected in low-fat dairy products. Refer to the box on page 188 for other common foods with calcium.
Lupe began having food cravings early in her pregnancy. Her craving for ice cream could have been a problem. She knew if she ate it as often as she wanted to, her weight would be out of control. She found that by using self-control and substituting low-fat frozen yogurt for higher-calorie ice cream, she was able to have a treat once in a while and still manage her weight.
Amino acids in protein are critical to the growth and repair of the embryo/fetus, placenta, uterus and breasts. The recommended amount of protein in pregnancy is 6 to 7 ounces a day, about twice the amount normally recommended. Foods you might choose from this group, and their serving sizes, include the following:
•2 tablespoons peanut butter
•½ cup cooked dried beans
•2 to 3 ounces cooked meat
•1 egg
Poultry, fish, lean cuts of red meat, dry beans, eggs, nuts and seeds are all good protein sources. If you need to watch your calorie intake, skinless chicken and fish are better choices than beef or pork. If you choose fish, keep your total weekly intake to a maximum of 12 ounces.
Fruits and vegetables will be a very important part of your pregnancy eating plan. Fruit is good for you, and it tastes good. It’s an excellent source of many important vitamins and minerals, so enjoy many types of fruit. Because they change with the seasons, fruits and vegetables are a great way to add variety to your menu. Some fruits and vegetables are good sources of iron, folic acid, calcium and fiber; check a nutritional guide for particular information about vegetables. (Your produce grocer may be able to answer your questions.)
Time-Saving, Energy-Saving Tip
One way to add low-calorie salads and extra fiber to your eating plan is to keep ready-to-use salad greens handy in the refrigerator. Wash and dry your salad fixings, then layer them in large, plastic zipper-lock bags or plastic containers. Place paper towels between layers, press air out and seal. Greens stay fresh for much longer.
Fruits you might choose, and their serving sizes, include the following:
•¾ cup grapes
•½ cup fruit juice
•1 medium banana, orange or apple
•¼ cup dried fruit
•½ cup canned or cooked fruit
Include one or two servings each day of a fruit rich in vitamin C, such as orange juice or orange slices. Fresh fruits are also a good source of fiber, which can help relieve constipation.
Vegetables you might choose from this group, and their serving sizes, include the following:
•¾ cup vegetable juice
•½ cup broccoli, carrots or other vegetable, cooked or raw
•1 medium baked potato or sweet potato
•1 cup raw, leafy vegetables (greens)
Eat a variety of vegetables for good nutritional balance in your diet. Eat at least one leafy green or deep-yellow vegetable a day for extra iron, fiber, vitamin C and folic acid. Avoid all types of sprouts during pregnancy. Research tells us sprouts may cause salmonella infections in people with altered immune systems.
Foods from this group are nearly interchangeable, so it shouldn’t be hard to get all the carbohydrates you need. If you don’t like pasta, choose rice. If cereal isn’t appealing, choose bread. Foods you might choose from this group, and their serving sizes, include the following:
•1 large tortilla, corn or flour
•½ cup cooked pasta, cereal or rice
•½ small bagel
•1 slice bread
•1 medium roll
Be careful with fats and sweets, unless you are underweight and need to add a few pounds. Although sugar adds flavor to food, it has little nutritional value. Use it sparingly.
Watch your intake of butter, margarine, oils, salad dressing, nuts, chocolate and sweets. Foods in this group are often high in calories but low in nutritional value. Use them sparingly. Foods from this group, and their serving sizes, include the following:
•1 tablespoon sugar or honey
•1 tablespoon olive oil or other type of oil
•1 pat margarine or butter
•1 tablespoon jelly or jam
•1 tablespoon prepared salad dressing
Sweets and junk food are full of empty calories. Replace these treats with nourishing choices, such as a piece of fruit or a slice of whole-wheat bread. You’ll satisfy your hunger and your nutritional needs at the same time.
You may believe it will be difficult for you to eat all the portions you need for the health of your growing baby. However, many people overeat because they don’t understand what a “portion” or “serving” really is.
Supersizing in fast-food restaurants and huge meal portions at other restaurants have skewed our idea of what a normal portion size really is. For example, a blueberry muffin is now about 500 calories. Twenty-five years ago, it was about 200 calories. Look for the following serving sizes when you eat—they’re what a “normal” portion size is:
•1 cup of vegetables—the size of a lightbulb
•1 serving of juice—a champagne flute
•1 pancake—the size of a CD
•1 teaspoon of peanut butter—the end of your thumb
•3 ounces of fish—an eyeglass case
•3 ounces of meat—a deck of playing cards
•1 small potato—a 3 x 5 index card
Read labels for portion sizes; a common mistake is to read the calorie/nutrient information on a label and not take into account the number of servings each package contains. Even a very small package may contain two or more servings, doubling or tripling the calories if you eat the whole thing.
Terry had a habit of going out for fast food every day for lunch before she got pregnant. But during her pregnancy, she was very tired by midday and needed to rest. She discovered if she brought a sack lunch to work, she could eat a healthful meal, then lie down on a couch in the staff lounge for 45 minutes. She got some rest and enjoyed her afternoon work a lot more.
To learn the correct serving size for each of the food groups, check out the USDA’s website, www.cnpp.usda.gov; it lists actual serving portions. For example, a large bagel may be four to five grain servings! If you don’t have access to a computer, ask your healthcare provider for some guidelines or nutrition handouts.
You may have to forgo most junk food while you’re pregnant. Junk food is high-calorie, high-fat food that contains little nutrition for you or your baby. It’s probably fine to eat some now and then, but don’t make it a regular part of your diet.
Avoid chips, sodas, cookies, pie, chocolate, candy, cake and ice cream. Instead, select foods that are high in fiber and low in sugar and fat, such as fruits and vegetables, legumes, dairy products and whole-grain crackers and breads.
Cravings for particular foods during pregnancy are normal. (Sometimes the chosen foods appear a little strange to other people!) Cravings can be both good and bad. If you crave foods that are nutritious and healthful, go ahead and eat them in moderate amounts. If you crave foods high in sugar and fat, loaded with empty calories, be careful about eating them. Sometimes you can get rid of a craving by eating fresh fruits and vegetables.
We don’t know why women sometimes crave unusual foods or food combinations during pregnancy. Hormonal and emotional changes that occur during pregnancy may have something to do with it.
Some women experience pica during pregnancy. They crave nonfood items, such as dirt, clay, laundry starch, chalk, ice, paint chips and other things. We don’t know why pregnant women develop these cravings. Some experts believe it may be caused by an iron deficiency. Others think pica may be the body’s attempt to get vitamins or minerals not being supplied in the food the woman eats. Still others speculate that pica cravings may be caused by an underlying physical or mental illness.
Pica cravings may be harmful to your baby and you. Eating nonfood items could interfere with nutrient absorption of healthy foods and result in a deficiency.
If you have pica cravings, don’t panic. Call your healthcare provider immediately. He or she will develop a plan with you to help deal with these cravings.
On the opposite side of cravings is food aversion. Some foods you usually love or foods you have eaten without problems before pregnancy may now make you sick to your stomach. This is common. The hormones of pregnancy have a significant impact on the gastrointestinal tract, which can affect your reaction to certain foods.
During pregnancy and lactation, the level of cholesterol in your blood rises naturally because of hormone changes. It probably won’t make sense to have your cholesterol tested while you’re pregnant or nursing.
What Foods Do Pregnant Women Crave?
One study of pregnant women found they craved the following foods:
•Chocolate (33% of the time they craved foods)
•Other desserts, such as ice cream (20% of the time)
•Citrus (19% of the time)
If you have food aversions, try to substitute foods to get the nutrients you need. For example, drink calcium-fortified juice if you can’t drink milk. Meat making you ill? Try eggs, beans or nuts.
You may be more sensitive to caffeine during pregnancy. For many years, the Food and Drug Administration (FDA) has recommended pregnant women avoid caffeine. It isn’t good for you or baby.
Caffeine is a component of many beverages and foods, including coffee, tea, cola drinks and chocolate. Some medications, such as cough medicines and headache preparations, contain a lot of caffeine. Read labels on foods, beverages and over-the-counter medications to determine caffeine content. Eliminate as much caffeine from your diet as possible. Experts recommend a pregnant woman not consume more than 200mg of caffeine in any one day.
As a central-nervous-system stimulant, caffeine can affect calcium metabolism in both you and your baby. Drinking as little as two 8-ounce cups of coffee a day may increase your risk of early miscarriage. Pregnant women who drink 800mg of caffeine a day are at risk of delivering a baby with decreased birthweight and a smaller head size. Half that amount of caffeine in a pregnant woman (400mg) may affect a baby’s developing respiratory system. One study showed exposure before birth may also be linked to sudden infant death syndrome (SIDS).
Cut down on caffeine, or eliminate it from your diet. Caffeine crosses the placenta to the baby—if you’re jittery, your unborn baby may suffer from the same effects. And caffeine passes into breast milk, which can cause irritability and sleeplessness if you breastfeed baby.
Read labels on the products you buy. Caffeine is found in many beverages and foods, including coffee, tea, various soft drinks and chocolate. It may even be added to some foods you eat. The list below details the amounts of caffeine from various sources:
•coffee, 5 ounces—from 60 to 140mg and higher
•tea, 5 ounces—from 30 to 65mg
•baking chocolate, 1 ounce—25mg
•1½ ounce chocolate bar—10 to 30mg
•cocoa, 8 ounces—5mg
•soft drinks, 12 ounces—from 35 to 55mg
•pain-relief tablets, standard dose—40mg
•allergy and cold remedies, standard dose—25mg
If you normally use herbs and botanicals in the forms of teas, tinctures, pills or powders to treat various medical and health problems, stop! We advise you not to treat yourself with an herbal remedy during pregnancy without checking first with your doctor!
You may believe an herbal remedy is safe, but it could be dangerous during pregnancy. For example, if you’re constipated, you may decide to use senna as a laxative. However, senna stimulates uterine muscles and may cause a miscarriage. Or you may use St. John’s wort before pregnancy. Avoid it now—St. John’s wort can interfere with various medications, including some pain-relief medicine and antidepressants. In addition, avoid dong quai, pennyroyal, rosemary (used for digestive problems, not cooking), juniper, thuja, blue cohosh and senna during pregnancy.
Play it safe—be extremely careful with any substance your doctor has not specifically recommended for you. Always check with him or her first before you take anything!
Some types of herbal tea are good for you and may help relieve certain pregnancy discomforts, which may make herbal tea a good alternative to coffee or regular tea. The herbal teas listed below are delicious and safe to use during pregnancy:
•chamomile |
helps digestion |
•dandelion |
helps reduce water retention and soothe an upset stomach |
•ginger root |
helps ease nausea and nasal congestion |
•nettle leaf |
rich in iron, calcium and other vitamins and minerals that are good for a pregnant woman |
•peppermint |
relieves gas pain and calms stomach acids; use alone or mix with chamomile |
•red raspberry |
helps relieve nausea and stabilize hormones |
You can safely drink red-raspberry-leaf tea during pregnancy; it may make labor a little shorter. But don’t drink it until after the first trimester.
Don’t drink green tea before conceiving and/or during pregnancy. Studies show it can interfere with your body’s absorption of folic acid. Other herbal teas are not safe to use during pregnancy because they could harm your developing baby. Herbs and teas to avoid during pregnancy include blue or black cohosh, pennyroyal leaf, yarrow, goldenseal, feverfew, psillium seed, mugwort, comfrey, coltsfoot, juniper, rue, tansy, cottonroot bark, large amounts of sage, senna, cascara sagrada, buckthorn, male fern, slippery elm and squaw vine.
I often use herbal and natural medications—up to six different ones a day. These substances are safe during pregnancy, aren’t they?
Treat herbs as you would prescription or over-the-counter medications. Ask before you take them! Herbs can be useful, but they can also be harmful when taken during pregnancy.
Many women use sugar and/or artificial sweeteners before pregnancy. Are they safe during pregnancy?
Caloric sweeteners include processed and unprocessed sugars, such as granulated sugar, brown sugar and corn syrup. Unprocessed sugars include honey, agave nectar and raw sugar. Caloric content ranges from 16 to 22 calories per teaspoon. If you use caloric sweeteners, you’re adding empty calories to your meal plan.
Artificial (noncaloric) sweeteners help a woman cut calories. Some common artificial sweeteners include aspartame, acesulfame K, sucralose, stevia and saccharin. Can a pregnant woman use artificial sweeteners?
Aspartame is used in many foods and beverages to help reduce calories and is sold under the brand names Nutrasweet and Equal. It’s a combination of two amino acids—phenylalanine and aspartic acid. If you suffer from phenylketonuria, you can’t use aspartame. You must follow a low-phenylalanine diet or your baby may be adversely affected.
Sucralose, sold under the brand name Splenda, is made from sugar and is found in a variety of products. It passes through the body without being metabolized. Your body doesn’t recognize it as a sugar or a carbohydrate, which makes it low calorie.
Stevia is a product made from the leaves of the stevia plant. It is sold under the brand names PureVia and Truvia. Ask your healthcare provider for information about using it during pregnancy.
Saccharin is an artificial sweetener used in many foods and beverages. Although it is not used as much today as it was in the past, it still appears in many foods, beverages and other substances. Saccharin is also added to many foods and beverages.
Research has determined artificial sweeteners are probably safe to use in small amounts during pregnancy. However, if you can avoid them, it’s best not to use them during pregnancy. Eliminate any substance you don’t really need from the foods you eat and the beverages you drink. Do it for the good of your baby.
Late-night nutritious snacks are beneficial for some women, especially if they must eat many small meals a day. However, many women should not snack at night because they don’t need the extra calories. For others, food in the stomach late at night can cause heartburn or indigestion.
It’s OK to eat out at restaurants; just be careful about what you eat. Avoid raw or undercooked meats or raw seafood, such as sushi. Avoid foods that may not agree with you.
At a restaurant, your best choices may be cooked chicken or fish, fresh vegetables and salads, but be careful with calorie-loaded salad dressings if you’re concerned about excessive weight gain. Avoid spicy foods or foods that contain a lot of sodium. Chinese food often contains large amounts of monosodium glutamate (MSG, a sodium-containing product). You may retain water after eating these foods.
Salmonella poisoning is caused by bacteria. Problems range from mild gastric distress to a severe, sometimes fatal, food poisoning. This situation can be serious for a pregnant woman and her developing baby if it prevents a woman from getting enough fluid or eating nutritiously. Almost 1400 salmonella strains have been identified.
We know cracked raw eggs may be contaminated with salmonella organisms. These organisms are found in uncracked eggs as well if a hen’s ovaries are contaminated. Salmonella bacteria can be found in raw chicken and other raw poultry.
Bacteria are destroyed in cooking, but it’s prudent to take additional precautions against salmonella poisoning. You can help avoid salmonella if you practice the following.
•Clean counters, utensils, dishes and pans with a disinfecting agent. Wash your hands after preparing any poultry or products made with raw eggs. You could pick up salmonella from these surfaces on your hands and transfer it to your mouth or another surface.
•Cook all poultry thoroughly.
•Avoid foods made with raw eggs, including salad dressings (Caesar salad), hollandaise sauce, eggnog, homemade ice cream made with eggs or any other food made with raw or undercooked eggs.
•Don’t eat cookie dough or cake batter.
•Boil eggs 7 minutes for hard-cooked eggs.
•Poach eggs for 5 minutes.
•Fry eggs for 3 minutes on each side.
•Avoid sunny-side up eggs (those not turned during frying). Cook the entire egg thoroughly, not just part of it.
Every year about 1500 cases of listeriosis, a form of food poisoning, are reported in the United States. About 500 of these cases occur in pregnant women, who are more susceptible to infection. Pregnant women are 20 times more likely to get listeriosis than other healthy adults.
Babies born to moms who had listeriosis are at higher risk of developing severe complications. Researchers believe there might be a link between listeriosis and miscarriage and stillbirth. Newborns can have infections similar to group-B strep. Treatment is with antibiotics, such as ampicillin.
To prevent listeriosis, avoid unpasteurized milk and any foods made from unpasteurized milk. You also need to be careful of other products that aren’t pasteurized, such as some cheeses. Avoid unpasteurized soft cheeses such as Camembert, Brie, feta, Gorgonzola, bleu cheese and Roquefort. If they have been made with pasteurized milk, these soft cheeses are OK to eat during pregnancy. Read labels very carefully.
Be careful buying fruit juice at a farmers’ market or a farm stand. It may not be pasteurized. Unpasteurized fresh juice can contain bacteria, viruses and parasites.
Undercooked poultry, red meat, seafood and hot dogs can also contain listeriosis. Cook all meat and seafood thoroughly before eating. Be careful about cross contamination of foods. If you place raw meat or poultry, raw seafood or uncooked hot dogs on a counter or other surface during preparation, thoroughly wash the surface with soap and hot water or a disinfectant before you place any other food on the same surface.
Phenylketonuria (PKU) is a condition in which the body is unable to use phenylalanine properly, and it accumulates in body fluids. The accumulation can lead to mental retardation and other nervous-system disorders in you or your developing baby. If you suffer from phenylketonuria, follow a diet low in phenylalanine. Avoid the artificial sweetener aspartame.
Eating fish is healthful, particularly during pregnancy. Fish contains omega-3 fatty acids; this substance may help prevent pregnancy-induced hypertension and pre-eclampsia, which are both greater risks for older pregnant women.
Women who eat a variety of fish during pregnancy have longer pregnancies and give birth to babies with higher birth weights, according to some studies. This is important because the longer a baby stays in the uterus, the better its chances are of being strong and healthy at delivery.
Many fish are safe to eat, and you should include them in your diet. Most fish is low in fat and high in vitamin B, iron, zinc, selenium and copper. Many fish choices are an excellent healthful addition to your diet, and you can eat them as often as you like. See the box on page 180 for a list of good fish choices.
Some researchers believe eating fatty fish or ingesting omega-3 fatty acids in another form (such as fish-oil capsules) may enhance your baby’s intellectual development. Studies show fish oil is important to fetal brain development. One study of pregnant women showed that when a pregnant woman eats fish oil, it reaches the brain of the developing fetus.
Omega-3 fatty acids are good for your skin. They keep it lubricated and help reduce any skin inflammation.
Include omega-3 fatty acids in your eating plan. Anchovies, herring, mullet, mackerel (not King mackerel), salmon, sardines and trout are some fish with a lot of omega-3 fatty acids. Fish-oil capsules may be another option for increasing omega-3 fatty-acid intake. If you buy fish-oil capsules, choose the filtered type because they don’t contain pollutants. Don’t exceed 2.4g of omega-3 fatty acids a day. Be aware that fish-oil capsules may upset your stomach. To solve this problem, freeze them or take them with meals or at bedtime.
Some fish are contaminated with a dangerous substance as the result of pollution. People who eat these fish are at risk of methyl-mercury poisoning. Mercury is a naturally occurring substance as well as a pollution byproduct. Mercury becomes a problem when it is released into the air as a pollutant. It settles into the oceans and from there winds up in some types of fish.
The FDA has determined that a certain level of methyl mercury in fish is dangerous for humans. We know methyl mercury can pass from mother to fetus across the placenta. Research has shown that 60,000 children born each year are at risk of developing neurological problems linked to the consumption of seafood by the mothers-to-be. Because of rapid brain development, a fetus may be more vulnerable to methyl-mercury poisoning.
The Food and Drug Administration (FDA) and Environmental Protection Agency (EPA) recommend pregnant women not eat swordfish, shark, king mackerel or tilefish. A woman should limit her fish and shellfish intake to no more than 12 ounces a week. Twelve ounces is two average servings. The FDA suggests choosing a variety of fish and shellfish that are lower in mercury. The amount of mercury in fish varies widely.
There is controversy about eating tuna during pregnancy. Studies indicate pregnant women and those trying to conceive should not eat tuna (fresh or frozen) more than once a month. Canned tuna may be a little safer, but don’t eat more than one 6-ounce can a week. Talk to your doctor about it at a prenatal appointment if this is a favorite food for you.
When choosing fish, you may want to double-check tilapia. Farm-raised tilapia is one of the most highly consumed fish in America; however, it has very low levels of omega-3 fatty acids and very high levels of unhealthy omega-6 fatty acids.
Good Fish and Shellfish Choices
Below is a list of fish you can eat as often as you like during pregnancy, as long as you don’t exceed 12 ounces of fish in any one week.
bass
flounder
mackerel
orange roughy
salmon
catfish
freshwater perch
marlin
Pacific halibut
scrod
cod
haddock
ocean perch
pollack
sole
croaker
herring
red snapper
You may eat the following shellfish if you thoroughly cook them. Again, don’t exceed 12 ounces of fish in any one week.
clams
crab
lobster
oysters
scallops
shrimp
Some freshwater fish may also be risky to eat, such as walleye and pike. To be on the safe side, consult local or state authorities for any advisories on eating freshwater fish in your area.
Other environmental pollutants can appear in fish. Dioxin and PCBs (polychlorinated biphenyls) are found in some fish, such as bluefish or lake trout; avoid them. Parasites, bacteria, viruses and toxins can also contaminate fish. Eating infected fish can make you sick, sometimes severely so. Sushi and ceviche are fish dishes that could contain viruses or parasites. Raw shellfish, if contaminated, could cause hepatitis A, cholera or gastroenteritis. Avoid all raw fish during pregnancy! If you’re craving raw fish, such as sushi, eat a California roll (no raw fish) or shrimp tempura. Dishes made with cooked eel and rolls with steamed crab and veggies are acceptable.
Other fish to avoid during pregnancy include some found in warm tropical waters, especially Florida, the Caribbean and Hawaii. Avoid the following “local” fish from those areas—amberjack, barracuda, bluefish, grouper, mahi mahi, snapper and fresh tuna.
If you’re unsure about whether you should eat a particular fish or if you want further information, contact the Food and Drug Administration.
You need to drink water during pregnancy—lots of it! Water enables your body to process nutrients, develop new cells, sustain blood volume and regulate body temperature—all very important during pregnancy. Your blood volume increases during pregnancy; drinking extra fluids helps you keep up with this change. You may feel better during pregnancy if you drink more liquid than you normally do.
When you don’t drink water, you can become dehydrated. If you’re dehydrated, you can become fatigued more easily. Being dehydrated may reduce the amount of nutrients baby receives from you. Your blood thickens, making it harder to pass nutrients to baby. Dehydration may also increase your risk of high blood pressure and pre-eclampsia, and it may cause contractions.
Water is important in regulating body temperature. In fact, for each degree above 98.6F (37C), you need to drink an extra pint of water (or other fluid) each day to help bring down a fever.
Our bodies contain 10 to 12 gallons (38 to 45l) of water. Studies show that for every 15 calories your body burns, you need about 1 tablespoon (15ml) of water. If you burn 2000 calories a day, you need to drink well over 2 quarts (1.9l) of water! As calorie needs increase during pregnancy, so does your need for water.
New guidelines suggest 100 ounces (3l) of fluid a day should be consumed during pregnancy. Water should account for at least 50 ounces (1.5l) of your fluid intake. Water in food can make up another 20 ounces (600ml). The other 30+ ounces (90+ml) should come from milk, juice and other beverages. Sip water and other fluids throughout the day. Some women drink water, one glass at a time, throughout the day. (Decrease your intake later in the day so you don’t have to go to the bathroom all night long.)
Many women wonder if they have to drink water—can they drink other beverages besides water? Water is the best source of fluid, but you can drink other fluids to help meet your needs. Don’t substitute foods that contain a lot of water for drinking water. You won’t be as hydrated unless you actually drink water. And keep the consumption of caffeinated beverages low. Tea, coffee and cola may contain sodium and caffeine, which act as diuretics. They essentially increase your water needs.
Drinking water may ease some of the common problems women experience during pregnancy. Headaches, uterine cramping and bladder infections may be less of a problem for you when you drink lots of water.
To determine if you’re drinking enough fluid, check your urine. When it’s light yellow to clear, you’re getting enough water. Dark yellow urine is a sign you need to increase your fluid intake. And don’t wait until you get thirsty to drink something. By the time you get thirsty, you’ve already lost at least 1% of your body’s fluids.
When you exercise, drink a cup of water before you begin your workout. Then drink ½ cup to 1 cup of water every 20 minutes while you are exercising to help prevent dehydration.
Water supplies in the United States are some of the least-contaminated in the world. Most of our country has high-quality drinking water. Most experts agree tap water in the United States is safe to drink. Often tap water contains minerals that have been removed from bottled water.
Drinking water contaminated with chemical byproducts from chlorine may not be safe for you to drink. One study showed an increased rate of problems when women drank water with chlorinated byproducts.
Chlorine is often added to drinking water to disinfect it. When added to water that contains organic matter, such as from farms or lawns, it can form unhealthy compounds (for pregnant women), such as chloroform. Check with your local water company if you’re concerned.
Do not rely on bottled water as safer than tap water. One study showed nearly 35% of over 100 brands of bottled water were contaminated with chemicals or bacteria. However, tap water must meet certain minimum standards if it is supplied by a municipal water company, so you know it’s safe to drink. In addition, some bottled water contains sugar, caffeine or herbs.
Fiber is important in your diet. The average American doesn’t consume enough fiber, which is important for your good health.
Just about everyone needs to eat more fiber. Experts suggest total fiber in-take for women of childbearing age be 15g for every 1000 calories you eat. That means if you’re eating a meal plan that is 2300 calories/day, you need about 33g of fiber every day! Most people take in only about 15g a day. In addition to helping you with constipation—a problem many women face during pregnancy—fiber may help reduce your risks of diabetes, heart disease, some cancers and obesity.
Fiber is not absorbed in your digestive tract. That’s one reason it helps with constipation; it helps move food through your body as you digest it. There are two types of fiber—soluble and insoluble. Soluble fiber will dissolve in water; insoluble won’t. Both sources are good for you.
Many foods are good sources of soluble or insoluble fiber. Good sources of soluble fiber include apples, berries, flaxseeds, nuts, oat bran, oranges and strawberries. Soluble fiber slows digestion, which helps you feel full longer. It also helps stabilize blood sugar, important during pregnancy, and helps inhibit the body’s absorption of cholesterol and fat.
Good sources of insoluble fiber include brown rice, carrots, cucumbers and whole wheat. As long as you drink enough fluid, insoluble fiber can help you deal with constipation.
Don’t go whole hog and start eating tons of fiber. You may need to increase your intake gradually. This can help you avoid bloating and flatulence (gas). Fiber will attract water, so you need to drink lots of fluid if you add fiber to your diet.
Below is a list of fiber sources you might include in your meal plan. It may be better to get a little too much (you can cut back if you feel bloated or have a lot of gas) than not enough.
•brown rice, cooked 1 cup—3.5g fiber
•whole-wheat bread, 2 slices—3.8g fiber
•black beans, ½ cup—7.5g fiber
•almonds, 1 ounce—3.5g fiber
•pear, 1 large—6.5g fiber
•blueberries or blackberries, 1 cup—3.5g fiber
•carrots, cooked, ½ cup—3.5g fiber
•peas, cooked, ½ cup—4.5g fiber
•potato, baked with skin, 1 medium—3g fiber
Be sure to read labels on food cans and packages to help you keep track of your fiber intake. A label will include the amount of dietary fiber so you can keep track of your daily intake.
Sodium is a chemical that helps maintain the proper amount of fluid in your body. (Table salt, a compound comprised of sodium and chloride, is about half sodium.) During pregnancy, sodium can also affect your baby’s system. Using too much or too little of it can cause problems. You need some sodium; you just don’t need a lot.
You need sodium during pregnancy to help deal with your increased blood volume. Aim for between 1500 and 2300mg a day. Consuming too much sodium may cause fluid retention, swelling and high blood pressure.
You can’t avoid something unless you know where to find it. With sodium, that can be tricky. It’s in the salt shaker and in salty-tasting foods, such as pretzels, chips, salted nuts, dill pickles, soup and meats. It’s frequently used as a preservative in foods that don’t taste salty, such as canned and processed products, fast foods, cereals, desserts, carbonated beverages and sports drinks—even some medications. Read nutrition labels. You can also buy pamphlets or books that list the sodium content of common foods and fast foods.
Some women choose to eat a meatless diet because of personal or religious preferences. Other women find that during pregnancy, the sight of meat makes them feel ill. Many pregnant women want to know if eating a vegetarian diet—a food plan without meat—is safe. Following a vegetarian diet while you’re pregnant can be safe and healthful if you pay close attention to the foods and combinations of foods you eat.
Most women who eliminate meat from their diets eat a more nutrient-rich variety of foods than those who eat meat. These women may make an extra effort to include more fruits and vegetables in their food plans when they eliminate meat products.
If you choose a vegetarian eating plan, be sure you eat enough calories to fuel your pregnancy. During pregnancy, you need to consume between 2200 and 2700 calories a day, depending on your prepregnancy weight. (See page 193 for a chart about weight gain during pregnancy.) In addition to eating enough calories, you must eat the right kind of calories. Choose fresh foods that provide a variety of vitamins and minerals. Avoid too many fat calories because you may gain extra weight. Eat enough different sources of protein to provide energy for the fetus and for you. Discuss your daily diet with your healthcare provider at your first prenatal visit. He or she may want you to see a nutritionist if you have any pregnancy risk factors.
It’s important to get the vitamins and minerals you need. If you eat a wide variety of whole grains, dried beans and peas, dried fruit and wheat germ, you should be able to meet your body’s demands for iron, zinc and other trace minerals.
Omega-3 fatty acids are found in animal foods, including grass-fed beef and eggs from hens fed special diets. If you’re a vegetarian or you don’t like fish, add tofu, canola oil, flaxseed, soybeans, walnuts and wheat germ to your food plan because these foods contain linolenic oil, which is a type of omega-3 fatty acid.
If you’re not eating meat because it makes you ill, ask your healthcare provider for a referral to a nutritionist. You may need help developing a good eating plan. If you’re a vegetarian by choice and have been for a while, you may know how to get many of the nutrients you need.
There are different vegetarian nutrition plans, each with unique characteristics. If you are a lacto vegetarian, your diet includes milk and milk products. If you are an ovo-lacto vegetarian, your eating plan includes milk products and eggs. A vegan diet includes only foods of plant origin, such as nuts, seeds, vegetables, fruits, grains and legumes. A macrobiotic diet limits foods to whole grains, beans, vegetables and moderate amounts of fish and fruits. A fruitarian diet is the most restrictive; it allows only fruits, nuts, olive oil and honey.
Macrobiotic and fruitarian diets are too restrictive for pregnant women. They do not guarantee the optimal intake of the vitamins, minerals, protein and calories you need for proper fetal development. Other vegetarian diets can provide complete nutrition for you and your growing baby; vegan diets, lacto diets or ovo-lacto diets can work if you eat a wide variety of foods in the right quantities.
As a vegetarian, your goal is to consume enough calories to maintain and to gain weight during pregnancy. You don’t want your body to use protein for energy because you need it for your growth and your baby’s growth.
Minerals are also a concern. By eating a wide variety of whole grains, legumes, dried fruit, beans and wheat germ, you should be able to get enough iron, zinc and other trace minerals. If you don’t drink milk or include milk products in your diet, you must find other sources of vitamins D, B2, B12 and calcium. See the discussion of vitamins and minerals in the section that follows.
Vitamins and minerals are important for good nutrition. Eating a nutritious, varied diet helps ensure you get most of the vitamins and minerals you need. Your healthcare provider may suggest you take a prenatal vitamin every day. Vegetarians may need to pay special attention to getting enough of some vitamins and minerals.
Iron is one of the most important elements for your body; women need more iron than men do because of menstruation. However, most women do not get enough iron in their diet. Research shows that between the ages of 20 and 50, American women consume only about two-thirds of the Recommended Dietary Allowance (RDA) of 15mg of iron a day. The average woman’s diet seldom contains enough iron to meet the increased demands of pregnancy.
Your iron needs are higher during pregnancy because your blood volume increases by as much as 50% to support the oxygen needs of your baby and the placenta. In the third trimester, your need for iron increases even more. Your baby draws on your stores to create its own stores for the first few months of its life.
You will also need adequate iron reserves to draw on during and after baby’s birth. The uterus’s oxygen requirements increase with labor contractions, and you will lose some blood during a normal delivery.
If you have an iron deficiency, you feel tired, have trouble concentrating, get sick easily or suffer from headaches, dizziness or indigestion. An easy way to check for iron deficiency is to examine the inside of your bottom eyelid—it should be dark pink. Or look at your nail beds; if you’re getting enough iron, they will be pink.
A healthy woman absorbs only 10 to 15% of the iron she consumes. To ensure you have enough iron in your diet, eat a variety of iron-rich foods, such as chicken, lean red meat, dried fruits, organ meats, such as liver, heart and kidneys, egg yolks, spinach, kale and tofu.
Your body stores iron efficiently, so you don’t need to eat these foods every day. However, you do need to eat them on a regular basis. Eat vitamin-C foods and iron-rich foods together because the body absorbs iron more easily when consumed with vitamin C. (A spinach salad with orange sections is a nutritious example.)
Prenatal vitamins contain about 60mg of iron. You may not need extra iron if you eat a healthful diet and take your prenatal vitamins every day. Discuss it with your healthcare provider.
The iron you ingest can cause constipation. Work with your healthcare provider to minimize this side effect while making sure you get enough iron.
Vegetarians and others who eat very little meat are at greater risk of iron deficiency during pregnancy. If you’re a vegetarian, pay close attention to this aspect of your diet. Fish, poultry and tofu are all excellent iron sources. Most legumes and peas also contain significant amounts of the mineral. Many breakfast foods and breads are now iron fortified.
Dried fruit and dark leafy vegetables are good sources of iron. Cook in cast-iron pans because traces of iron will attach to whatever you’re cooking. Don’t drink tea or coffee with meals because tannins present in those beverages inhibit iron absorption by 75%. If you are a lacto or ovo-lacto vegetarian, don’t drink milk with foods that are iron rich; calcium reduces iron absorption.
Calcium is important in the diet of every woman, especially women in their 30s and 40s. During pregnancy, your needs increase because your developing baby requires calcium to build strong bones and teeth, and you need calcium to keep your bones healthy. The daily requirement for a nonpregnant woman is between 800 and 1000mg of calcium. During pregnancy, your needs increase to 1200mg or more a day. Discuss it with your healthcare provider.
Dairy products are excellent sources of calcium and vitamin D, which is necessary for calcium absorption. It may be difficult for you to get enough calcium without eating dairy foods. Most prenatal vitamins contain only a small amount of the calcium you need. If your calcium intake is inadequate, your baby may draw needed calcium from your bones, which increases your risk of developing osteoporosis later in life.
If you are lactose intolerant and unable to drink milk, a condition that is more frequent among older women, you may be able to eat hard cheeses and yogurt. Lactose-reduced or lactose-free dairy products are also available. You may be able to use Lactaid, a preparation that helps your body deal more efficiently with lactic acid. Discuss the situation with your healthcare provider.
You may also choose nondairy sources of calcium; calcium is found in legumes, spinach, some fish, nuts and other foods. Some foods are now fortified with calcium. Read nutrition labels. The chart on page 188 lists some common calcium-containing foods.
| Food | Serving Size | Amount of Calcium |
Almonds |
¼ cup | 95 mg |
Beans, dried, cooked |
1 cup | 90 mg |
Bok choy |
½ cup | 79 mg |
Collards |
½ cup | 179 mg |
Milk, 2% |
8 ounces | 300 mg |
Orange juice, calcium-fortified |
6 ounces | 300 mg |
Sardines |
3 ounces | 324 mg |
Spinach, cooked |
½ cup | 140 mg |
Tofu processed with calcium sulfate |
4 ounces | 434 mg |
Trout |
4 ounces | 250 mg |
Waffle |
1 medium | 180 mg |
Yogurt, fruit |
8 ounces | 345 mg |
Yogurt, plain |
8 ounces | 400 mg |
If you need to watch your calories and avoid unnecessary fats, choose your calcium sources wisely. Select low-fat products and those with reduced-fat content. Skim milk and low-fat, fat-free and part-skim cheeses are better choices than whole milk and regular cheese.
Some foods interfere with your body’s absorption of calcium. Be very careful about consuming salt, protein, tea, coffee and unleavened bread with a calcium-containing food.
Many women grow tired of drinking milk or eating cheese or yogurt to meet their calcium needs during pregnancy. Below are some suggestions for adding calcium to your diet.
•Make fruit shakes with milk and fresh fruit.
•Drink calcium-fortified orange juice.
•Add nonfat milk powder to recipes.
•Cook brown rice or oatmeal in low-fat or nonfat milk instead of water.
•Drink calcium-fortified skim milk.
•Make soups and sauces with undiluted evaporated nonfat milk instead of cream.
•Eat calcium-fortified breads.
If you and your healthcare provider decide calcium supplements are necessary, you will probably take calcium carbonate combined with magnesium, which aids calcium absorption. Avoid supplements derived from animal bones, dolomite or oyster shells because they may contain lead.
Vitamin B9 is beneficial to all pregnant women. The synthetic form of this B vitamin is folic acid. Folate is the form found in food. Folic-acid deficiency can result in a type of anemia called megaloblastic anemia. Additional folic acid may be necessary for situations in which pregnancy requirements are unusually high, such as a pregnancy with twins or triplets, alcoholism or Crohn’s disease.
Prenatal vitamins contain 0.8 to 1mg of folic acid, sufficient for a woman with a normal pregnancy. Most women do not need extra folic acid during pregnancy.
A neural-tube defect called spina bifida afflicts nearly 4000 babies born in the United States every year. It develops in the first few weeks of pregnancy, when the fetus is highly susceptible to some substances or the lack of them. Research has proved nearly 75% of all cases of spina bifida can be prevented if the mother takes 0.4mg of folic acid a day, beginning 3 or 4 months before pregnancy. Folic acid for this purpose is required only through the first 13 weeks of pregnancy.
If a woman gives birth to a baby with spina bifida, she may need extra folic acid in subsequent pregnancies to reduce her chances of having another baby with the same problem. Some researchers, in hopes of significantly decreasing the chances of this serious problem, recommend all women of childbearing age take 0.4mg of folic acid a day.
Folate is found in a variety of foods. Many cereals and bread products are fortified with folic acid. Although it is sometimes difficult to get enough folic acid through food intake alone, a varied diet can help you reach this goal. Common foods that contain folate include asparagus, avocados, bananas, black beans, broccoli, egg yolks, green beans, lentils, liver, citrus fruit, peas, plantains, spinach, strawberries, wheat germ and yogurt.
Eating a breakfast of 1 cup of fortified cereal, with milk, and a glass of orange juice supplies about half of your daily requirement of folic acid.
A word of warning—give up green tea before conceiving and during pregnancy. Studies show it can interfere with your body’s absorption of folic acid.
Getting enough folic acid is usually not a problem for vegetarians. Folate is found in many fruits, legumes and vegetables (especially dark leafy ones).
Vitamin A is essential to human reproduction. Vitamin-A deficiency in North America is rare; most women have adequate stores of the vitamin in the liver.
What concerns healthcare providers is the excessive use of vitamin A before conception and during early pregnancy. (This concern extends only to the retinol forms of vitamin A, often derived from fish oils. The beta-carotene form, usually derived from plants, is believed to be safe.) Studies indicate that elevated levels of the retinol form of vitamin A during pregnancy may cause birth defects.
The RDA of vitamin A is 2700 international units (IU) a day for a woman of childbearing age (5000IU is a maximum dosage). The requirement is the same whether a woman is pregnant or not. Most women get the vitamin A they need during pregnancy from the foods they eat. Supplementation during pregnancy is not recommended. Be cautious about taking any substances you have not discussed with your healthcare provider. This includes vitamin A.
The B vitamins—B6, B12 and folic acid (B9)—influence fetal nerve development and red-blood-cell formation. If your vitamin-B12 level is low, you could develop anemia. Milk, eggs, tempeh and miso provide vitamins B6 and B12. Other good sources of B6 include bananas, potatoes, collard greens, avocados and brown rice. (See page 189 for folic-acid information.)
Vitamin E is important during pregnancy because it helps metabolize polyun-saturated fats and contributes to building muscles and red blood cells. Vitamin E appears in adequate quantities in meats, but if you don’t eat meat, it can be harder to get from the rest of your diet. If you’re a vegetarian or not eating meat, pay particular attention to getting enough vitamin E to meet the minimum requirements.
Unbleached, cold-pressed vegetable oils (such as olive oil), wheat germ, spinach and dried fruits are all good sources of vitamin E. Ask your healthcare provider if your prenatal vitamin contains 100% of the RDA for vitamin E.
Zinc stabilizes the genetic code in cells and ensures normal tissue growth in the fetus. It may help prevent miscarriage and premature delivery and can help regulate blood sugar in you and your baby.
Some thin women can increase their chances of giving birth to bigger, healthier babies by taking zinc supplements during pregnancy. In one study, babies born to thin women who took zinc during pregnancy were an average 4.5 ounces (128g) heavier, and head circumference was 0.16 inch (0.4cm) larger. Zinc also plays a critical role in immune functions.
Zinc is found in many foods, including seafood, meat, nuts and milk. Prenatal vitamins include 15 to 25mg of zinc, an adequate amount for most women.
If you’re a vegetarian, you’re more likely to have a zinc deficiency, so pay close attention to getting enough zinc every day. Lima beans, whole-grain products, nuts, dried beans, dried peas, wheat germ and dark leafy vegetables are all good sources of this mineral.
Benefits of fluoride supplementation during pregnancy is controversial. Some researchers believe fluoride supplements result in improved teeth in your child, but not everyone agrees. Fluoride supplementation in pregnancy has not been found to be harmful to baby. Some prenatal vitamins contain fluoride.
Every woman needs to gain a certain amount of weight during pregnancy. Proper weight gain helps ensure you and your baby are healthy at the time of delivery.
The recommended weight gain during pregnancy for a normal-weight woman is 25 to 35 pounds (11.25 to 15.75kg). If you’re underweight at the start of pregnancy, expect to gain between 28 and 40 pounds (12.5 to 18kg). If you’re overweight before pregnancy, you probably should not gain as much as other women during pregnancy. Acceptable weight gain for you is between 15 and 25 pounds (6.75 to 11.25kg). If you’re obese, the recommendation is a gain of between 11 and 20 pounds (5 to 9kg) for an entire pregnancy. Recommendations vary, so discuss the matter with your healthcare provider. Eat nutritious, well-balanced meals during your pregnancy. Do not diet now!
Many healthcare providers suggest a weight gain of 
of a pound (10 ounces; 283g) a week until 20 weeks as an average for a normal-weight woman, then 1 pound (0.45kg) a week until the end of your pregnancy. This is only an average; actual suggestions vary according to the individual.
It isn’t unusual not to gain weight or even to lose a little weight early in pregnancy. Your healthcare provider will keep track of changes in your weight.
Watch your weight, but don’t be obsessive about it. If you’re in good shape, with an appropriate amount of body fat when you get pregnant and you exercise regularly and eat healthfully, you shouldn’t have a problem with excessive weight gain.
During pregnancy, you need to increase your calorie consumption; the average recommended increase is about 300 calories a day. Some women need more calories; some women need fewer. If you’re underweight when you begin pregnancy, you will probably have to eat more than 300 extra calories each day. If you’re overweight, you may have less need for extra calories. See the discussions below.
The key to good nutrition and weight management is to eat a balanced diet throughout your pregnancy. Eat the foods you need to help your baby grow and develop. Choose wisely. For example, if you’re overweight, avoid high-calorie peanut butter and other nuts as a protein source; choose water-packed chicken or low-fat cheeses instead. If you’re underweight, high-calorie ice cream and milk shakes are acceptable dairy sources.
Getting on the scale and seeing your weight increase is hard for some women, especially those who watch their weight closely. You must acknowledge at the beginning of pregnancy that it’s OK to gain weight—it’s for the health of your baby. You can control your weight gain by eating carefully and nutritiously, but you must gain enough weight to meet the needs of your pregnancy. Your healthcare provider knows this; that’s why your weight is checked at every prenatal visit.
In the past, women were allowed to gain a very small amount of weight during pregnancy, sometimes as little as 12 to 15 pounds (5.5 to 6.75kg) for an entire pregnancy! Through research and advances in technology, we have learned these restrictive weight gains were not in the best interests of mother or baby.
General Weight-Gain Guidelines for Pregnancy
| Weight before Pregnancy | Recommended Gain (pounds) |
| Underweight | 28 to 40 (12.6 to 18kg) |
| Normal weight | 25 to 35 (11.25 to 15.75kg) |
| Overweight | 15 to 25 (6.75 to 11.25kg) |
| Obese | 11 to 20 (5 to 9kg) |
| Morbidly obese | Your healthcare provider will determine weight gain |
Another way to figure how much weight you should gain during pregnancy is to look at your BMI (body mass index). BMI guidelines for weight gain during pregnancy include the following:
•BMI of less than 18.5—gain between 28 and 40 pounds (12.6 to 18kg)
•BMI of 18.5 to 25—gain between 25 and 35 pounds (11.25 to 15.75kg)
•BMI of 26 to 29—gain between 15 and 25 pounds (6.75 to 11.25kg)
•BMI of 30 or more—gain between 11 and 20 pounds (5 to 9kg)
•BMI of 40 and over—healthcare provider will determine weight gain
Ask your healthcare provider to help you figure your BMI if you don’t know how to do it.
If you’re underweight when you begin pregnancy, you face special challenges. Studies show 20% of all pregnant women fail to gain the amount of weight their healthcare provider recommends. You may need to gain between 28 and 40 pounds (12.5 to 18kg) during your pregnancy. Gaining weight will supply your baby the nutrients it needs to grow and to develop.
Weight loss during the first trimester is not uncommon if you have morning sickness. If you’re underweight when you become pregnant and lose weight because of morning sickness or other problems, talk to your healthcare provider.
If you don’t gain enough weight during pregnancy, you’re at higher risk of preterm delivery, some birth defects, low birthweight or having a baby with heart or lung problems. Being underweight may also contribute to various pregnancy problems, including pre-eclampsia, gestational diabetes and intrauterine-growth restriction.
You may find if you’re underweight you need to gain extra weight during pregnancy. Below are some tips to help you reach that goal.
•Don’t drink diet sodas or eat low-calorie foods.
•Choose nutritious foods to help you gain weight, such as cheeses, dried fruits, nuts, avocados, whole milk and ice cream.
•Eat foods with a higher calorie content.
•Try to add nutritious, calorie-rich snacks to your daily menu.
•Avoid junk food with lots of empty calories.
•You may need to exercise less if you burn too many calories in these activities.
•Eating small, frequent meals may help improve digestion and absorption of nutrients.
If you’re underweight, make a good nutrition plan at the beginning of pregnancy. Ask your doctor about seeing a dietician to help you.
About 7 million women in the United States have an eating disorder; eating disorders are becoming more recognized in pregnant women. Experts believe that as many as 1% of all pregnant women suffer from some degree of eating disorder. The two primary eating disorders are anorexia nervosa and bulimia nervosa. Other eating disorders include restricting calories or food, and weight obsession, but those afflicted with them don’t meet the anorexia or bulimia criteria.
Distribution of Pregnancy Weight
| 7 to 10 pounds | Maternal stores (fat, protein and other nutrients) |
| 4 pounds | Increased fluid volume |
| 2 pounds | Breast enlargement |
| 2 pounds | Uterus |
| 7 ½ pounds | Baby |
| 2 pounds | Amniotic fluid |
| 1 ½ pounds | Placenta |
Women with anorexia usually weigh less than 85% of what is normal for their age and height. They are often extremely fearful of becoming fat, have an unrealistic body image, purge with laxatives or by vomiting, and binge. Bulimia is characterized by repeated binging and purging; a woman may feel a lack of control over the situation. A bulimic binges and purges at least twice a week for a period of 3 months or more.
It’s often difficult for any woman to see her body gain the weight that is normal with a pregnancy. It may be even harder for a woman with an eating disorder to see the pounds add up. It may take a lot of hard work and effort to accept these extra pounds, but you must try to do it for your good health and the good health of your baby.
Eating disorders may worsen during pregnancy. However, some women find their eating disorder gets better during pregnancy. For some, pregnancy is the first time they can let go of their obsessions about their bodies.
If you believe you have an eating disorder, try to deal with it before you get pregnant. An eating disorder affects you and your baby! Problems associated with an eating disorder during pregnancy include the following:
•a weight gain that is too low
•a low-birthweight baby
•miscarriage and an increased chance of fetal death
•intrauterine-growth restriction (IUGR)
•baby in a breech presentation (because it may be born too early)
•high blood pressure in the mother-to-be
•depression during and after pregnancy
•birth defects
•electrolyte problems in the mother-to-be
•decreased plasma volume
•low 5-minute Apgar scores after baby’s birth (see Chapter 19)
Your body is designed to provide your baby with the nutrition it needs, even if it has to take it from your body stores. For example, if your calcium intake is low, your baby will take the needed calcium from your bones. This could lead to osteoporosis for you later in life.
More frequent prenatal visits and monitoring during pregnancy are often recommended for a woman with an eating disorder. Researchers believe eating disorders may disrupt the way nutrients are delivered to the fetus, which could result in slower fetal growth or IUGR. Your healthcare provider will want to keep close tabs on how your baby is growing. Antidepressants may also be used to help treat the problem. An eating disorder may increase your risk of postpartum depression.
Talk to your healthcare provider about your problem as soon as possible. It’s serious and can adversely affect both you and your baby.
A weight gain of 25 to 35 pounds (11.25 to 15.75kg) may sound like a lot when the baby only weighs about 7 pounds (3.15kg); however, weight is distributed between you and your baby. Weight gained normally during pregnancy is distributed as shown in the box on the previous page.
If you’re overweight when you get pregnant, you’re not alone. Statistics show up to 38% of all pregnant women fall into this category. Over 72 million Americans are considered obese, and 12 million are considered morbidly obese.
The National Academy of Sciences Institute of Medicine has added a new category to pregnancy weight-gain guidelines. The category is for obese women, and the recommendation is a weight gain of between 11 and 20 pounds (5 to 9kg) for an entire pregnancy. Some experts also cite morbid obesity as a subcategory of obesity; experts suggest weight gain should be determined on an individual basis for women in this category.
You are considered overweight if your body mass index (BMI) is between 25 and 29; over 30, you are considered obese. If you have a BMI of 40 or over, you are considered morbidly obese.
Being overweight brings special challenges. Pregnancy can be harder on you and your baby, and it can contribute to a variety of problems. You may have more problems with backaches, varicose veins and fatigue. Baby’s shoulders may be too broad to fit through the birth canal (shoulder dystocia). In addition, your baby may be overdue. Morbid obesity brings additional risks.
A prenatal meeting with an anesthesiologist may be recommended because obese pregnant women have a higher risk for anesthesia complications. In addition, studies show overweight/obese women often have a slower progression of labor from 4 to 10cm dilatation compared with normal-weight women.
Research shows over 65% of all overweight women gain more weight than their healthcare provider recommends during pregnancy. Gaining too much weight may increase your chances of a Cesarean delivery. It can make carrying your baby more uncomfortable, and delivery may be more difficult. Studies also show it’s harder to lose any weight you gain during pregnancy after baby is born.
Babies are at risk if a mom-to-be is overweight or obese. Various birth defects have been attributed to overweight/obesity. Cleft palate and cleft lip are more common in children born to obese women. Overweight/obese women have lower levels of prolactin, which can result in a decreased milk supply.
Women who are overweight may need to see their healthcare provider more often during pregnancy. Ultrasound may be needed to pinpoint a due date because it’s harder to determine the size and position of a baby; abdominal fat layers make manual examination difficult. You may be screened for gestational diabetes. Other diagnostic tests may also be necessary during pregnancy. Diagnostic tests may also be done on your baby as your delivery date approaches.
Try to gain your total-pregnancy weight slowly. Weigh yourself weekly, and watch your food intake. Eat nutritious, healthful foods, and eliminate those with empty calories. A visit with a nutritionist may help you develop a healthful food plan.
Do not diet during pregnancy. To get the nutrients you need, choose nonfat or low-fat products, meats, grain products, fruits and vegetables. Many supply a variety of nutrients. Take your prenatal vitamin every day throughout your entire pregnancy.
Talk to your healthcare provider about making exercise part of your daily routine. Discuss swimming and walking, which are good exercises for any pregnant woman.
Eat regular meals—5 to 6 small meals a day is a good goal. This helps maintain blood-sugar levels and helps with nutrient absorption. Your total calorie intake should be between 1800 and 2400 calories a day. Keeping a daily food diary helps you track of how much you’re eating and when you’re eating. It can help you identify where to make changes, if necessary.
When you’re expecting two or more babies, you face an even greater nutritional challenge. Taking your prenatal vitamin every day provides some assurance you’re getting the nutrients you need, but the best sources of nutrients and calories for you and your developing babies are the foods you eat. Proper food choices can provide you with adequate protein, calories and calcium.
When you’re expecting more than one baby, nutrition and weight gain are important. If you don’t gain weight early in pregnancy, you may be at risk for developing pre-eclampsia. Your babies are more likely to be significantly smaller at birth than others.
Weight gain is important with a multiple pregnancy. You will probably be advised to gain more than the normal 25 to 35 pounds (11.25 to 15.75kg), depending on the number of fetuses you’re carrying. With twins, if you were normal weight before pregnancy, you may be advised to gain 40 to 54 pounds (18 to 24.5kg). If you’re expecting triplets, your weight gain will probably be between 50 and 60 pounds (22.7 and 27kg).
If you are overweight and expecting twins, a weight gain between 31 and 50 pounds (14 to 22.7kg) may be recommended. A weight gain between 25 and 42 pounds (11.25 and 19kg) may be recommended for obese women pregnant with twins.
Usually women who gain the targeted amount of weight during pregnancy lose it after delivery. One study showed women who gained the suggested amount of weight during a twin pregnancy were close to their prepregnant weight 2 years after delivery. You don’t have to carry the extra weight forever, so don’t worry about it now.
When you consider the average size of the babies (about 7½ pounds each, 3.4kg) and the weight of the placentas (1½ pounds, 0.68kg for each), plus the weight of the additional amniotic fluid, you can see where some of the extra weight gain goes. Don’t be alarmed when your healthcare provider discusses this target weight gain with you, even if it seems like a lot.
Research shows higher weight gains (within targeted ranges) are associated with better fetal growth. Better fetal growth means healthier babies.
