BabyBlog (TM) .com Pregnancy FAQ / Pregnancy and a Healthy Diet

Why is a healthy diet important before and during pregnancy?
What you eat every day, even before you are pregnant, is important for your health as well as for the health of your baby. Your diet before pregnancy and while you are pregnant should contain the vitamins and nutrients that your body will need to help your baby develop and grow the way he or she should. Practice healthy eating and take a multivitamin each and every day. Start this good habit before you become pregnant and continue eating healthy and taking a prenatal multivitamin throughout your pregnancy. If you need help choosing healthy foods or have questions about how to improve your diet for your future baby, ask a health professional at your doctor’s office or at a local clinic.

How should my diet change now that I am pregnant?
If you are eating a healthy diet before you become pregnant, you may only need to make a few changes to meet the nutritional needs of pregnancy. According to the American Dietetic Association, pregnant women should increase their usual servings of a variety of foods from the four basic food groups (up to a total of 2,500 to 2,700 calories daily) to include the following:

Fruits and Vegetables
Seven or more servings of fruits and vegetables combined (three servings of fruit and four of vegetables) daily for vitamins and minerals. Fruits and vegetables with vitamin C help you and your baby to have healthy gums and other tissues, and help your body to heal wounds and to absorb iron. Examples of fruits and vegetables with vitamin C include strawberries, melons, oranges, papaya, tomatoes, peppers, greens, cabbage, and broccoli. Fruits and vegetables also add fiber and other minerals to your diet and give you energy. Plus, dark green vegetables have vitamin A, iron, and folate, which are important nutrients during pregnancy.

One Serving Size Fruit = 1 medium apple, 1 medium banana, 1/2 cup of chopped fruit, 3/4 cup of fruit juice

One Serving Size Vegetable = 1 cup raw leafy vegetables, 1/2 cup of other vegetables (raw or cooked), 3/4 cup vegetable juice

Whole-grains or Enriched Breads/Cereals
Aim for nine or more servings. Whole grain products and enriched products like bread, rice, pasta, and breakfast cereals contain iron, B vitamins, some protein, minerals, and fiber that your body needs. Some breakfast cereals have been enriched with 100% of the folic acid your body needs each day. Folic acid has been shown to help prevent some serious birth defects. Choosing a breakfast cereal or other enriched grain products that contain folic acid is important before and during pregnancy.

One Serving Size = 1 slice bread, 1/2 cup of cooked cereal, rice, or pasta, 1 cup ready-to-eat cereal

Dairy Products
Aim for four or more servings of low-fat or non-fat milk, yogurt, or other dairy products like cheese for calcium. You and your baby need calcium for strong bones and teeth. Dairy products also have vitamin A and D, protein, and B vitamins. Vitamin A helps growth, resistance to infection, and vision. Pregnant women need 1,000 milligrams (mg) of calcium each day. If you are 18 or younger, you need 1,300 mg of calcium each day. Try to have low-fat or non-fat milk and milk products to lower your fat intake. Other sources of calcium include dark green leafy vegetables, dried beans and peas, nuts and seeds, and tofu. If you are lactose intolerant or can’t digest dairy products, you can still get this extra calcium. There are several low-lactose or reduced-lactose products available. In some cases, your doctor might advise you to take a calcium supplement.

One Serving Size = 1 cup of milk or yogurt, 1 1/2 oz. natural cheese, 2 oz. processed cheese

Proteins
Pregnant women need about 60 grams of protein per day. This is about the same as two or more 2-3 oz. servings of cooked lean meat, poultry without the skin or fish, or two or more 1 oz. servings of cooked meat. Don’t eat uncooked or undercooked meats or fish. These can make you sick. Pregnant women should avoid deli luncheon meats, also. Eggs, nuts, dried beans, and peas also are good forms of protein. Most women in this country have no problem getting at least this amount of protein each day. Protein builds muscle, tissue, enzymes, hormones, and antibodies for you and your baby. These foods also have B vitamins and iron, which is important for your red blood cells. Your need for protein in the first trimester is small, but grows in your second and third trimesters when your baby is growing the fastest, and your body is working to meet the needs of your growing baby.

One Serving Size = 2-3oz. of cooked lean meat, poultry, or fish, 1 oz. meat also = 1/2 cup cooked dried beans, 1 egg, 1/2 cup tofu, 1/3 cup nuts, 2 T. peanut butter

Should I limit how much fish I eat when I’m pregnant?
Some fish have mercury, which, in high doses, can hurt your baby’s growing brain and nervous system. There are some fish you should NOT eat if you are pregnant.

Here are some guidelines:

Do not eat any shark, swordfish, king mackerel, or tilefish (also called golden or white snapper) because these fish have high levels of mercury.
Do not eat more than six ounces of “white” or “albacore” tuna or tuna steak each week.

Limit your fish to no more than 2 servings (12 ounces total) per week. When you eat fish, choose shrimp, salmon, pollock, catfish, or “light” tuna as they are usually low in mercury. For more information on the mercury levels of different kinds of fish, go to: http://www.cfsan.fda.gov/~frf/sea-mehg.html

What other nutrients do I need for a healthy pregnancy?

Folic Acid
Folic acid is an important vitamin for any woman who could possibly become pregnant. Folic acid is a B vitamin that helps prevent serious birth defects of a baby’s brain or spine (called neural tube defects) and other birth defects like cleft lip and congenital heart disease. Folic acid is needed very early in pregnancy, usually before a woman knows she is pregnant. That is why it’s so important that every woman who could possibly become pregnant gets enough folic acid every single day, starting at least one month before pregnancy. One easy way to ensure getting enough folic acid every day is to take a daily multivitamin. Most multivitamins sold in the U.S. contain enough folic acid for the day. Check the label! Your vitamin should contain 400 micrograms (400 mcg) or 100% of the Daily Value (DV) for folic acid. Another way to get enough folic acid is to eat a serving of breakfast cereal that contains 100% (DV) for folic acid, every day. Just check the nutrition label to be sure—look for “100%” next to folic acid. So, eat a healthy diet that contains plenty of fruits and vegetables, and don’t forget to get your folic acid. Every day!
Iron
You need iron to keep your blood healthy for you and your baby. Bones and teeth also need iron to develop properly. Too little iron can cause a condition called anemia. If you have anemia, you might look pale and feel very tired. Your doctor can check for signs of anemia through the routine blood tests that are taken in different stages of your pregnancy. All pregnant women should take a low-dose iron supplement, beginning at the first prenatal visit, or even before, when you are planning to get pregnant. Prenatal vitamins that your doctor prescribes or that you find over the counter usually have the amount of iron you need. Check the label to make sure they contain iron. If your doctor finds that you have anemia, he or she will give you a higher dose of iron supplements to take once or twice a day. You can help prevent anemia by eating more iron-rich foods like lean red meat, fish, poultry, dried fruits, whole-grain breads, and iron-fortified cereals.
Water
Water plays a key role in your diet during pregnancy. It carries the nutrients from the foods you eat to your baby and helps prevent you from getting constipation, hemorrhoids, excessive swelling, and urinary tract or bladder infections. Drinking enough water, especially in your last trimester, prevents you from becoming dehydrated. Not getting enough water can then lead you to have contractions and premature or early labor. Pregnant women should drink at least six eight-ounce glasses of water per day and another glass for each hour of activity. You can drink juices for fluid, but they also have a lot of calories and can cause you to gain extra weight. Coffee, soft drinks, and teas that have caffeine actually reduce the amount of fluid in your body, so they cannot count towards the total amount of fluid you need.

Should I take a multivitamin during my pregnancy?
Even women who plan carefully to eat healthy every day can be missing out on some important nutrients like folic acid, which helps prevent serious birth defects of your baby’s brain and spine. Those birth defects happen before most women know they are pregnant. To be certain that you are getting enough folic acid and other vitamins, it is helpful to take a daily multivitamin or prenatal vitamin, starting before you get pregnant. But, don’t overdo it—taking more than one multivitamin daily can be harmful.

How much weight should I gain during pregnancy?
You should gain weight gradually during your pregnancy, with most of the weight gained in the last trimester. Good rates of weight gain are about two to four pounds during the first three months of pregnancy and three to four pounds per month for the rest of the pregnancy. The average total weight gain should be about 25 to 30 pounds. But, the amount you gain might be slightly less or more, depending on your weight before you became pregnant and your height.

According to the American College of Obstetricians and Gynecologists (ACOG):

If you were underweight before becoming pregnant, you should gain between 28 and 40 pounds.
If you were overweight before becoming pregnant, you should gain between 15 and 25 pounds.

Check with your doctor to find out how much weight gain during pregnancy is healthy for you.

Recent research shows that women who gain more than the recommended amount during pregnancy and who fail to lose this weight within six months after giving birth are at much higher risk of being obese nearly 10 years later.

Total weight gained during pregnancy includes six to eight pounds for the weight of the baby. The remaining weight consists of a higher fluid volume, larger breasts, larger uterus, amniotic fluid, and the placenta. Make sure to visit your doctor throughout your pregnancy so he or she can check on your weight gain.

Is it hard to lose weight after pregnancy?
It can be hard to lose weight after you have your baby if you gained too much weight during pregnancy. During pregnancy, fat deposits can increase by more than one-third of the total amount you had before becoming pregnant. If weight gain during pregnancy is normal, most women lose this extra weight in the birth process and in the weeks and months after birth. Breastfeeding also can help to deplete the fat gained during pregnancy by helping the body to expend at least 500 more calories each day.

Should I avoid drinking alcohol while I am pregnant?
There is no safe time during pregnancy for you to drink alcohol. There is also no known safe amount of alcohol to drink during pregnancy. When you are pregnant and you drink beer, wine, hard liquor, or other alcoholic beverages, alcohol gets into your blood. The alcohol in your blood goes to your baby through the umbilical cord. When the alcohol enters the baby's body, it can slow down the baby’s growth, affect the baby’s brain, and cause birth defects. Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term describing the range of effects that can occur in a person whose mother drank alcohol during pregnancy. Some people with FASD may have abnormal facial features and growth and central nervous system problems. People with FASD may have problems with learning, memory, attention span, communication, vision, and/or hearing. These problems often lead to problems in school and problems getting along with others. The effects of FASD last a lifetime. If you are pregnant and have been drinking alcohol, stop drinking now to protect your baby. If you need help to stop drinking, talk with your doctor or nurse.

Should I avoid caffeine while I am pregnant?
Caffeine is a stimulant found in colas, coffee, tea, chocolate, cocoa, and some over-the-counter and prescription drugs. Consumed in large quantities, caffeine can cause irritability, nervousness and insomnia as well as low birth-weight babies. Caffeine is also a diuretic and can dehydrate your body of valuable water. Some studies show that caffeine intake during pregnancy can harm the fetus. Until more is known, you should avoid caffeine. Caffeine is an ingredient in many over-the-counter and prescription drugs. Talk with your doctor before taking any drugs or medicines while pregnant.

Why do pregnant women crave certain foods?
The "pickles and ice cream" choices and other appetite cravings of pregnant women might be reflections of the changes in nutritional needs. The fetus needs nourishment, and the mother’s body begins to absorb and metabolize nutrients differently. These changes help ensure normal development of the baby and fill the demands of lactation, or breastfeeding, after the baby is born.

Do I really need to "eat for two?"
While you are pregnant, you will need additional nutrients to keep you and your baby healthy. But, that does not mean you need to eat twice as much. You should increase your caloric intake with only 300 calories per day. A baked potato has 120 calories, so getting those extra 300 calories should not be that hard.

Make sure not to restrict your diet during pregnancy. If you do, you might not get the right amounts of protein, vitamins, and minerals that are necessary to properly nourish your unborn baby. Low-calorie intake can cause a pregnant mother’s stored fat to break down, leading to the production of substances called ketones. Ketones, which can be found in the mother's blood and urine, are a sign of starvation or a starvation-like state. Constant production of ketones can result in a mentally retarded child.

What about diabetes and nutrition during pregnancy?
If you already have diabetes and would like to get pregnant, your chances of having a healthy baby are good. But, it’s important to plan your pregnancy and follow these steps:

Bring your diabetes under control before you get pregnant. Try to get your blood sugar under control three to six months before you get pregnant.
Keep your blood sugar under control during your pregnancy. Keep food, exercise, and insulin in balance. Talk with your doctor or a registered dietitian to help you follow a special meal plan. Remember, as your baby grows, your body changes, and these changes will affect your sugar levels. If your blood sugar rises too high, the increased sugar crossing into the placenta can result in a large, over-developed fetus with birth defects or an infant with blood sugar level problems.
Be sure to get enough of the B vitamin folic acid, every day. Women with diabetes might be at increased risk for having a baby with a serious birth defect. Getting enough folic acid each day can help reduce this risk.

Gestational diabetes is a form of diabetes that begins during pregnancy and usually goes away after the birth of the baby. If you have gestational diabetes, this means that you have a high amount of sugar in your blood during pregnancy. This form of diabetes can be controlled through diet, medication, and exercise, but if left untreated, gestational diabetes can cause health problems for both you and your baby. If you develop gestational diabetes, your doctor will refer you to a registered dietitian who can help you with special meal plans to control your blood sugar.

Why do I get morning sickness and nausea, and what can I do about it?
Morning sickness and nausea are common problems for pregnant women. Most nausea occurs during the early part of pregnancy and, in most cases, will subside once you enter the second trimester. For some women, morning sickness and nausea might last longer than the early stages of pregnancy or even throughout the entire nine months.

The changes in your body might cause you to be nauseated or to vomit when you smell or eat certain things, when you are tired or stressed, or for no apparent reason at all. Nausea in early pregnancy is a condition that often can be managed by changing when and what you eat.

Try these tips:

Eat smaller meals each day, such as six to eight small meals instead of three larger ones.
Avoid being without food for long periods of time.
Drink fluids between, but not with, meals.
Avoid foods that are greasy, fried, or highly spiced.
Avoid foul and unpleasant odors.
Rest when you are tired.

Severe nausea and vomiting in pregnancy is rare, but if it occurs, it can cause you to become dehydrated. If you feel that your nausea or vomiting is keeping you from eating right or gaining enough weight, talk with your doctor.

For More Information
You can find out more information about pregnancy and nutrition by contacting the National Women's Health Information Center or the following organizations:

American College of Obstetricians and Gynecologists (ACOG) Resource Center
Phone Number: (202) 863-2518
Web Site: http://www.acog.org

U.S. Department of Agriculture
Food and Nutrition Service
Phone Number: (703) 305-2286
Web Site: http://www.fns.usda.gov/fns/

National Maternal and Child Health Clearinghouse
Phone Number: (703) 356-1964
Web Site: http://www.ask.hrsa.gov/MCH.cfm

The Centers for Disease Control and Prevention
Phone number: (800) 311-3435
Web Site: http://www.cdc.gov/

This FAQ was reviewed by Christine Prue, PhD, Joe Mulinare, MD, Katie Kilker, BS, CHES, and Patricia Mersereau, MN, CPNP at the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC).