Diet During Pregnancy

In this discussion you will learn why you need a well-balanced diet while you are pregnant and what foods you should eat. You will also find out foods you should avoid and foods that will help some of the unpleasant side effects of pregnancy.

What foods do I need to eat?

Eating regular, well-balanced meals is more important when you are pregnant than at any other time of your life. What you eat provides food for your baby as well as yourself. The best time to begin eating a healthy, balanced diet is before you become pregnant.

You need about 300 more food calories a day than when you were not pregnant. Your healthcare provider will suggest a range of weight that you should gain. The usual recommended gain is about 20 to 35 pounds.

Your need for protein while pregnant is about 60 grams (g) a day. Many women already eat this amount or more of protein daily when they are not pregnant. However, if you are vegetarian or eat little meat or dairy, you may not be getting enough protein in your diet. You also need more vitamins and minerals, especially folic acid and iron. These nutrients are important for your baby's growth and development. They give your baby strong bones and teeth, healthy skin, and a healthy body.

Foods that are excellent sources of protein and vitamins are:

• beans and peas
• nuts
• peanut butter
• eggs
• meat
• fish
• poultry
• cheese, milk, and yogurt

Good sources of folic acid (also called folate) are:

• leafy green vegetables, such as collard greens, spinach, kale, and mustard greens
• broccoli
• asparagus
• fortified breakfast cereals and grains
• beans
• oranges and strawberries
• yellow squash
• tomato juice

Foods rich in iron are:

• lean red meats, pork, chicken, and fish
• fortified cereals
• dried fruit
• leafy green vegetables
• beans
• eggs
• liver
• kidneys
• whole-grain or enriched bread

If you need advice on what foods to eat for a healthy, balanced diet, ask your healthcare provider to refer you to a dietician. If you need financial help buying nutritious foods, a government program called the Special Supplemental Food Program for Women, Infants, and Children (WIC) can help you buy foods like milk, eggs, cheese, and bread.

How do I know if I am eating a balanced diet?

Eat a variety of whole, fresh foods. Use the following as a guideline for what you should eat every day.

Meat, poultry, fish, beans, or eggs

• You need 2 to 3 servings every day.
• One serving of meat is 2 to 3 ounces (oz) of lean meat, poultry, or fish.
• Single servings of other foods in this food group are 1 cup cooked beans, 2 eggs, 4 egg whites, 1/2 cup tofu, 1/2 cup nuts, or 1/4 cup peanut butter. Note that nuts and peanut butter, although healthy, are very high in calories and should be eaten in moderation, especially if you are gaining more weight than your healthcare provider recommends.

Grains, rice, pasta, bread

• It is good to have 6 to 9 servings every day.
• One serving is 1/2 cup pasta, 1/2 cup cooked cereal, or 1 slice of bread.
• Choose less-processed, higher-fiber whole grains more often.

Fruits

• You need 3 or more servings of fruits every day.
• One serving of fruit is 1 medium apple, 1 medium banana, 1/2 cup chopped fruit, or 3/4 cup fruit juice.

Vegetables

• You need 3 or more servings of vegetables every day.
• In general, 1 cup of cooked or raw vegetables or vegetable juice or 2 cups of raw leafy vegetables would be considered a serving.

Milk, cheese, or yogurt

• You need 3 to 4 servings every day.
• One serving is 1 cup of milk, 1 cup of yogurt, 1 and 1/2 ounces of hard cheese, or 2 ounces of processed cheese. It's best to choose low-fat or nonfat dairy products.

What if I am gaining more weight than my provider recommends?

• Keep eating the recommended servings for all of the food groups, but make lower fat choices.
• Avoid high-fat, high-sugar treats and high-calorie drinks, such as soda pop or large servings of juice.
• Get enough exercise at the level your healthcare provider recommends.

For a more individualized approach to meal planning during your pregnancy, go to MyPyramid Plan for Moms at http://www.mypyramid.gov/mypyramidmoms/pyramidmoms_plan.aspx.

Do I need to take dietary supplements?

Your healthcare provider will most likely prescribe a prenatal vitamin and mineral supplement. This will help make sure you get the vitamins and minerals you need, such as calcium, iron, and folic acid.

• Calcium: Calcium needs for pregnant women are the same as for women who are not pregnant: 1000 mg a day for adult women and 1300 mg a day for adolescents. Many women do not get enough calcium in their diet, so it's important to make sure you're meeting your calcium needs every day. Dairy products such as milk, yogurt, cheese, and smoothies are great sources of calcium.
• Folic acid: Folic acid is important for spinal cord development of the baby. Pregnant women need 400 micrograms (mcg) a day. Synthetic folic acid added to fortified foods and vitamin supplements is almost twice as well absorbed as the folic acid in natural foods. It is recommended that pregnant women get 400 micrograms (mcg) of folic acid from fortified foods (cereals and whole grains) and supplements, in addition to eating foods that are good sources of folate, such as legumes and leafy green vegetables. Read labels. Many foods are supplemented, and you should not have more than 1,000 mcg each day. Ask your provider if you need a folic acid supplement.
• Iron: Women need 30 mg of iron a day during the last half of pregnancy. An iron supplement may be necessary to meet this need. Women carrying twins, women with low iron in their blood, and large women may need more than 30 mg of iron a day. Taking an iron supplement in addition to the iron already contained in your prenatal vitamin is not recommended unless prescribed by your healthcare provider.

Is it OK to follow a vegetarian diet while I am pregnant?

• If you do not eat any animal foods, it may be hard to get enough important nutrients, including protein, iron, vitamin B12, and vitamin D. Your healthcare provider may ask you to meet with a dietitian who can help you plan meals. Your provider may recommend that you take additional supplements.
• Ovo-lacto vegetarians (women who include dairy and eggs in their diet) usually can meet their nutrition needs with diet and prenatal vitamins.

What foods and substances should I avoid when I am pregnant?

• Avoid alcoholic drinks, tobacco, and drugs.
• Check with your provider before taking any medicines or herbal supplements. Some medicines and supplements can cause birth defects.
• Limit caffeine. High amounts of caffeine from coffee, tea, soft drinks, and chocolate could increase the risk to your baby. Caffeine can cross the placenta and affect your baby's breathing and heart rate. A recent study suggests that as little as 200 milligrams (mg) of caffeine a day (the amount found in two 8-ounce cups of regular brewed coffee) may slow the growth of your baby. Some healthcare providers recommend no caffeine during the first trimester and no more than 200 mg during the second and third trimesters.
• Avoid herbal teas unless your healthcare provider recommends them. Some herbal teas, if drunk in large amounts, may cause early contractions and increase your risk for early (preterm) labor.
• Avoid meat, fish, shellfish, and eggs that are raw or undercooked. Also avoid foods from deli counters, or thoroughly reheat cold cuts before you eat them. Cook leftover foods or ready-to-eat foods, such as hot dogs, until they are steaming hot before you eat them.
• Do not eat soft cheeses, such as Brie, Camembert, feta, blue-veined cheeses, queso fresco or queso blanco, and panela, unless the label says they are pasteurized or made from pasteurized milk. The pasteurization process kills dangerous bacteria called listeria, which live in unpasteurized soft cheeses. Although most cheeses processed in this country are pasteurized, there is no guarantee. Always read the labels. If you are unsure which soft cheeses are safe, you may choose to avoid soft cheeses altogether. Hard cheese (such as cheddar), processed cheese slices, cottage cheese, and cream cheese are safe.
• Do not eat or drink any other unpasteurized dairy products, such as unpasteurized milk.
• Avoid raw vegetable sprouts and fresh (unpasteurized) fruit and vegetable juices. They can carry disease-causing bacteria such as E. coli and Salmonella.
• Avoid anything that is not food. Sometimes pregnant women crave something that is not food, such as laundry starch, dirt, clay or ice. This condition is called pica, and you need to tell your healthcare provider if you are having this kind of craving. Pica can cause poor nutrition for you and your baby. It can also make it hard for you to gain weight and is dangerous to your health.

Keep following these recommendations while you are breast-feeding your baby.

You do not have to eat less salt during pregnancy, as was thought in the past. A moderate amount of salt helps keep proper levels of sodium in your body as your baby develops. Use iodized salt.

Is it OK to eat fish?

Fish and shellfish are an important part of a healthy diet. They contain high-quality protein and other essential nutrients. They are low in saturated fat, and many fish contain omega-3 fatty acids, which have been shown to help promote brain development in babies. However, nearly all fish and shellfish contain traces of mercury. Some fish and shellfish contain higher levels of mercury that may harm an unborn baby's developing brain and nerves. The Food and Drug Administration (FDA) advises women who may become pregnant, pregnant women, nursing mothers, and young children to avoid some types of fish with high mercury levels. Instead, they should eat fish and shellfish that are lower in mercury.

Here are some guidelines for eating fish and other types of seafood:

• Do not eat shark, swordfish, king mackerel, or tilefish (also called golden or white snapper) because these fish contain high levels of mercury.
• Do not eat more than 6 ounces of canned white (albacore) tuna, tuna steak, or halibut each week.
• Do not eat more than 2 servings or a total of 12 ounces of fish each week.
• Choose shrimp, scallops, salmon, pollock, cod, catfish, or light canned tuna. These types of fish and seafood contain less mercury. Eating oysters and clams may increase your risk for infection. Avoid eating them or make sure to boil them for at least 4 to 6 minutes (as you should do with all shellfish).
• Most fish should be cooked to an internal temperature of 145° F (63° C).
• Do not eat refrigerated smoked seafood unless it is contained in a cooked dish, such as a casserole. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna, and mackerel, is most often labeled as nova-style, lox, kippered, smoked or jerky.
• Check local advisories about the safety of fish caught in local lakes, rivers, and coastal areas. If no advice is available, eat up to 6 ounces (one average meal) per week of fish caught from local waters, but don't eat any other fish during that week.

What should I do if I don't feel like eating or if I have other digestive problems?

Morning sickness

Many women have morning sickness during the early months of pregnancy. (In most cases, symptoms of nausea and vomiting are less common by the second trimester.) In early pregnancy, the changes in your body can cause you to feel nauseated when you eat or smell certain foods or when you get tired or anxious. It may help if you:

• Eat crackers, pretzels, or dry cereal before you get out of bed in the morning.
• Eat small meals often.
• Avoid greasy, fried, or spicy foods that may upset your stomach.
• Drink plenty of liquids, but between meals rather than with them.
• Try crushed ice, fruit juice, or fruit-ice pops if water makes you feel nauseous.
• Avoid unpleasant odors.
• Get enough rest.
• Ginger has been shown to help some women have less nausea, but you should talk to your healthcare provider about this before you add ginger to your diet.

Constipation

To help relieve constipation:

• Eat more fresh fruits, vegetables, high-fiber breads, and cereals.
• Get as much as exercise as you can. Walking and swimming are good choices.
• Try fiber supplements such as psyllium powder, Metamucil, or Citrucel. (You must drink plenty of fluids when taking these supplements.)
• Drink more liquids.
• Do not use laxatives unless your healthcare provider tells you to.

Diarrhea

• Try eating more yogurt, rice, dry toast, or bananas.
• Ask your healthcare provider about taking Pepto-Bismol or Maalox.

Heartburn

For heartburn you should:

• Eat 5 or 6 small meals a day.
• Avoid foods that commonly cause symptoms such as spicy and fried foods, orange and grapefruit juices, peppermint, garlic, and onions.
• Cut down on soft drinks, chocolate, coffee, and other drinks with caffeine. Drink instead water, milk, and apple or cranberry juice.
• Don't lie down for at least 1 to 2 hours after you eat. If heartburn gets worse when you lie down, raise the head of your bed 4 to 6 inches.
• Ask your healthcare provider which antacids you can take.