Eating for Two: Nutritional Choices in Pregnancy Are Twice as Important

Pregnancy is a good time for a woman to redouble her efforts to lead a healthy lifestyle. One of the most important determinants of your health is diet. The old adage “you are what you eat” is true in many ways, and pregnancy is a time when your nutrition doesn’t impact you alone. It is a time when nutrients are used as building blocks to form your baby.   

The most important concept to keep in mind is that wholesome, unprocessed, natural foods are the best choices at this time. The more processed a food is, the fewer nutrients and more unhealthy additives it is likely to contain. Natural foods such as fruits, vegetables, whole grains including brown rice and quinoa, beans and legumes, lean proteins and dairy should make up the majority of your diet.  

The importance of nutrition in pregnancy is particularly highlighted by a very hot topic of research today surrounding epigenetics. Epigenetics is the study of how environmental influences including stress, pollution and nutrition impact our DNA. It is now known that the environment in pregnancy and early childhood sets a child up for either lifelong health or disease. Given this knowledge, it is important to make an even greater effort to provide a healthy in utero environment through good nutrition, stress management and avoidance of pollutants to reduce disease and set our children up for success in the next generation.

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The other equally important concept to be aware of is that the caloric requirements in pregnancy are not substantially above a woman’s baseline nutritional needs. Starting late in the second trimester, a woman needs approximately 300 calories above her usual intake daily. This equates roughly to two pieces of whole grain bread and an egg. Earlier in pregnancy, the caloric needs above the baseline are even less. Throughout pregnancy, meals should be smaller but more frequent, approximately four per day.

 

A Healthy Diet During Pregnancy

A healthy diet in pregnancy includes food from the five food groups which include grains, proteins, vegetables, fruits and dairy. The increased calorie requirements in pregnancy should be mainly consumed in the form of lean proteins and whole grains.  Every day, pregnant women should eat 2-3 servings of vegetables, 2 servings of fruit, at least 3 servings of whole grains, and 3 servings of protein.

Protein is important for growth and development of the fetus, especially in making muscle and brain tissue.  In particular, protein needs in pregnancy should be about 75 grams per day based on a 150-pound pre-pregnancy weight. To calculate the number of grams of protein you need, divide your pre-pregnancy weight by two. Protein is found in meat, fish, beans, nuts, and eggs.  The recommendation is to have 3 servings of protein per day.  A serving of meat should be approximately the size of a deck of cards.

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Calcium is important in pregnancy in building bones and teeth for the fetus. The recommended amount of calcium in your diet should be 1000 milligrams per day and can be found in dairy products, especially milk and yogurt. This is approximately 4 servings of calcium-rich foods. If you cannot tolerate dairy, some calcium can be found in dark green leafy vegetables and fortified orange juice. 

It is possible to get all the nutrients needed in pregnancy from your diet; however, some nutrients are commonly deficient in the average diet. Folic acid, in particular, is one that can be deficient, and it is important during the first trimester of pregnancy. The American College of Obstetrics and Gynecology recommends that women who are trying to get pregnant should start taking a prenatal vitamin containing 600 micrograms of folate three months prior to conception. Folate is found in lentils, green leafy vegetables, nuts, beans and citrus fruits and is fortified in some grain products.

Another important topic is fish consumption in pregnancy. Fish contains naturally occurring DHA, a fatty acid so important in brain and eye development that it is now supplemented in
most prenatal vitamins and infant formulas. As with all nutrients, the best source of intake is in natural form, by consuming 3 or more servings of fish weekly. However, there is a concern regarding intake of methyl mercury or Polychlorinated Biphenyls (PCBs) when eating fish that are higher on the food chain.  In particular, shark, swordfish, tilefish and king mackerel contain higher levels of mercury and should be avoided. Tuna also contains more mercury than smaller fish and should be limited to about 6 ounces per week. According to the March of Dimes, bluefish, bass, pike, trout and walleye contain higher levels of PCBs, which could lead to developmental delay if consumed excessively.  

 

What to Avoid

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Of course there are also restrictions during pregnancy. In particular, there are concerns for food contamination with a specific bacteria called Listeria which dictate caution with eating hot dogs, lunch meats, refrigerated pates and unpasteurized milk or cheese. Listeria can cause fetal demise or miscarriage. Additionally, uncooked meat and fish is not recommended during pregnancy since their consumption can lead to food poisoning, which can be severe in pregnant women.  

Caffeine and alcohol consumption in pregnancy should be modified. Caffeine has been linked to miscarriage risk, but it is believed that intake below 200-300mg of caffeine per day is safe. If you are a coffee drinker, one 12-oz cup of coffee per day is acceptable. Remember that caffeine is also found in tea (particularly green tea), soft drinks, and chocolate, so be careful not to include too much of any of these in your diet. Because there is no known safe level of alcohol intake in pregnancy it should be restricted.  Use of alcohol can lead to fetal alcohol syndrome, or potentially to behavioral or learning problems.

Cravings in pregnancy are common. In general, it is fine to indulge them as long as they are not often. However, craving non-food items such as ice, paint chips, baking soda, dirt, or laundry detergent can be a sign of nutrient deficiencies. See your doctor if this occurs.

 

Resources

There are several health resources available to help provide information regarding specific diet plans and goals tailored to women’s needs. 

Choosemyplate.gov, a website of the U.S. Department of Agriculture (USDA), has a feature to help predict your goal for pregnancy weight gain and food plan worksheets to help you choose foods in recommended proportions for each food group.   

There are also smartphone apps available that can determine the number of calories in foods to help you make healthy food choices. 

The Carrot helps you keep calorie counts of your intake, tracks blood pressures and logs your exercise to keep you motivated to lead a healthy lifestyle. 

Fooducate, developed by dietitians, contains nutrition information for various foods and helps suggest healthy alternatives when you are making poor choices. 

• If you eat out frequently, Restaurant Nutrition can help guide healthier choices at restaurant chains.  

Calorie Tracker contains a searchable database to help you understand what is on your plate, track your eating habits and calculate your energy needs so you can adjust your requirements based on your activity level.


Janice Teixeira, DO, MS, is board certified in obstetrics/gynecology and is a Fellow of the American College of Obstetricians and Gynecologists. She attended the New York College of Osteopathic Medicine and completed her residency in OB/Gyn at St. Luke’s Roosevelt Hospital Center. Dr. Teixeira is an Assistant Professor in the Department of Obstetrics & Gynecology at the Mount Sinai School of Medicine. She sees patients on the Phelps campus in Suite 308 of the 777 Building (914-631-0908) and in Suite 560 of the 755 Building (914-366-5400).

 

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