Diet and nutrition during pregnancy

Good nutrition during pregnancy is important for you and your baby. After all, the food you eat is your baby's only source of nutrition. It supplies your baby with the proper nutrients and calories needed for normal growth and development. An inadequate diet, on the other hand, can lead to premature labor and delivery, as well as low birthweight, birth defects and developmental problems.


Weight gain
The recommended average weight gain during pregnancy varies, and your doctor will help you decide how much weight gain is best for you. Keeping in mind that every woman is different, here are some general recommendations from the American College of Obstetricians and Gynecologists (ACOG):
If you're underweight or an adolescent: 28 to 40 pounds
If you're of normal weight: 25 to 35 pounds
If you're overweight: 15 to 25 pounds
If you're obese: 15 pounds
If you're having twins: 35 to 45 pounds
A full-term baby weighs much less than the recommended weight gains above, but factors in addition to the baby, such as increased blood volume, stored fat and body fluids account for the weight gain. The placenta also adds some weight, as well as your enlarged breasts and uterus. Remember, your body is producing a baby and preparing to nourish him or her after birth.

To gain a healthy amount of weight, you may not have to significantly increase your caloric intake. In fact, many women only need an additional 300 calories a day. It's important to remember that pregnancy is not the time to diet. Weight loss can actually harm the baby. If your diet lacks protein, vitamins and minerals, your body will have to break down its fat stores. This process creates substances known as ketones, too much of which can lead to birth defects. A deficient diet can also cause your baby to be smaller than normal at birth.


Dietary recommendations
The food guide pyramid, developed by the U.S. Department of Agriculture, is a good tool for helping you plan a healthful diet. Copies of the pyramid may be available from your doctor or local health department. Here's a summary of the pyramid's six food groups, the recommended minimum servings for each during pregnancy and examples for each of what is considered one serving:
Milk, yogurt and cheese: Three servings a day

One serving:

1 cup milk or yogurt
1½ ounces natural cheese
2 ounces processed cheese
½ cup cottage cheese
Meat, poultry, dried beans, eggs and nuts: Three servings a day

One serving:

2 to 3 ounces cooked meat or poultry (1 ounce of cooked meat is equal to: ½ cup cooked, dried beans; 1 egg; 2 tablespoons peanut butter; 1/3 cup nuts)
Breads, cereals, rice and pasta: Nine servings a day

One serving:

1 slice bread
1 small biscuit, muffin or roll
half a bagel, bun or English muffin
3 to 4 small crackers
2 large crackers
½ cup cooked cereal, rice or pasta
1 ounce dry cereal
Vegetables: Four servings a day

One serving:

½ cup cooked vegetables
1 cup raw vegetables
¾ cup vegetable juice
Fruits: Three servings a day

One serving:

2 small fruit, such as tangerines or apricots
1 medium fruit, such as an apple, orange or pear
½ of a large fruit, such as a grapefruit
¼ melon
½ cup berries
½ cup chopped, cooked or canned fruit
¼ cup dried fruit
¾ cup fruit juice
Fats, oils and sweets: Use sparingly

Along with getting the recommended number of servings each day, it's important to choose from a wide variety of foods to ensure the proper mix of vitamins and minerals. Each day, it's best to have at least one serving of a citrus fruit and at least two servings of leafy dark-green, yellow or orange vegetables. Remember that fats, oils and sweets should only be eaten sparingly. Treats may occasionally be included in your diet if you eat them in reasonable portions. Also, remember to drink six to eight glasses of water a day.

Morning sickness may interfere with your nutrition during the first trimester, and maybe even longer. If you're feeling nauseated, you may not be able to follow the recommended diet. Try to maintain a healthful diet as much as possible, eating mostly foods that don't upset your stomach.


Important nutrients
It's important to get the proper nutrients during pregnancy, especially folic acid, protein, iron and calcium.
Folic acid
Folic acid is one of the B vitamins. If you don't get enough folic acid early in pregnancy, your baby may be at risk for serious neural tube defects (affecting the brain and spinal cord). All women of childbearing age are encouraged to get at least 400 micrograms of folic acid each day because these defects can develop very early in pregnancy -- often even before you're aware you're pregnant.

It's difficult to get enough folic acid from your diet unless you eat an exceptional amount of fruits, vegetables and legumes. The ACOG recommends that all women take a daily supplement of 400 micrograms (0.4 milligrams) of folic acid before and during pregnancy. If you've had a baby with a neural tube defect, it's recommended that you take a daily supplement of 4 milligrams of folic acid one month before pregnancy and during the first three months of pregnancy.

Good food sources of folic acid include:

dark-green leafy vegetables
broccoli and asparagus
citrus fruits and juices
most berries
dried beans and peas
nuts
liver and other organ meats
whole-grain bread
enriched bread, cereal, pasta, flour, cornmeal, crackers and rice
Protein
Getting enough protein is also important for both you and your baby. Eat a well-balanced diet containing the recommended amounts of meat, fish, poultry, cheese, eggs, beans and nuts. If you're a vegetarian who eats only plant foods, you may want to discuss your diet with a dietitian to make sure you're getting enough protein as well as the necessary vitamins and minerals.

Iron
Your body uses the mineral iron to make hemoglobin, a protein found in the red blood cells that's responsible for carrying oxygen to the tissues in your body. Your need for iron increases significantly during the second and third trimesters because of the increase in your blood volume, as well as your baby's increasing need for iron. Insufficient iron can lead to anemia (a condition marked by a decreased number of red blood cells or hemoglobin), weakened defense against infections and a decreased ability to tolerate blood loss during delivery. Dietary sources of iron include:

beef, pork, lamb and organ meats
dried peas
beans and lentils
egg yolks
dark-green leafy vegetables
iron-fortified cereal
Your doctor may recommend taking an iron supplement to ensure that you and your baby get enough iron.

Calcium
For healthy women, the adequate intake (AI) of calcium is the same before, during and after pregnancy. Women age 19 and older need at least 1,000 milligrams of calcium a day (about the amount of calcium found in three cups of milk). Women age 18 and younger need at least 1,300 milligrams of calcium a day. If your diet doesn't contain enough calcium, it will be taken from your bones, which leads to lower bone density. To prevent this, eat at least three servings of dairy products every day.

Dietary sources of calcium include milk, yogurt, cheese, cottage cheese and tofu. Single-serving examples listed below contain about the same amount of calcium as 1 cup of milk:

Dairy products:
1 cup milk or yogurt
1½ ounces natural cheese
2 ounces processed cheese
2 cups cottage cheese
1½ cups frozen yogurt
½ cup tofu processed with calcium or 1½ cups boiled soy beans
2 cups baked beans
¾ cup almonds
10 dried figs
5 oranges or 1 cup calcium-fortified orange juice
dark-green leafy vegetables, such as:
1½ cups cooked broccoli
1½ cups cooked greens (turnip)
2 cups collards, dandelion or bok choy
3 cups kale or mustard
½ cup canned salmon or 2½ ounces sardines with the bones
2 tablespoons blackstrap molasses
If you're lactose intolerant, consult your doctor about the best alternative sources of calcium.


Vitamin and mineral supplements
Your doctor may recommend a vitamin and mineral supplement to take during pregnancy. If you're already taking supplements, be sure to discuss them with your doctor. It's important to only take recommended supplements in the recommended doses. Some vitamins and minerals, such as iodine and vitamins A and D, can actually harm your baby if taken in excessive amounts.

WIC
Because good nutrition during pregnancy is so important for you and your baby, the U.S. Department of Agriculture has established a special supplemental nutrition program for women, infants and children, otherwise known as WIC. The program assists states in providing supplemental food, health care referrals, and nutritional education for low-income pregnant and postpartum women and their children up to age 5 who are found to be at nutritional risk. This risk may be due to certain health problems, pregnancy risks or complications, or to an inadequate diet. The program is available in every state, the District of Columbia, Indian Tribal Organizations, Puerto Rico, the Virgin Islands, American Samoa and Guam. The program may vary from state to state.
WIC helps women and children obtain foods high in nutrients such as protein, calcium, iron and vitamins A and C, which are often lacking in their diets. It provides breastfeeding education and also assists families obtain infant formula and cereals. For further information, talk to your health care provider or contact your state WIC agency. Information can also be obtained from the U. S. Department of Agriculture.


What to avoid
Alcohol
To ensure a healthy pregnancy, it's important to avoid alcohol. Because no level of alcohol consumption has been proven safe during pregnancy, complete abstinence is recommended. Alcohol consumption during pregnancy has been associated with growth problems, developmental delays, and facial and other skeletal abnormalities.

Chemicals
Limit eating foods with added chemicals such as:

artificial coloring, flavoring and preservatives
artificial sweeteners, such as saccharine and aspartame
nitrates and nitrites (abundant in processed meats and smoked fish or meat)
Fish
Talk to your doctor before you eat any type of fish, including seafood or shellfish. Several groups have recently cautioned pregnant women and small children to avoid canned and fresh tuna, as well as other types of fish, due to mercury levels.

It's best to avoid fish that may be contaminated with PCBs, high levels of mercury or other chemicals. The Environmental Protection Agency (EPA) and the U.S. Food and Drug Administration (FDA) recommend that pregnant women avoid eating or greatly reduce intake of fish caught from polluted waters. Contact your health department or local environmental protection department to check for advisories about the safety of fish caught by family and friends in local lakes, rivers and costal areas. If no advice is available, eat no more than one 6-ounce serving of freshwater fish per week, and donny other fish during that week.

The EPA and FDA recommend not eating any swordfish, shark, king mackerel or tilefish during pregnancy because these fish may have high levels of mercury that can damage a fetus's developing nervous system. (Women contemplating pregnancy should avoid these fish as well.)Select a variety of other fish and shellfish that are lower in mercury, such as shrimp, canned light tuna, salmon, pollock and catfish. You may eat up to 12 ounces (two average meals) of these types of fish or shellfish per week. Albacore tuna contains more mercury than light tuna. You may eat up to 6 ounces of albacore tuna, but no other fish during that week. If youafras and others -- have been found to be harmful during pregnancy. Discuss the use of any herbal teas or supplements with your doctor.

Caffeine
The effect of caffeine on a developing baby has not been well established. Because of the unknowns, experts at the FDA recommend limiting caffeine intake as much as possible, including caffeinated coffee, tea and sodas.

Food-borne infections
To protect yourself from food-borne infections, follow these general guidelines:

Thoroughly cook raw meat, poultry and eggs, and thoroughly reheat all leftovers.
Wash raw vegetables thoroughly before eating.
Never eat food that doesn't look or smell right or that may have been stored too long.
Keep uncooked meats separate from vegetables, cooked foods and ready-to-eat foods.
Avoid unpasteurized milk or foods made from unpasteurized milk.
Wash your hands with hot, soapy water before food preparation and after handling raw meat, fish, seafood, eggs or poultry.
Wash your hands, knives and cutting boards after handling uncooked foods.
Refrigerate perishable foods promptly and properly (40 °F or cooler).
Pregnant women are 20 times more likely than other healthy adults to develop a food-borne illness called listeriosis. Listeriosis may cause only mild, flu-like symptoms for the mother, but can lead to miscarriage, stillbirth, premature birth or serious illness in the baby. To prevent listeriosis, pregnant women should be careful to avoid the following foods:

hot dogs, luncheon meats and deli meats, unless reheated so they're steaming hot (Be careful not to cross-contaminate other foods, utensils or food preparation surfaces with fluid from hot dog packages. Wash your hands after handling these foods.)

soft cheeses not labeled as made with pasteurized milk, such as feta, Brie, Camembert, blue-veined cheeses, Mexican-style cheeses (such as queso blanco, queso fresco, queso de hoja, queso de crema and asadero) and Panela (You may eat hard cheeses, semisoft cheeses such as mozzarella, pasteurized processed cheese slices and spreads, cream cheese and cottage cheese.)

refrigerated pâtés or meat spreads, unless they're canned

refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna or mackerel (This type of seafood is most often labeled Nova-style, lox, kippered, smoked or jerky. You may eat smoked seafood that's been canned or cooked in a casserole or other dish.)