IN THIS CHAPTER
Balancing the food you eat with the energy you burn every day of your pregnancy
Knowing how to get more calories from nutritious foods
Understanding why carbs, proteins, fats, fiber, and water are all essential nutrients
Recognizing special nutrient needs you may have
If there’s ever a time to eat right, it’s during pregnancy. Why? Because the right mix of nutrients (everything that’s nourishing your body, from protein and iron to fiber and water) helps keep you going strong and your baby growing steadily. This chapter gives you the nitty-gritty details of pregnancy nutrition. If you’re a numbers person, you’ll love this chapter because it specifies how many more calories you really need during pregnancy and shows you how to distribute those calories into the three major nutrients that make up your diet: carbohydrates, protein, and fat. If you’re not a numbers person, just gloss over the numbers and pay attention to the foods recommended in this chapter.
Either way, you need to be aware that certain vitamin and mineral needs change when you’re pregnant, whereas others don’t change at all. Don’t worry, though. This chapter tells you exactly which nutrients require your attention and which foods can provide you with them. It also covers fiber and hydration — the keys to smooth digestion — and reveals how to get the proper nutrients in your pregnancy diet if you’re a vegetarian or facing unique circumstances like gestational diabetes and food allergies.
Eating for Baby and You: Balancing Calories Eaten and Calories Burned
Rule number one of pregnancy nutrition: Don’t let anyone tell you (and don’t tell yourself either!) that you’re eating for two. Thankfully, your baby will never be as big as you while inhabiting your uterus. To think that you need to eat as many calories to support your baby as you need to support yourself is misguided. Eating for two may be a cute saying, but, in reality, eating for two won’t make you look or feel cute!
You do need to consume some extra calories during the course of your pregnancy, but how many you consume varies according to the trimester you’re in. (Also, depending on your size pre-pregnancy — whether you’re petite or tall — you may need slightly more or less than the recommended numbers.) The following sections give you the specifics.
Your weight status prior to pregnancy can dictate the number of calories you need. If you were overweight before you got pregnant, you may need fewer calories. If you were underweight, you may need to supplement the calorie numbers provided in this chapter with more calories to gain the proper amount of weight. Talk to your obstetrician (OB) to determine the approximate total amount of weight you can gain for a healthy pregnancy and the number of additional (or fewer) calories you need to consume to get there.
First trimester (weeks 1 through 13): Don’t purposely take in extra calories
Even though the first trimester (weeks 1 through 13) is a time of incredible growth for your baby, she’s still so small that her growth doesn’t require any significant energy. So during these first few months, don’t worry about purposely eating any more calories than you ate pre-pregnancy. No additional calories are required during the first trimester, and the total weight gain during this period is 1 to 4 pounds.
If food is the last thing on your mind because of nausea, take a deep breath and relax. Your pre-pregnancy nutrient stores will get you through this first trimester even if you aren’t able to hold down much food. Just be sure to take your prenatal vitamin every day so you know you’re getting enough folic acid. (For advice on dealing with nausea, refer to Book 1, Chapter 4.)
If you’re not experiencing nausea, you may have the opposite problem — ravenous hunger! When hunger strikes, go with your instincts and eat, but eat foods that will fill you up and provide good nutrients. Avoid foods high in sugar and fat and focus instead on healthy foods.
TRUST YOUR GUT
Don’t start purposely eating extra calories as soon as you learn you’re pregnant. Instead, follow your body’s natural hunger cues.
What? Don’t women need more calories while they’re pregnant? Isn’t it a mom-to-be’s responsibility to ensure that she begins to stock up stores right away to ensure that she gets the nutrition she needs to support her pregnancy? How can she do that if she’s not eating more?
After living as a pregnant woman for another month or so, you’ll start to realize that this advice is simply brilliant. If you truly listen to your hormone-raging pregnant body, you will eat more when you need to eat more to support your pregnancy. Some days, you’ll be nauseous and not eat much, but other days your appetite will be ravenous and you’ll eat more. If you start at week 8 purposely trying to take in more calories every day, you’ll likely gain too much in the first trimester, setting the stage for excess weight gain for the entire pregnancy.
Second trimester (weeks 14 through 27): Take in an extra 300 to 350 calories
The second trimester (weeks 14 through 27) is a time of incredible growth for your baby. She goes from weighing only about an ounce at the end of week 13 to weighing more than 2 pounds by the end of week 26. To support your little one’s growth during this phase of pregnancy, you need to consume about 300 to 350 extra calories per day. If you’re at a normal weight, look to gain approximately 1 pound per week; if you’re overweight or obese, try to gain half a pound per week.
You don’t have to eat all 300 to 350 calories at one time. You can spread them out over the course of the day. Check out the following list for some great meal and snack ideas that’ll give you the calories you need during your second trimester (the number of calories is in parentheses). Feel free to mix and match to make your own yummy combinations.
· 1 large banana (120) + 1 large apple (95) + 30 pistachios (100)
· 1 ounce whole-grain crackers (120) + 1 piece of string cheese (85) + ½ cup frozen yogurt (140)
· 1 cup 1% cottage cheese (160) + 1 cup fresh sliced strawberries (50) + ½ cup edamame (95)
· 1 cup fat-free milk (90) + 1 cup whole-grain cereal (175) + ½ cup blueberries (45)
· Two slices whole-wheat toast (160) + 1 tablespoon almond butter (100) + 1 tablespoon raspberry preserves (55)
· 1 ounce tortilla chips (140) + ¼ cup salsa (20) + ½ cup black beans (110) + 1 cup fresh pineapple chunks (80)
· 6 ounces Concord grape juice (130) + ½ ounce dark chocolate (85) + 6 ounces nonfat fruited Greek yogurt (130)
· 1 smoothie (310) made with ½ banana + ½ cup strawberries + ½ cup nonfat milk + 1 scoop protein powder + 1 tablespoon wheat germ
· 1 frozen meal of your choice (about 300)
Some days you’ll be hungrier than others. Follow your hunger cues and eat more on the days when you’re hungrier, but don’t force yourself to eat on the days when you aren’t. For most women, it all evens out. Besides, your doctor will let you know whether you’re gaining too little or too much weight, so you can adjust your calories up or down as appropriate.
If you’re so inclined, you can rely on the scale to tell you whether you’re getting enough to eat (or too much, for that matter). Look at your average weight gain over the course of a few weeks to assess your progress. Turn to Book 3, Chapter 1 to see how much weight you should be gaining throughout your pregnancy.
THE SCIENCE BEHIND THOSE EXTRA CALORIES
Women need about 85,000 calories for the entire 40 weeks of pregnancy. If you do the math, those 85,000 calories break down to about 300 extra calories per day. However, studies vary, some estimating pregnant women need more calories and others estimating they need fewer calories.
One reason you need more calories when you’re pregnant (at least in the second and third trimesters) is that your resting metabolic rate (RMR) increases. Your RMR is the number of calories you burn each day at rest. Your RMR increases with pregnancy because you burn more calories to grow another life. The other reason you need more calories is that you have to store fat and protein in your body throughout pregnancy.
While your RMR plays a large part in determining the number of calories you burn in a day, you can’t forget about your daily physical activities. Some studies suggest that pregnant women don’t need as many calories as many experts estimate because many women end up decreasing their physical activity during pregnancy. Whether that means exercising less intensely or simply sitting with your feet up more often, you may find yourself moving less than your pre-pregnancy self who kick-boxed her way to fitness and never sat down. As you work with your doctor to determine how many more calories you need, be sure to think about how much more or less you’re moving during your pregnancy. Head to Book 4 for exercise information and tips.
Third trimester (weeks 28 through 40): Take in an extra 450 to 500 calories
During the third trimester, your baby gains about 4 more pounds. Because you’re now carrying around even more weight than you were in the second trimester, you need to consume more calories so you have the energy to cart that extra weight around. Aim to eat about 450 to 500 more calories than you did pre-pregnancy (to gain about 1 pound a week if you’re at a normal weight or half a pound per week if you’re overweight or obese).
Follow your hunger. Some days you’ll be ravenous, and other days your appetite will subside. As long as you’re gaining the proper weight, don’t stress about eating exactly 450 to 500 extra calories per day.
Here are some ideas for how to get those extra 450 to 500 calories each day (the number of calories is in parentheses). Keep in mind that you can spread out the extra calories throughout the day. Mix and match foods from this list to create your own meals and snacks.
· ¼ cup hummus (100) + 1 cup fresh raw veggies (50) + 1 whole-grain pita pocket (120) + 1 ounce pasteurized feta cheese (75) + 1 cup chocolate soymilk (140)
· 2 Medjool dates (130) + 1 ounce (or 19 halves) pecans (195) + 1 ounce cheddar cheese (115) + 1 plum (30)
· 1 hard-boiled egg (75) + one 4-inch cinnamon raisin bagel (230) + 1 tablespoon peanut butter (95) + 4 ounces 100% pomegranate juice (80)
· 3 ounces salmon (175) + ½ cup quinoa (115) + 1 cup asparagus (40) + 1 tablespoon olive oil (120)
· 3 ounces lean strip steak (165) + 2 cups raw spinach (15) + 20 pine nuts (25) + 2 tablespoons Italian salad dressing (100) + 1 KIND or other fruit and nut nutrition bar (190)
· ½ cup garbanzo beans (130) + 1 mango (135) + 1 cup chocolate pudding (210)
· 6 ounces nonfat fruited Greek yogurt (130) + ½ cup granola (200) + 1 tablespoon honey (65) + 1 cup raspberries (65)
· ⅓ cup dry rolled oats (150) + 1 cup skim milk (90) + 1 ounce (or 14 halves) walnuts (185) + 1 large peach (70)
· ½ cup homemade tuna or chicken salad (200) + 1 cup grapes (65) + 15 almonds (105) + 1 SOYJOY or other soy protein nutrition bar (130)
· 2 mini Babybel or other round cheeses (140) + ½ cup barley (100) + 6 dried apricot halves (50) + 2 small chocolate chip cookies (160)
You can also get your extra 450 to 500 calories by eating larger portions at your meals, but adding some nutritious snacks in between meals is probably a better idea. Why? Because as the third trimester goes on, the sheer size of your belly may suppress your appetite or cause gastric reflux by pressing on your stomach. Limiting portions at meals and relying on snacks for added nutrients and energy can help you feel better overall.
Figuring Out Where Your Calories Should Come From
Of course, variety is the spice of life, and it should definitely be a part of your diet, whether you’re pregnant or not. If you eat the same foods all the time, you get the same nutrients all the time. But if you vary your food choices, you get different nutrients in the foods you consume. But what should those foods be?
The majority of the extra calories you get while you’re pregnant should come from three sources: carbohydrates, protein, and fat. The following sections explain why each of these nutrients is so important during pregnancy.
The United States Department of Agriculture (USDA) provides a guideline for the average person to follow for good nutrition. This guideline is called MyPlate, and it shows the proportion of calories that should come from each of the five food groups (grains, protein, vegetables, fruits, and dairy). You can see the MyPlate graphic and get specific recommendations for calories and portions based on your height, weight, age, and activity level by going to www.choosemyplate.gov.
The role nutrition plays in your baby’s development is critical. In fact, some researchers suggest that the nutrients a developing fetus receives in the womb (and that a newborn receives in the first few weeks of life) are more critical than the nutrients received at any other time in life. That may seem quite shocking, but more and more evidence is connecting a woman’s nutritional status during pregnancy to the health of her child, not just at birth but throughout that child’s life.
A FEW RULES ABOUT FOODS
Before you got pregnant, you may have thought that all you needed to stay away from during your pregnancy was alcohol and possibly caffeine. In reality, the list of taboo foods is a bit longer and includes the following:
· Raw and undercooked beef, chicken, fish, and pork: A meat thermometer can tell you for sure whether a particular meat has reached a safe temperature. (Book 3, Chapter 3 lists minimum safe temperatures.)
When most people think of sushi, they think of raw fish. If you’re a sushi fan, you may be heartbroken by the thought of not having it while you’re pregnant. But take heart: You can have sushi — as long as it’s not the raw tuna or salmon kind. Imitation crab (used in the California roll), real crab, shrimp, and eel are all cooked, so you can enjoy any of those in your sushi.
· Runny eggs: Eggs need to be cooked all the way through, whether they’re in the skillet, a sauce, or a casserole. Cook (or order your eggs in a restaurant) scrambled well or over hard. If the white or yolk is still runny, send it back to the skillet to be cooked until firm. Egg casseroles should be cooked until they reach 160 degrees. Avoid sauces that contain raw eggs, such as hollandaise and béarnaise. And don’t forget about raw cookie dough — no licking the spoon if there are raw eggs in the dough!
· Unpasteurized milk and cheeses: Avoid milk or cheese that claims to be raw or that doesn’t say pasteurized on the label. You’re free to eat any cheese (including soft cheeses) as long as it’s been made with pasteurized milk.
For the full scoop on which foods to avoid completely and which to be cautious of during pregnancy, see Book 3, Chapter 3.
Carbohydrates: Energy for the body
Carbohydrates (or carbs, as they’re often called) are your body’s (and your baby’s) preferred source of energy, providing you with the glucose you need to keep your brain functioning. Some examples of carb-containing foods include grains (bread, cereal, oatmeal, and tortillas, just to name a few), fruits, vegetables, milk, desserts, and anything that contains sugar.
Without enough carbohydrates, your body has to break down other nutrients, like proteins and fats, for energy instead of letting them do what they’re supposed to do in the body (see the next two sections for details). You can avoid this situation by making sure that anywhere from 45 to 65 percent of your daily calories come from carbs. A single gram of carbs contains 4 calories, so just multiply the grams of carbs in a food by 4 to figure out how many carb calories that food contains. (You can see how many carbs are in the foods you eat by looking for the phrase Total carbohydrate on the food label. Under the total carbohydrates, you usually also see the amount of fiber and sugar, in grams, that the food contains. Both fiber and sugar are part of the total carbohydrate number.)
An easier option is to keep track of the total grams of carbs you consume. If you take this approach, aim to eat between 225 and 325 grams (g) of carbs per day for an average 2,000-calorie intake. For fruits and veggies, you can skip the counts and just eat a lot of plants, especially the green, leafy kind.
The two categories of carbs are simple carbs and complex carbs. Simple carbs are sugars — not just table sugar but also the sugar found naturally in food, like fructose in fruit and lactose in milk. Complex carbs, also called starches, are long chains of sugars; they’re found in foods like grains, rice, pasta, potatoes, and beans. Your body has to break down complex carbs into simple sugars for them to be absorbed from the digestive tract into the bloodstream. Focus on getting the majority of your carbohydrates as complex carbs.
Plan on having carbohydrates in the form of grains, fruits, and vegetables at every meal. Maintaining good energy means keeping your body fueled with its preferred energy source (you guessed it: carbs!) all day long.
Protein: Cell building and repair
Protein is made up of amino acids, which are basically the building blocks of every cell in your body and in your developing baby’s body. Aim to get 20 percent of your daily calories from protein (that’s about 100 grams per day if you’re eating a 2,000-calorie diet). A single gram of protein contains 4 calories. To figure out how many protein calories a food contains, simply multiply the grams-of-protein-per-serving info by 4. Of course, you can always eat more protein if you want, up to 35 percent of your daily calories (which amounts to 175 g if you’re eating a 2,000-calorie diet).
Because a lot of protein-containing foods are fresh (think raw meat), they don’t require a food label. That’s nice for manufacturers but challenging for you when you’re trying to keep track of your protein intake. Let Table 2-1 be your guide to how many grams of protein are in some common foods.
Table 2-1 Amount of Protein in Some Common Foods
|
Food |
Amount of Protein |
|
3 ounces lean cooked meat (poultry, pork, beef, and fish) |
About 21 g (7 g/ounce) |
|
6 ounces Greek yogurt |
12–16 g |
|
3 ounces firm tofu |
9 g |
|
1 cup lowfat milk |
8 g |
|
2 tablespoons peanut butter |
8 g |
|
½ cup black beans |
7 g |
|
6 ounces lowfat yogurt |
5–7 g |
|
1 large egg |
6 g |
|
1 ounce (or about 23) almonds |
6 g |
|
Most grain products (for example, a slice of bread, 1 ounce of cereal, or 2 ounces of dry pasta) |
1–4 g per serving |
Protein takes longer to digest than carbs, so eating protein keeps you full for a longer period of time than eating carbs. Always try to include protein at every meal. At breakfast, your protein source can be milk, eggs, or yogurt, and at lunch and dinner, it can be meat or meat alternatives. You can also get protein from your snacks by eating nuts and nut butters.
Fat: Nervous system development and function
Even though you may be nervous about the weight you’ll gain, pregnancy is not the time to go on a fat-free diet! Fat plays a key role in developing your baby’s brain and keeping your brain and nervous system running smoothly. It’s also an energy source for your body and helps keep you feeling fuller longer. Aim to get 20 to 35 percent of your calories from fat. Fat is more calorically dense than carbs and protein; a single fat gram contains 9 calories. Multiply the grams of fat in a food by 9 to figure out how many fat calories a food contains.
An easier way to track how many of your daily calories come from fat is to look for the Calories from Fat info on the Nutrition Facts panel. Another alternative is to track grams of fat. If you’re eating a 2,000-calorie diet, you need to consume 45 to 78 g of fat per day.
Different fats have very different reactions in your body. So you need to be aware of what types of fats you’re eating. Research has shown that certain fats are better for you than others. For example, saturated fat (butter, whole-fat dairy, and fatty meats) and trans fat (hydrogenated oils) have been shown to raise “bad” LDL cholesterol levels, leading to clogging of arteries and increased risk of heart disease. On the flip side, monounsaturated fats, like those found in olive oil and avocados, trigger less LDL cholesterol and more of the “good” HDL cholesterol. Polyunsaturated fats, like those found in vegetable oils and fish, are also beneficial. In fact, two specific types of polyunsaturated fats have a significant impact on brain development; for information on these fats, go to the later section “Omega-3 fatty acids.”
Limit your consumption of saturated fat to less than 22 g per day (that’s 10 percent if you’re consuming 2,000 calories a day) and try to avoid trans fat (like the kind found in hydrogenated oils and fried foods).
Not sure how to figure out how much fat you’re getting? Just look for the Total Fat listing on the food label. The amounts of saturated fat and trans fat appear underneath that listing. Sometimes you also find the amounts of monounsaturated fat and polyunsaturated fat listed, but they don’t have to be there.
Getting the Nutrients You Need
During pregnancy, you’re literally forming a new life within your body — an act that requires more than just carbs, protein, and fat. Vitamins and minerals are also important members of the nutrition team, playing many different roles in the growth and development of your baby.
A supplement is one way to ensure you’re getting the vitamins and minerals you and your little one need throughout your pregnancy. You find most, if not all, of the nutrients you need to supplement in a basic prenatal vitamin. Several brands of prenatal vitamins exist, including both over-the-counter and prescription varieties. A prescription prenatal isn’t necessarily better, but your doctor may prescribe one for two reasons:
· Women take pills better when they’re prescribed rather than just recommended.
· Some health insurance companies cover prescription prenatal vitamins, meaning that they may cost you less than the over-the-counter varieties.
In addition to a balanced diet, a regular multivitamin made with a women’s formula (so it has extra folic acid and iron) may also get the job done. Women’s multivitamins usually have all the essential nutrients for pregnancy, although they may not have as high of doses as the prenatal varieties. Prenatal vitamins also tend to have more iron and sometimes even the DHA omega-3 all in one place (see the later sections “Iron” and “Omega-3 fatty acids” for details).
Iron can cause nausea and constipation in some women. If you’re one of them, skip the prenatal vitamin and at least take a separate folic acid supplement (with between 600 and 800 micrograms) or a general multivitamin with less iron.
Depending on your diet, you may also want to take extra calcium, iron, vitamin D, or DHA omega-3. Estimate how much of each nutrient you’re getting in your diet and talk to your doctor about getting your blood values checked for certain nutrients, such as iron and vitamin D. Then supplement your diet with additional nutrients as needed.
A supplement is just that — a supplement to your diet. In other words, don’t eat junk and think the vitamins you’re taking will be enough to keep you and your baby healthy. Nutritious food is still important!
Of course, because some nutrients are of special concern during pregnancy, you may want to take a closer look at them so you can really understand what they do for your growing baby, how much of them you need, and what you can eat to get them. The next sections provide these details.
Folate (folic acid)
Folate (the food form), also called folic acid (the supplement form), plays a key role in developing your baby’s spinal cord early in pregnancy, but it’s also an important nutrient to get later in pregnancy. Aim to get 600 micrograms (mcg) per day throughout your pregnancy. Your prenatal vitamin probably contains about this amount (check the label to make sure), but because vitamins are generally absorbed and utilized better through food than supplements, try to get it naturally in food, too.
You find folate in oranges (and orange juice), strawberries, avocados, beans (specifically black, garbanzo, kidney, navy, and pinto), black-eyed peas, lentils, nuts, dark-green leafy vegetables (like spinach, kale, and collards), asparagus, broccoli, and Brussels sprouts. You can also find folate-fortified grain products, such as flour and cereal.
Iron
Your daily iron needs practically double during pregnancy, from 18 to 27 milligrams (mg). This increase is due in large part to the increase in blood volume you’re experiencing. Iron helps your body form hemoglobin, the protein that carries oxygen to the blood. You need this oxygen to get to your placenta to help your baby develop.
Aside from your prenatal vitamin, you find iron in animal foods like beef, poultry (higher in dark meat), pork, fish, and egg yolks, although you can also get iron in seeds, beans, lentils, dark-green leafy vegetables, dried fruit (like prunes, raisins, and apricots), and whole grains. Manufacturers often add iron into other grains such as rice and cereals as well. In packaged food products, you can find the amount of iron per serving listed on the food label, but be aware that the percentage listed is based on the average 18 mg daily requirement and you now need 27 mg.
Iron, especially the form found in vegetable sources, is often not absorbed in high quantities by your body. To help improve absorption, eat foods that are high in vitamin C along with your iron-rich foods. For example, include oranges, tomatoes, cantaloupe, strawberries, kiwi, peppers, or broccoli in the same meal as your iron-rich foods. The vitamin C in these foods helps your body absorb more iron. Cooking iron-rich foods in an iron skillet may also help boost your iron intake because some of the iron actually gets into the foods.
Your doctor will probably check your iron levels periodically throughout your pregnancy to make sure they’re within the normal range. One symptom of iron deficiency is fatigue, but you may have a hard time figuring out whether you’re tired because you’re iron deficient (called anemic) or because you’re just plain exhausted from pregnancy! A blood test is the only way to know for sure. If you find out that you’re iron deficient, your doctor may recommend that you take a higher dose of supplemental iron. Iron supplements can cause nausea, loss of appetite, and constipation, though, so if you’re suffering, talk to your doctor about taking a lower dose and focus on getting as much iron as possible from food.
Calcium
Calcium helps with blood pressure control, but it’s best known for its role in bone health — both maintaining yours and building your baby’s. If you don’t get enough calcium in your diet (1,000 mg), your body will take it from your bones, leaving you at higher risk of osteoporosis. The good news is that your body actually absorbs calcium better when you’re pregnant.
Most prenatal vitamins contain only about 250 mg of calcium, so plan to supplement that amount by eating dairy foods (like milk, cheese, and yogurt) daily. You can also find calcium-fortified soymilk, orange juice, breads, cereals, and nutrition bars. Some vegetables and fruits, like dark-green leafy vegetables, broccoli, okra, and figs, also contain calcium. For packaged foods, calcium has to appear on food labels, so you can easily find out how much calcium the food you’re eating contains. Fortunately, the daily recommendation is the same for pregnant and nonpregnant people, so looking at the percent on food labels is a good way to see whether you’re getting enough calcium.
Choline
Although you may not have heard of it, choline is pretty important to your little one. Preliminary evidence suggests that it works along with folate to ensure the proper development of the neural tube and central nervous system. In addition, choline plays a key role in developing the hippocampus, which is the memory center of the brain. So if you want your child to remember Mother’s Day, get plenty of choline — 450 mg of it.
Choline isn’t difficult to get in your diet, but purposely include some of the best food sources daily so you get your fill. Eggs are the best source of choline, with 125 mg; just make sure you eat the yolk because all the choline is in the yolk, not in the white part. You also find choline in meats such as beef, poultry, pork, and fish. If you’re looking for vegetarian sources, try wheat germ, cauliflower, broccoli, potatoes, and nuts (especially pistachios). Check the label of your prenatal vitamin to see if it includes choline; most prenatal vitamins have it, but some may not.
Omega-3 fatty acids
Omega-3 fatty acids have been shown to help reduce the risk of preterm births, preeclampsia, and hypertension in pregnancy. Two specific omega-3 fatty acids found mainly in fish and seafood are essential during pregnancy:
· Docosahexaenoic acid (DHA): Most research emphasizes getting plenty of DHA in pregnancy because the brain is made up primarily of DHA. Aim to get a minimum of 300 mg of DHA a day while pregnant.
· Eicosapentaenoic acid (EPA): EPA is essential to building every structural cell in the body. Aim to get a minimum of 220 mg per day (which is actually the same amount you need when you’re not pregnant).
The key to getting plenty of omega-3s in pregnancy is focusing on the best sources of omega-3s while avoiding the sources with higher mercury contents. How do you know which sources are best? Take a look at Table 2-2. It shows a list of high-omega-3 fish that are also low in mercury (and, thus, safe to eat during pregnancy).
Table 2-2 Low-Mercury Sources of DHA and EPA Omega-3s
|
Fish |
DHA + EPA Content |
|
Atlantic salmon, farmed, 3 ounces cooked |
1,835 mg |
|
Coho salmon, farmed, 3 ounces cooked |
1,087 mg |
|
Anchovies, 2 ounces canned |
924 mg |
|
Sardines, 3 ounces canned |
835 mg |
|
Crab, 3 ounces cooked |
335 mg |
|
Flounder, 3 ounces cooked |
255 mg |
|
Clams, 3 ounces cooked |
241 mg |
|
Light tuna, 3 ounces canned |
230 mg |
|
Scallops, 3 ounces cooked |
80 mg |
|
Shrimp, 3 ounces cooked |
80 mg |
|
Catfish, 3 ounces cooked |
77 mg |
Source: USDA nutrient database (www.nal.usda.gov)
If you’re not a fan of fish, look for sources of algae because the algae the fish eat produce their high omega-3 content. But before you start scraping the sides of your fish tank, look for food products on store shelves that boast high DHA contents. Most of these products are fortified with algal oil and contain between 30 and 50 mg of DHA per serving.
A great nonfish source of omega-3s is a DHA-enhanced egg. Eggland’s Best farms feed their hens sea kelp, which results in each egg having about 57 mg of DHA per large egg. Regular eggs have 29 mg on average.
If you can’t fathom eating a ton of fish or omega-3-fortified food, consider taking an omega-3 supplement. Your prenatal vitamin may already have some omega-3s in it, so look at the label for DHA and EPA. Aim to get a minimum of 300 mg of DHA but ideally more like a total of 1,000 mg of DHA and EPA combined. If your prenatal vitamin doesn’t have enough omega-3s, consider a fish-oil supplement. Just be sure to read the label carefully to see how many pills you need to take to get to the 1,000 mg amount.
Fish oil supplements can cause a nasty case of fish burps. If you don’t think you can handle tasting fish for a while after taking a supplement, look for a supplement that’s made from high-quality, highly purified fish oil, like Nordic Naturals. Alternatively, choose one that’s enteric coated, like Vital Remedy MD’s VitalOils1000 or a store-shelf brand like Nature Made’s Ultra Omega-3 Minis, which give you 1,000 mg of combined DHA and EPA in three small pills that are easier to swallow. If you’re a vegan, look for Ascenta brand NutraVege, which has 400 mg of DHA in 2 teaspoons.
The rest of the essential pregnancy nutrients
The preceding five sections describe specific nutrients that have a direct relationship to various key areas of your baby’s development, but they’re not the only nutrients worth knowing about. The following list highlights four additional nutrients that are important for keeping you and your baby properly nourished:
· Vitamin D: Vitamin D helps build bones and protect the immune system of both you and your baby. Low levels of vitamin D have been linked to increased risk of cesarean (C-section) delivery, preeclampsia, and gestational diabetes for pregnant moms and to weak bones, seizures, respiratory infections, and brain disorders in babies. Vitamin D is difficult to get in the diet, so make sure your prenatal vitamin contains at least 600 international units (IU). If you want to do even better by you and your baby, try to get at least 1,000 IU of vitamin D per day. (You can take an extra vitamin D supplement to reach this amount.)
The American Academy of Pediatrics recommends that every pregnant woman get her vitamin D level checked and aim for a blood level above 32 nanograms/milliliter (ng/mL). It takes about 1,000 IU of vitamin D to raise blood levels 10 ng/mL. Many researchers now recommend that all pregnant and nursing women take 5,000 IU of vitamin D daily, but check with your doctor for his or her recommendation.
· Vitamin A: This nutrient is necessary in pregnancy because of its key role in building healthy cells and developing vision in your baby. Do your best to get 2,566 IU (770 mcg) of vitamin A per day.
Getting enough vitamin A isn’t typically a problem. The concern is consuming too much of this particular nutrient. Some studies have connected high levels of vitamin A to birth defects. Getting too much vitamin A in your diet is pretty hard to do unless you eat liver several times per week (liver is really high in vitamin A), but getting too much from supplements is much easier. Check all the supplements you’re taking and make sure that you’re not getting more than 10,000 IU total of preformed vitamin A daily. Also make sure your supplement uses beta carotene as its source of vitamin A rather than the potentially problematic form called retinol.
· Zinc: This mineral is essential for keeping your immune system strong and for cell growth in your baby. During your pregnancy, aim to get a minimum of 11 mg of zinc per day; it’s okay to get more than that. Good sources of zinc include animal proteins as well as fortified grains, sunflower seeds, wheat germ, tofu, and peanuts. You may also be able to meet your daily zinc requirement just by taking your prenatal vitamin; check the label to be sure.
· Iodine: In pregnancy, iodine helps with brain development and hormone production in your baby, so be sure to get 220 mcg of it daily. You can find iodine in iodized salt, a common staple in many people’s homes, as well as in fish (especially saltwater fish), dairy foods, and some vegetables, like potatoes and beans. Some prenatal vitamins contain iodine, but some don’t, so don’t rely on your vitamin to get your iodine.
RESEARCHING THE LINK BETWEEN MOM’S NUTRITION AND BABY’S DEVELOPMENT
A recent study found that a mother’s nutrition while pregnant can actually alter the function of her child’s DNA, predisposing the child to conditions and diseases such as obesity, diabetes, and heart disease. Eating a poor diet during the times that are most critical in the development of your baby may even cause certain organs not to function correctly and may lead to complications in your baby. For example, one study on baboons (hey, they’re not so different from humans!) found that poor nutrition during fetal and early life damaged the pancreas and predisposed the offspring to type 2 diabetes later on in life.
Another study looked at survivors of the Dutch Famine in the 1940s. The women who were pregnant during the famine had children who were more likely to develop a preference for fatty foods and to be less active. They also had increased risk of type 2 diabetes, obesity, hypertension, and cardiovascular disease. Although a famine probably isn’t on the horizon in your life, this study is a great example of the impact a lack of nutrition during pregnancy can have on your child’s lifelong health.
Discovering the Numerous Benefits of Fiber
Fiber offers your body several health benefits. Probably the most well-known benefit is its broom-like quality. That is, fiber keeps things moving through your digestive tract, cleaning out the colon. Fiber is the part of complex carbohydrates that literally doesn’t get digested. Because your body can’t digest it, fiber creates bulk in the stool, leaving you with a softer stool that passes with regularity.
Fiber also keeps you feeling fuller longer and keeps your blood sugar under control while your body tries to digest it. In addition, fiber can help you control your blood pressure, decrease your risk of preeclampsia, and reduce your cholesterol levels. The following sections tell you everything you need to know about how much fiber to get during pregnancy and where to go to get it.
Knowing how much fiber you need
During pregnancy, you need to get 28 g of fiber per day (that’s 3 g more than the recommended pre-pregnancy amount). Pregnant women need more fiber in their diets to combat their increased risk of constipation, which is a common occurrence for many expectant mothers due to hormonal changes in the body. (For additional constipation-prevention tips, turn to Book 1, Chapter 4.)
Eating fiber can leave you feeling a bit gassy. To avoid this experience, increase your fiber intake slowly. Eat a bit more fiber every day for several weeks to get up to the full 28 g per day. Doing so allows your digestive tract to get used to the added fiber.
Filling up on fiber-rich foods
The only place you find fiber is in plant foods. So look to whole grains, beans, fruits, vegetables, nuts, and seeds to get your fill of fiber. Table 2-3 provides you with a list of common plant foods along with their fiber content. (For any foods with a range of fiber contents, just check the label on the food you’re about to eat to find out exactly how much fiber it contains.)
Table 2-3 Common High-Fiber Foods
|
Food |
Fiber Content |
|
High-fiber cereals (like All-Bran, Fiber One, Kashi, Raisin Bran, and Shredded Wheat) |
6–14 g |
|
Beans (like black, kidney, garbanzo, pinto, lima, and baked beans), ½ cup cooked |
5–9 g |
|
Lentils, ½ cup cooked |
8 g |
|
Blackberries, 1 cup raw |
8 g |
|
Pear, medium with skin |
5 g |
|
Apple, medium with skin |
4 g |
|
Russet potato, medium with skin |
4 g |
|
Whole-wheat bread, pasta, and brown rice, serving size |
2–4 g |
|
Popcorn, 3 cups popped |
3.5 g |
|
Banana, medium |
3 g |
|
Strawberries, 1 cup raw |
3 g |
|
Broccoli, ½ cup cooked |
2.5 g |
|
Spinach, ½ cup cooked |
2 g |
|
Oatmeal, ½ cup cooked |
2 g |
|
Flaxseed, 1 tablespoon ground |
2 g |
|
Wheat germ, 2 tablespoons |
2 g |
|
Hummus, 2 tablespoons |
1.5 g |
Fiber is listed as Dietary Fiber on the Nutrition Facts panel on food labels (under the Total Carbohydrate line). Looking for this entry is the best way to find the exact amount of fiber in a packaged food.
Sneaking more fiber into your day
Look for opportunities throughout the day to add more fiber to your diet. Start with a high-fiber cereal or a piece of whole-grain toast and be amazed at how easily you can get your required 28 g every day. Here are some additional creative ways of adding fiber to your diet:
· Use whole-wheat flour in place of part or all of the white flour in recipes.
· Leave the skin on fruits and vegetables (if it’s edible!).
· Sneak more vegetables into foods by shredding and pureeing them and adding them to casseroles, sauces, and soups.
· Use fresh or frozen fruits and vegetables to make smoothies.
· Add canned beans to salads, soups, and pasta dishes — basically anywhere and everywhere you can think to add them. (Just remember to drain and rinse the beans to cut back on sodium and potentially reduce gas.)
· Use snacks like popcorn, fresh fruit, raw veggies, canned beans, and high-fiber cereal or crackers as midday fiber opportunities.
Realizing Why Proper Hydration Matters
Whether you’re pregnant or not, fluid is critical. You could survive for a long time on your body’s stores of nutrients, but without fluid, you may not even last a week. Fluid transports nutrients to your cells and transports waste material away from them, keeps your body at the proper temperature (something that’s especially important when you’re pregnant), and moves fiber through your digestive system. Read on to find out how much fluid you need to stay hydrated (having proper fluid balance in your cells) and where to get it.
How much fluid do I need?
You need 102 ounces (that’s 3 liters or 12.7 cups) of fluid per day throughout your pregnancy. Why so much? Well, blood is about 83 percent water, and your blood volume increases when you’re pregnant. Also, what do you think your baby is floating around in? You guessed it — fluid! Without that extra fluid, your baby wouldn’t have the proper cushioning he needs to protect his delicate, developing body.
To determine whether you’re properly hydrated, look at the color of your urine. You don’t need to examine it for hours; just taking a quick peek to see whether your urine is barely yellow can leave you feeling assured that you’re hydrated. If it’s bright yellow or dark in color, reach for a beverage after you wash your hands. If you’re having trouble with vomiting during your pregnancy, you may have a hard time staying hydrated. Check with your doctor about monitoring and improving your hydration.
Where should my fluid come from?
Water should be your primary source for hydration (it’s calorie-free and easily available), but the 102-ounce recommendation also includes the water you get from food and other fluids. Food (including fruits, vegetables, rice, pasta, and even bread) typically contributes about 20 ounces of your fluid for the day. The remaining 90-plus ounces comes from everything you drink.
Coffee, tea, soft drinks, sparkling water, juice, and milk all earn you hydration points. Because you’re not drinking alcohol and you’re limiting your caffeine (see Book 1, Chapter 4 for details), you won’t be getting any major diuretic effects from those beverages. Decaffeinated beverages hydrate essentially the same as water.
Note: Tap water is generally safe in the United States, so don’t feel like you have to drink bottled water throughout your pregnancy. If you’re concerned about the safety of your tap water, use a reverse osmosis filter to be sure it’s as safe as you can make it.
What if I can’t stay hydrated?
If staying hydrated isn’t easy for you, employ some of these tips to help you hit your 102-ounce fluid goal:
· Create a fluid checklist for yourself and mark off your progress throughout the day.
· Carry a water bottle with you at all times. You’ll be more inclined to drink up if you have water sitting in front of you.
· Set a timer to remind yourself to drink on average about 8 to 12 ounces every one to two hours.
· Add cucumber or fresh orange slices (or pineapple, berries, lemon slices, or lime slices) to keep your water interesting.
· Drink a tall glass of liquid at every meal.
· Fill up on liquid-containing foods, like soup, gelatin, fruits, and veggies.
· Drink water or sports drinks before, during, and after you exercise.
· Drink more fluid on hot days or if you’re traveling by plane.
· Add more fluid to your daily diet if you’ve been sick with a fever, diarrhea, or vomiting.
Don’t wait for thirst to tell you to drink. When you feel thirsty, you’re likely already at least slightly dehydrated.
Living a Vegetarian Lifestyle While Pregnant
If you’re a vegetarian, you can continue to live your lifestyle and have a healthy baby. Although it’s probably not the best idea to become a vegetarian right before or during your pregnancy, if you’ve been one for some time, you’ve likely mastered the skills you need to plan properly nutritious meals.
The term vegetarian means different things to different people. For example, if you’re a lacto-ovo vegetarian (meaning you eat dairy and eggs), you likely won’t have any problem meeting your nutrient requirements as long as you’re eating the iron-rich foods listed in the upcoming bulleted list. If you’re vegan (meaning you don’t eat any dairy or eggs), you’ll likely have to take dietary supplements to ensure you’re getting the proper nutrients.
Regardless of what being vegetarian means to you, make sure you’re getting enough calories and gaining the proper amount of weight as your pregnancy progresses. As a vegetarian, focus on eating beans, soy, nuts, and seeds to get plenty of protein, and if you avoid dairy, choose calcium-fortified milk replacements like soy-based milk, yogurt, and cheese.
Vegetarian diets generally tend to be lower than traditional meat-containing diets in a few key nutrients that are essential during pregnancy. The following list breaks down these essential nutrients and explains how you can get more of them in your diet (to figure out the amount you need of each nutrient, see the earlier section “Getting the Nutrients You Need”):
· Iron: Choose fortified grains, dark leafy greens, dried fruit, tofu, prunes, beans, and blackstrap molasses. Or consider taking an iron supplement.
· Vitamin B12: Because only animal products like dairy and eggs contain this vitamin, vegans need to get their vitamin B12 from supplements or fortified foods.
· Protein: Incorporate a protein-rich food, like dairy, eggs, beans, nuts, seeds, or soy foods, into every meal.
· DHA: If you avoid fish, getting enough of this omega-3 can be a challenge. Look for algal-oil-fortified foods or choose eggs that have been laid by hens that eat special feed high in DHA. You can also look for an algae-based supplement (see the earlier section “Omega-3 fatty acids” for details).
· Calcium: If you eat your three servings of dairy per day, you’ll likely meet your calcium needs. If you don’t, look for fortified foods or supplements.
· Zinc: You find zinc in wheat germ, beans, nuts, seeds, milk, and fortified foods.
· Vitamin D: You find a small amount in fortified milk, seafood, and some mushrooms, but you probably still need to consider taking a vitamin D supplement to make sure you’re getting enough of this important nutrient.
For more detailed information on good pregnancy nutrition for vegetarians, check out the latest edition of Living Vegetarian For Dummies by Suzanne Havala Hobbs (Wiley).
Sticking to Good Nutrition When Faced with Unique Circumstances
Every woman brings with her a unique set of genetics and lifestyle habits that guides how her pregnancy will progress. Various nutrition-related medical complications may creep up on you. For example, if you find out you have gestational diabetes, your best bet is to seek the counsel of a registered dietitian to guide you in exactly how many and what kind of carbohydrates to eat. If you’re faced with preeclampsia or high blood pressure, you’ll have to watch your sodium intake very carefully. If you develop anemia, you’ll need to focus on getting plenty of iron-rich foods and making sure your body absorbs as much of it as possible.
Gestational diabetes
Gestational diabetes, a type of diabetes that can develop in the second half of pregnancy, affects how your body uses glucose (blood sugar). Scientists aren’t sure why some pregnant women develop gestational diabetes and others don’t, because pregnancy itself affects certain hormones that impact how insulin clears glucose out of the blood and gets it into cells. As your pregnancy progresses and your baby grows, the placenta produces hormones that block insulin, which may cause higher-than-normal glucose levels in the blood. Some women develop gestational diabetes in response to insulin’s not working as efficiently during pregnancy.
The universal treatment for gestational diabetes — whether you have a mild case or a severe one that requires daily insulin injections — is a diet that moderates your carbohydrate intake. As explained earlier in this chapter, carbohydrates are found mostly in grains, fruits, vegetables, and sweet foods. Although you shouldn’t start following a diet that’s very low in carbohydrates, you do need to use caution with portion sizes of carb-containing foods. Also try to avoid sugary foods, specifically liquid sources of sugar like regular soft drinks and even fruit juices, and limit portions of desserts, candy, and processed starches, like white bread, white rice, and many low-fiber cereals and crackers.
Fill up on foods that are high in fiber and protein to prevent spikes in your blood sugar.
Regular exercise is another part of the standard gestational diabetes treatment plan. Exercise can increase your body’s sensitivity to insulin, meaning that your body doesn’t need to produce as much of it to clear out the excess glucose. Check with your doctor for any limitations you may need to incorporate into your exercise routine.
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is a common hormonal disorder that results in irregular menstruation, cysts on the ovaries, and overproduction of androgens (male hormones). PCOS is a leading cause of infertility, in part because many women with PCOS are overweight or obese. If you have PCOS and you’re reading this, then congratulations on overcoming this pregnancy hurdle!
The big pregnancy complication for many women with PCOS is that PCOS can lead to insulin resistance, which results in high blood sugar and diabetes. If you have PCOS, alert your doctor as soon in your pregnancy as possible so you can be screened earlier for gestational diabetes (see the preceding section for details on this condition). Follow your doctor’s instructions on medications and lifestyle modifications, such as a carb-controlled diet and increased exercise, that are necessary to keep your blood sugar under control.
Depending on your pre-pregnancy weight, you may also be advised to adjust the desired amount of weight gain during your pregnancy (to find out the average weight gain numbers, refer to Book 3, Chapter 1). Also consider visiting a registered dietitian (RD) who specializes in pregnancy and PCOS to create an individualized nutrition plan for you.
High blood pressure and preeclampsia
Even if you didn’t have high blood pressure (also called hypertension) before you were pregnant, you may develop it while you’re pregnant, particularly in the second or third trimester. This is especially true if you have a family history of high blood pressure or you’re overweight prior to getting pregnant. Your doctor measures your blood pressure at every prenatal visit. Because you likely won’t feel any symptoms if you have high blood pressure, it’s extremely important that you attend all your prenatal appointments.
Whether you have high blood pressure or preeclampsia, the primary nutrition recommendation is the same: Limit your intake of sodium to less than 2,300 mg per day. (Your doctor may want you to lower your intake to 1,500 mg if your case is more severe, so be sure to check with him or her to find out how much you need to modify your diet.) Chances are most of your daily sodium comes from processed and prepared foods, including soups, sauces (such as soy, BBQ, and tomato), condiments (think pickles and olives), cheese, processed meats (such as ham, pepperoni, and sausage), and restaurant food. Try to avoid these major sodium sources and read labels to see how much sodium is in the foods you’re consuming.
Here are some additional diet-related ways to keep high blood pressure at bay:
· Take in more potassium. Potassium helps you maintain proper fluid balance in your body and has been shown to help with blood pressure control. Every fruit and vegetable has at least a little bit of potassium, but bananas, potatoes, and legumes (beans) have the most. Aim to consume at least five servings of fruits and vegetables every day to get your daily 4,700 mg.
· Embrace dairy products. Calcium has been shown to help keep blood pressure in check, so drink your milk and eat your yogurt (these foods are also good sources of potassium) or take a calcium supplement to get your 1,000 mg per day.
· Avoid caffeine. Caffeine can raise blood pressure, so avoid it if you have blood pressure issues.
· Consider taking an omega-3 supplement. Omega-3 fatty acids (DHA and EPA) have been found to help reduce blood pressure, so eat fatty fish such as salmon or take a fish-oil-based omega-3 supplement. Find out more about omega-3s in the earlier section “Omega-3 fatty acids.”
Along with adjusting your diet, you can make two other important lifestyle changes to help control your blood pressure: exercise and stress management. Check with your doctor to find out if you need to incorporate any limitations into your exercise routine and then head over to Book 4 for tips on adding exercise to your day. Controlling stress isn’t easy, especially when you’re preparing to bring a new life into the world, but getting plenty of rest and relaxation can help you keep it under control.
Anemia
Anemia, or abnormally low levels of red blood cells, is fairly common in pregnancy because of the increased blood volume and the high demand for iron (the mineral that helps make red blood cells, which carry oxygen from the lungs to all parts of the body). To account for the increase in blood volume, pregnant women need to consume about 27 mg of iron per day.
The best way to treat anemia is to consume more iron-containing foods; refer to the earlier section “Iron” for information on this key nutrient and foods that contain a lot of it. Another way to get your daily dose of iron is to take a supplement. Your prenatal vitamin has some iron, but your doctor may recommend that you take even more iron in supplement form if your blood levels are too low. Note: Iron in supplements has been known to constipate some people, so eat high-fiber foods and drink plenty of water to prevent that unpleasant side effect.
Food allergies
If you’re allergic to milk or wheat and worried about whether your allergy is causing you to miss out on important nutrients, never fear. To ensure you’re eating a diet that’s filled with all the nutrients you and your baby need, just make the simple food substitutions recommended in this list of the eight most common food allergies:
· Milk: Milk is rich in calcium and vitamin D, among other nutrients. Choose fortified soymilk in place of regular milk, and look for dairy-free cheeses to get your calcium. If soymilk isn’t your thing, take a calcium supplement (500 to 1,000 mg). Also take a vitamin D supplement because it’s difficult to get through food.
· Eggs: Eggs are high in choline, so if you can’t have eggs, incorporate beef, poultry, wheat germ, cauliflower, broccoli, and soy lecithin into your diet to make sure you’re still getting enough choline (refer to the earlier section “Choline” for information on this important nutrient).
· Peanuts: Peanuts have monounsaturated fat, protein, fiber, folate, and other B vitamins. To get these same nutrients, you can eat tree nuts (if you’re not allergic to them), beans (garbanzo beans, navy beans, kidney beans, black beans, and so on), or lentils.
· Tree nuts: These nuts include walnuts, almonds, cashews, and pecans. They’re full of protein, fiber, unsaturated fats, vitamin E, folate, and B vitamins. To get these nutrients if you’re allergic to tree nuts, simply include some vegetable oils, avocados, and whole grains in your diet.
· Fish: Fish, such as salmon, tuna, and cod, is an excellent source of protein and the best place to get the omega-3 fatty acids DHA and EPA. If you’re allergic to all fish, turn to other meats and meat alternatives for protein. To get your omega-3 fatty acids, your best bet is to take a fish-free DHA/EPA omega-3 supplement, like Ascenta NutraVege or Spectrum’s Vegetarian DHA supplement.
· Shellfish: Shellfish, such as shrimp, lobster, and crab, is a lean protein that offers various vitamins and minerals, including selenium, vitamins D and B12, and zinc. You can get protein and many of these nutrients from other lean meats (lean beef, white-meat skinless poultry, or lean pork) or meat alternatives (soy foods and legumes), and you can take a vitamin D supplement and get selenium from chicken, eggs, nuts, and seeds. You can get your omega-3 fatty acids (DHA and EPA) from a shellfish-free supplement (check the label to make sure it’s shellfish-free).
· Soy: Soy is a good source of protein and nutrients such as folate and other B vitamins, potassium, and iron. If you can’t have soy, eat meat, eggs, or dairy to make sure you still get these nutrients.
· Wheat: Wheat foods contain complex carbohydrates, folate, iron, B vitamins, and more. Look for wheat-free foods that provide similar nutrients, like rice, potatoes, and quinoa.