Pregnancy and Nutrition

A balanced diet is key to a healthy pregnancy. Vitamins and minerals play important roles in all of your bodily functions. During pregnancy, you need more folic acid and iron than a woman that is not pregnant. But why are vitamins and minerals important in your diet? How can you get the extra amounts of vitamins and minerals you need during pregnancy? What is a well-balanced diet? How can you plan healthy meals during pregnancy?

Vitamins and nutrition

First of all, let’s talk more about the nutrients that are recommended during pregnancy.

Folic acid: Also known as folate, this is a B vitamin that is important for pregnant women. All women of childbearing age should take a daily multivitamin containing 0.4 milligrams of folic acid and include natural food sources of folic acid in their diets. Taking 400 micrograms of folic acid daily for at least one month before pregnancy and 600 micrograms of folic acid daily during pregnancy may help prevent major birth defects in a baby’s brain and spine, called neural tube defects. Natural sources of folic acid include orange juice, leafy green vegetables, beans, peanuts, broccoli, asparagus, peas, lentils, and enriched grain products. It may be hard to get the recommended amount of folic acid from food alone. For this reason, all pregnant women and all women that may become pregnant should take a daily vitamin supplement that contains the right amount of folic acid. The vast majority of brands of prenatal vitamins will contain at least this much folic acid, and most contain anywhere from 400 to 1,000 micrograms of folic acid. If you have already had a baby with an open neural tube defect, such as spinal bifida or anencephaly, you will need to take much higher doses of folic acid. In general, however, most women only require the 400 micrograms/day dose.

Vitamin C: This nutrient is essential in preventing infection, promoting healing, and encouraging iron absorption. Good sources include oranges, grapefruit, vitamin C-fortified juices, tomatoes, strawberries, watermelon, cantaloupe, broccoli, spinach, potatoes, cabbage, coleslaw, collard and mustard greens, and green peppers.

Vitamin D: This works with calcium to help a baby’s bones and teeth develop. It also is essential for healthy skin and eyesight. All women, including those that are pregnant, need 600 international units of vitamin D a day. Good sources are milk fortified with vitamin D and fatty fish such as salmon. Exposure to sunlight also converts a chemical in the skin to vitamin D.

Calcium: This is used to build a baby’s bones and teeth. All women, including pregnant women, aged 19 years and older should get 1,000 milligrams of calcium daily. Those aged 14 to 18 years should get 1,300 milligrams daily. Milk and other dairy products, such as cheese and yogurt, are the best sources of calcium. If you have trouble digesting milk products, you can get calcium from other sources, such as broccoli, dark and leafy greens, sardines, or calcium supplements.

Iron: This is used by your body to make a substance in red blood cells that carries oxygen to your organs and tissues. During pregnancy, you need extra iron – about double the amount that a non-pregnant woman needs. This extra iron helps your body make more blood to supply oxygen to your baby. Anemia is most often caused by a deficiency in iron. The recommended daily dose of iron during pregnancy is 27 milligrams, which is found in most prenatal vitamin supplements. You also can eat iron-rich foods, including lean red meat, poultry, fish, dried beans and peas, iron-fortified cereals, and prune juice. Iron also can be absorbed more easily if iron-rich foods are eaten with vitamin C-rich foods, such as citrus fruits and tomatoes.

Omega-3 fatty acids: These are a type of fat found naturally in many kinds of fish. They may be important factors in your baby’s brain development both before and after birth. Good sources are fish, eggs, flax seeds, walnuts, leafy green vegetables, and soybean and canola oils. To get the most benefit from omega-3 fatty acids, women should eat at least two servings of fish or shellfish (about eight to 12 ounces) per week while pregnant or breastfeeding.

Oils and fats: These do give you important nutrients. During pregnancy, the fats that you eat provide energy and help build many fetal organs and the placenta. Most of the fats and oils in your diet should come from plant sources. Limit solid fats, such as those from animal sources. Solid fats also can be found in processed foods.

Calories: Your calorie requirements depend on your pre-pregnancy weight. The last six months of pregnancy generally require the woman to consume an additional 300 calories a day. It is important to remember you are not “eating for two” and do not have unrestricted license to eat whatever you want and as much as you want. Conversely, it is never safe to diet to lose weight during pregnancy as losing weight can affect a baby’s growth. Not all calories are equal. You and your baby need healthy, nutritional foods, not the empty calories found in soft drinks, candies, desserts, and fast food.

Weight gain

Overweight and obese women are at increased risk of several pregnancy problems. These problems include gestational diabetes, high blood pressure, preeclampsia, preterm birth, and need for Cesarean delivery. Babies of overweight and obese mothers also are at greater risk of certain problems, such as birth defects, macrosomia with possible birth injury, and childhood obesity. But how much weight gain is healthy? According to the Institute of Medicine (IOM) in the United States, the recommended weight gain during pregnancy is as follows:

If you are:

Underweight – body mass index (BMI) 30                               Gain 11 to 20 pounds (5 to 9 kilograms)

Carrying twins                                                          Gain 35 to 45 pounds               (16 to 20.5 kilograms)

Well-balanced diet

To get the nutrients you and your unborn baby need, plan your meals to include these daily basics:

• Six to 11 servings of grain products
• Three to five servings of vegetables
• Two to four servings of fruits
• Four to six servings of milk and milk products
• Three to four servings of meat and protein foods
• Six to eight glasses of water, fruit juice, or milk
• Limited servings of fatty foods and sweets

Planning healthy meals during pregnancy is not hard. The United States Department of Agriculture has made it easier by creating www.choosemyplate.gov. This website helps everyone from dieters to children to pregnant women learn how to make healthy food choices at each mealtime.

Food safety

Food poisoning: In a pregnant woman, this can cause serious problems for both her and her baby. Vomiting and diarrhea can cause your body to lose too much water and can disrupt your body’s chemical balance. To prevent food poisoning, follow these general guidelines:

• Wash food. Rinse all raw produce thoroughly under running tap water before eating, cutting, or cooking.
• Keep your kitchen clean. Wash your hands, knives, countertops, and cutting boards after handling and preparing uncooked foods.
• Avoid all raw and undercooked seafood, eggs, and meat. Do not eat sushi made with raw fish. (Cooked sushi is safe.) Food such as beef, pork, or poultry should be cooked to a safe internal temperature.

Listeriosis: This is a type of food-borne illness caused by bacteria. Pregnant women are 13 times more likely to get listeriosis than the general population. Listeriosis can cause mild, flu-like symptoms such as fever, muscle aches, and diarrhea, but it also may not cause any symptoms. Listeriosis can lead to miscarriage, stillbirth, and premature delivery. Antibiotics can be given to treat the infection and to protect your unborn baby. To help prevent listeriosis, avoid eating the following foods during pregnancy:

• Unpasteurized milk and foods made with unpasteurized milk
• Hot dogs, luncheon meats, and cold cuts, unless they are heated until steaming hot just before being served
• Refrigerated pate and meat spreads
• Refrigerated smoked seafood
• Raw and undercooked seafood, eggs, and meat

Mercury and fish: Mercury can come from natural and also man-made sources. Mercury in the air settles into rivers, lakes, and oceans. Small amounts of mercury can damage a baby’s brain, which is just starting to form and grow. Too much mercury can affect a child’s behavior and lead to learning problems later in life. Some types of fish have higher levels of mercury than others. To limit your exposure to mercury, follow a few simple guidelines. Choose fish and shellfish such as shrimp, salmon, catfish, and pollock. Do not eat shark, swordfish, king mackerel, or tilefish. Limit white (albacore) tuna to six ounces a week. You also should check advisories about fish caught in local waters.

Other considerations

Caffeine: Although there have been many studies on whether caffeine increases the risk of miscarriage, the results are unclear. Most experts state that consuming fewer than 200 milligrams of caffeine (one 12-ounce cup of coffee) a day during pregnancy is safe.

Vegetarians: If you are a vegetarian, as long as you eat a variety of foods, there are only a few things that need special attention. Be sure you are getting enough of the following:

• Calcium (obtained by consuming four servings a day of milk, vegetables such as bok choy, kale, mustard greens, broccoli, and cauliflower, or calcium-fortified orange juice)
• Vitamin D (800 international units per day)
• Iron
• Vitamin B12
• Protein (A complete protein contains all essential amino acids. You will need to consult a vegetarian cookbook to ensure the proper combination of plant-based foods to make sure a complete protein is obtained.)

Contributed by Dr. Shen Jia, OB/GYN, of Shanghai United Family Hospital and Clinics