Nutrition in Pregnancy – Eating Healthy for Two
The correlation between nutrition and health has been well established. In pregnancy, this correlation remains the same, but the impact is even greater as your nutritional choices have a double impact- you and your baby. Healthy moms have a reduced risk of pregnancy complications. And babies born to healthy moms have reduced risk of disease in adulthood.
Maintaining a healthy nutritional state during pregnancy can be challenging. Challenges of morning sickness and food cravings can wreak havoc on a previously healthy balance. Still, eating healthy in pregnancy should and can be a very realistic goal. Not only for the long-term health benefits but also the immediate benefit of increased energy and gratification in the knowledge that you are creating positive health habits for you and your baby. Becoming familiar with the benefits and potential harm of commonly encountered foods will empower you to make well-informed decisions to ensure a great start for your little one.
Maintaining a nutritionally sound pregnancy involves maintaining proper body weight. Changes in body weight and appearance can be a very stressful part of pregnancy. It is best to continue your healthy eating habits. You will create lifelong habits that continue long after delivery. Becoming knowledgeable on proper food choices will help keep you and your baby healthy and decrease your risk of inadequate weight gain (too little or too much) in pregnancy. If you are planning to become pregnant, healthy weight and eating habits before becoming pregnant is paramount.
Caloric Requirements
Your caloric requirement varies depending on your physical activity level and weight goals. On average, if you are at a healthy weight and not pregnant you will need anywhere from 1200- 2000kcal/day. Pregnancy will have an added caloric requirement to accommodate the recommended weight gain. Pregnant women will need an additional 500 calories per day on average.
Underweight
While the problem of being overweight is much more common than being underweight, not having adequate weight in pregnancy can be problematic. Underweight women tend to have smaller babies. Smaller babies are more likely to have difficulty breastfeeding, experience more illnesses and developmental delays. Studies find that about one third (32%) of pregnant women gain the recommended weight during pregnancy. Close to half gain (48%) more than recommended and one fifth (21%) gain less than the recommended weight gain.
Obesity
In pregnancy, excessive caloric intake will increase your risk of obesity which has a ripple effect. Obese pregnancies have an increased risk of developing diabetes, hypertension, and labor abnormalities which in turn increase your risk of cesarean delivery. Obese patients who undergo surgery, including C-sections, have an increased risk of surgical complications. It is imperative to maintain a healthy weight in pregnancy.
Risks Associated with Obesity in Pregnancy
- Diabetes
- Hypertension
- Labor Abnormalities
- Cesarean Delivery
- Surgical Complications
Increased Surgical Risks Associated with Obesity
- Wound infection
- Poor wound healing
- Developing blood clots in blood vessels
- Injury to other organs
Recommendations for Weight Gain in Pregnancy
| WHO* Recommended Total Weight Gain in Pregnancy | WHO Recommended Rate of Weight Gain in Pregnancy (lbs per week) | ||
| Pre-pregnancy BMI* | BMI (kg/m2) (WHO) | Total Weight Gain Range (lbs*) | Rates of Weight Gain 2nd and 3rd Trimester (Mean range in lbs/wk) |
| Underweight | <18.5 | 28-40 | 1(1-1.3) |
| Normal Weight | 18.5-24.9 | 25-35 | 1(0.8-1) |
| Overweight | 25.0-29.9 | 15-25 | 0.6 (0.5-0.7 |
| Obese | > 30.0 | 11-20 | 0.5 (0.4-0.6) |
| Twin Pregnancies | BMI (kg/m2) (WHO) | Total Weight Gain Range (lbs) | |
| Underweight | <18.5 | 50-62 lbs | |
| Normal Weight | 18.5-24.9 | 37-54 lbs | |
| Overweight | 25.0-29.9 | 31-50 lbs | |
| Obese | > 30.0 | 25-42 lbs |
It is important to note that you are not expected to gain any weight during your first trimester. It is not unusual to lose weight during your first trimester. In achieving your weight gain goals, since 3500 calories are the equivalent of 1 pound, to gain 1 pound per week, you would need to consume roughly 500 additional calories daily. It is important to remember that these additional calories, like all your calories, should be nutritionally sound.
Recommended Daily Allowances
| Recommended Daily Intake | Common Sources | |
| Added Sugar | <10% of calories per day | Fruit drinks, baked goods, grains |
| Saturated Fats | <10% of calories per day | Meat, dairy, poultry skin |
| Sodium | <2300mg | Processed foods, deli meats, soup, pizza |
Macronutrients
Macro-nutrients are the nutrients we consume in high quantities. This is how we gain the energy needed each day. The food on your plate would be considered macronutrients as opposed to a multivitamin that contains micronutrients. Macronutrients consist of fats, carbohydrates, and proteins. Let’s break these down.
| Macronutrient | Calories per gram | Recommended Daily Intake |
| Fat | 9 | 20-35% |
| -saturated fat | <10% | |
| Protein | 4 | 10-35% |
| Carbohydrate | 4 | 45-65% |
Fats
Fats are the most caloric dense. A small quantity of fat will still be high in calories. Fats have 9 calories in each gram. Like all other food groups there are healthy and not so healthy fats. Fats should make up 20-35% of total caloric intake, however, saturated fats, in particular, should make up less than 10 percent.
Saturated Fats
Saturated fats are the least healthy fats. These are the fats found in fast foods, processed foods, cakes, crackers, and cookies. Consumption of these fats is directly linked to obesity and heart disease. Their consumption should be kept to a bare minimum and should be less than ten percent of your daily calories. Solid fats are often saturated fats. They are very difficult for our bodies to break down. Hence, the tendency for the fat to deposit on the walls of our blood vessels leading to heart disease.
Unsaturated Fats
Unsaturated fats are healthier than their saturated versions. These are fats found in foods such as olive oil, soybean, fish. Consumption of these may reduce your risk of heart disease.
Carbohydrate
Like all the other nutrients, there are good and bad carbohydrates. Carbohydrates that are processed and refined are less healthy. In processed carbohydrates, the processing removes the nutrients and then the manufacturer adds back some of them. Foods are best consumed as close to the way you would find them in mother nature. Whole foods are always healthier than processed foods. Carbohydrates are the most abundant food groups. It consists of fruits, veggies, and starches. It is recommended that carbohydrates make up 45 to 65% of our caloric intake. Whole grains, fruits, and vegetables are the healthiest forms of carbohydrates.
Protein
Lean protein is best. Lean proteins include fish, poultry, peas, soy, nuts, and seeds. High protein drinks are not recommended in pregnancy and may cause harm. Proteins should account for 10-35% of our caloric intake.
- Micro- Nutrients
- Micronutrients is the term used to describe vitamins and nutritional supplements.
Folic acid
Folic acid is one of the most beneficial micronutrients in pregnancy. Folic acid reduces the risks neural tube defects and spina bifida. For maximum benefit it is recommended that all women who can become pregnant consume 400 mcg of folic acid daily. Ideally, it is best to take folic acid supplements for at least 3 months before conceiving. It is important to continue taking folic acid at least through the first trimester. While it is possible to eat folic acid in our foods, it is difficult to get the recommended daily allowance consistently through our diet and so a supplement is recommended.
Iron supplements
Iron requirements during pregnancy are high. Because this mineral is actively transported across the placenta to your baby, your body will need to constantly replace its iron stores. It is not feasible that you will be able to consume iron in the quantities needed in food. Supplementation is needed. 30-60 mg of elemental iron daily is recommended in pregnancy. If you are unable to tolerate iron in early pregnancy. Then start in the second or early third trimester. Iron absorption is hindered by calcium. Avoid taking iron with dairy products or calcium supplements. Your body will improve its absorption of iron if you take it along with citric acid or vitamin C. It is best to take your iron supplements with either a vitamin c tablet or a citrus drink, such as orange or grapefruit juice.
Calcium and Vitamin D
Your doctor will check your calcium and vitamin D levels to determine if supplementation is necessary. Deficiencies in these nutrients are not uncommon and usually have no symptoms unless the deficiency is severe. If deficient, supplementation is the fastest way to correct your levels, rather than relying on food consumption. Calcium and vitamin D play an important role in both your health as well as your baby’s development. Calcium helps protect and strengthen the skeletal system in both mom and babies. Calcium supplementation may reduce the risk of pre-eclampsia, a very serious potential complication of pregnancy. Vitamin D helps maintain normal neurological function in both mom and baby, helps skeletal development, and assists in maintaining a healthy immune system. Low vitamin D levels can contribute to low birth weight babies, fetal hypocalcemia, and increased risk of childhood allergies. The dose recommendation is individualized and based on your levels.
Multi-Vitamins
In a healthy diet, supplementation with vitamins, other than those noted above, is usually not necessary. However, since most moms to do not always have a consistent intake of healthy nutrients, most doctors will recommend multivitamins in pregnancy.
Examples of Macro vs Micro-Nutrients
| Macronutrients | Micronutrients |
| Fat (9 cal/gram) | Folic Acid |
| Carbohydrate (4 cal/gram) | Iron |
| Protein (4 cal/gram) | Calcium |
| Multivitamins |
Special Diets:
Vegetarian
A vegetarian diet can be very healthy in pregnancy. Be sure to minimize your intake of high-fat dairy products. Continue to ensure variety in your diet with a healthy mix of fruits, vegetables, and nuts. Ensure you keep up your protein requirements with the consumption of beans, seeds, and nuts.
Vegan
Vegan diets devoid of all animal fat have very little vitamin B12. Be sure that your vitamin supplement has 100% of the daily recommended allowance of vitamin B12. It is important to maintain food variations. Eat fruits, veggies along the color spectrum. Consume whole grains, beans, seeds, and nuts.
Alcohol
Alcohol is never recommended in pregnancy. If, however you have consumed alcohol in early pregnancy before realizing you were pregnant, speak with your doctor. The concern for the development of fetal alcohol syndrome (FAS) exists. While you commonly see this diagnosis in cases where large quantities of alcohol are consumed throughout the pregnancy, there are also reports of FAS developing with little consumption of alcohol. The risk of development is greatest for exposure occurring in the first trimester when organ formation takes place. While no one test can conclusively diagnose or exclude a dx of FAS, some findings may be seen on ultrasound that will suggest if there is an increased likelihood. It is recommended that pregnant women and women planning to become pregnant abstain from alcohol.
Caffeine
It is unclear if caffeine consumption in pregnancy can cause harm. Some studies suggest an association with caffeine consumption and miscarriages, others have not. Studies regarding caffeine and preterm birth have been more consistent- no association. Based on these conflicting studies, it is recommended that pregnant women consume no more than 200mg of caffeine daily.
Caffeine Content of Food and Beverages
| Food/beverage | mg of Caffeine on average |
| Coffee (8oz) | |
| -brewed, drip | 137 |
| -instant | 76 |
| Tea (8oz) | |
| -brewed | 48 |
| -instant | 26-36 |
| Caffeinated Soft Drinks (12oz) | 37 |
| Hot Cocoa (12oz) | 8-12 |
| Chocolate Milk (8oz) | 5-8 |
| Dark Chocolate (1.45 oz) | 30 |
| Milk Chocolate (1.55 oz) | 11 |
| Semi-sweet chocolate (1/4 cup) | 26-28 |
| Chocolate Syrup (1tbsp) | 3 |
| Ice cream or frozen yogurt (1/2 cup) | 2 |
US Dept of Agriculture, Agricultural Research Service, 2000
Meats
In general, raw or undercooked animal-based products should be avoided in pregnancy. The heating process through cooking is relied upon to kill the bacteria or parasite that may be present in these food products. While these products may be Ok to eat when you are not pregnant, in pregnancy, your immune system does not work as well, which makes you more vulnerable to becoming sick when exposed to these organisms. Also, some of these microbes may cross the placenta and harm the baby which does not yet have a functioning immune system. All animal products should be cooked thoroughly and heated to appropriate internal temperatures to ensure no raw or undercooked food is consumed.
Deli Meats
Cold cuts and deli meats may contain the Listeria bacteria that has been linked to miscarriage and preterm birth. It is important to cook any deli meat, hot dog, etc. to reduce the risk of contracting listeriosis.
Fish
Large fish that are high in mercury should be avoided. Examples of fishes high in mercury are swordfish, kingfish, tuna, king marlin.
Hummus
May be consumed in cooked items such as a casserole. It may be safe if prepared at home where there is less risk of cross-contamination.
Cheeses
Soft cheeses made from unpasteurized milk should not be consumed. Some examples of these cheeses include brie, camembert, feta. These food products may contain Listeria or E. Coli bacteria.
Raw Egg
Raw eggs may be found in hollandaise sauce, ice cream, home-made eggnog, caesar dressing. There is a risk of salmonella infection with any undercooked chicken products. This can cause very serious infection even when not pregnant, so this should be avoided in pregnancy.
Fruits/Veggies
Thoroughly wash ALL fruits and vegetables for at least 30 seconds before eating.
