Nutrition during pregnancy

I've been into learning about nutrition lately.  It's something we learn very little about during medical school, only skimming the surface.  We all know "healthy foods" vs. "junk foods" but how do we optimize our health with diet?  If you think about it, food is a type of medicine, and very definitely affects how our bodies function.  I plan to write a series about nutrition, and thought it best to start with nutrition during pregnancy.  I get asked on at least a weekly basis "Can I eat _______?" 

To start off, it's important to talk about weight gain during pregnancy.  It's good to know whether you're at a healthy weight at the beginning of your pregnancy, and your doctor/provider can then advise on a recommended amount to gain.  For women of normal weight (i.e. body mass index (BMI) 18.5-24.9), a 25-35 pound total weight gain is recommended.    If you're underweight (BMI less than 18.5), plan on 28-40 pounds.  If you are overweight (BMI 25-29.9), shoot for 15-25 pounds, and if you're obese (BMI greater than 30), minimal weight gain to a maximum of 20 pounds.   Most of your weight gain should come in the second half of pregnancy.

If you're pregnant with twins and are of normal weight, 37-54 pounds of weight gain is recommended.  This decreases to 31-50 pounds for overweight women, and 25-42 pounds for obese women.

Of course, it is impossible to control exactly how much weight you gain during pregnancy, but being aware of these guidelines and paying attention to how much weight you've gained to try to stay within these ranges can decrease your risk of complications such as gestational diabetes, preeclampsia, and gestational hypertension.  Gaining too much weight also increases your risk for c-section, and having a large infant.

 

In general, pregnant women should follow the same food guidelines as before pregnancy.  You should take in more calories, but only about 300 more than usual. 
Click the link to learn more about Healthy Food Choices During Pregnancy and calculate your BMI.

The most important nutrients you need to pay attention to during pregnancy are:

Folic acid - helps to prevent neural tube defects (problems with development of the baby's brain and spine), and ideally should be supplemented before pregnancy
Iron - protects against anemia as your blood volume increases during pregnancy
Calcium - helps to protect your bone health

When it comes to specific foods, there are certain food-borne illnesses that can cause birth defects or other problems during pregnancy.  One specific issue that I get asked about frequently is listeriosis.  Listeria is a type of bacteria that can be present in unpasteurized dairy products and undercooked meat, however there was a listeria outbreak in 2011 as a result of unwashed cantaloupe.  Listeria usually causes flu-like symptoms such as fever, abdominal pain, and diarrhea, but can be passed to the fetus through the placenta and has been linked to miscarriage, stillbirth, and preterm delivery.  This is a very rare infection (about 0.3 cases per 100,000 people per year), but in order to avoid these issues, make sure you only drink milk and eat cheese that has been pasteurized.  You don't need to avoid deli meats and hot dogs, but make sure they are heated until steaming hot.  Make sure you wash all produce before you cut it or eat it. 

Another concern is mercury exposure.  Mercury can be present in high levels in certain types of fish.  High levels of methylmercury in a pregnant woman can cause problems with development of a baby's nervous system, causing altered memory, attention deficity-hyperactivity disorder, or problems with language development and coordination.  It is advised to avoid eating shark, swordfish, king mackerel, and tilefish during pregnancy, as these have the highest levels of mercury.  Fish does have great nutritional value, however, so you should not cut it out entirely.  Recently, the FDA and the American College of OB/GYN released a statement encouraging pregnant women to eat 8-12 ounces of low-mercury fish each week.  Click here to read:  FDA recommendation on fish consumption during pregnancy.

 

 

Of course, fish should be cooked well, so avoid raw sushi.

 

A good source of information if you have any questions about what is safe to eat during pregnancy can be found by clicking the following link:

FDA food safety guidelines

 

In general, the most important things to remember are to eat a variety of foods, avoid excessive salt and sugar intake, cook your meat thoroughly and wash all produce well.    These simple steps will help to ensure the safest pregnancy for you and your baby.