What can (and can’t) you eat during pregnancy?

We spoke with two local nutritionists about what expecting mothers should know when it comes to pregnancy eating habits.

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This story is part of our continuing coverage on family health.

Creating a balanced diet that allows you to enjoy food but also gets you an adequate amount of nutrients is challenging enough, but how does it change when you add a growing baby to the mix?

With the rise of internet-based information on every type of food and diet, it can be difficult to navigate exactly what you should and shouldn’t be eating when you’re expecting, and it’s best to turn to a professional if you believe you need guidance.

That’s why we spoke with Jennifer Haas, MS, RD, CPT, registered dietitian and owner of The Healthy Haas, as well as registered dietitian and certified health coach Joanna Pustilnik, MS, RD, CDE, CRPT, of Mind Body Health. They shared their thoughts on everything from sushi and caffeine to “eating for two,” habits. Highlights from our conversations are below.

What do expectant mothers (or future expectant mothers) need to know about how their current diets might change while pregnant?
The biggest dietary change would be the avoidance of sushi and raw seafood, and undercooked meats in general, as well as deli meat items. [Future or expectant mothers] should also take care to avoid certain kinds of fish because they contain high levels of mercury, which can potentially harm a growing baby. These include tuna, swordfish, king mackerel and tilefish. I also advise to cut out artificial sweeteners and additives found in many packaged food products. Also, it is necessary to cut out all alcohol. It is important to eat well-balanced meals at regular times and be able to pronounce the ingredients in your foods to ensure a whole food (not chemical-based) meal plan.

JP: A great way to increase the likelihood of a healthy pregnancy is to start with a couple small, easy changes before conception. Starting prenatal vitamins three months before trying to get pregnant helps ensure maternal micronutrient stores are optimized for both mom and baby. If mom is a latte lover, a reduction in excessive caffeine intake will need to happen right away, because very high levels of paraxanthine, a caffeine metabolite, have been linked with early miscarriage. Moderate amounts of caffeine (300 mg a day or less, or approximately two cups) seem to be tolerated well. If mom is on a diet, this is a good time to stop. Restricting calories or food groups and weight loss behaviors during pregnancy can increase risks to both baby and mom. If mom has a history of disordered eating, is following a dietary pattern that restricts food groups such as veganism, or has a medical condition with a nutritional impact, it would be helpful to consult with a dietitian.

Should expectant mothers be more concerned with the amount of food they’re getting per day, or the amount of nutrients?
JH: Pregnancy isn’t as much as an “eating for two” mentality as it is eating a balance of carbs, proteins and healthy fats in small amounts every three to four hours to avoid blood sugar spikes and dips. It is imperative to avoid skipping meals or grabbing something from the vending machine. Instead, focus on eating fresh, whole foods. In terms of nutrients, the key micronutrients a pregnant woman should ensure that she is getting are calcium, iron, folate and vitamin D, as well as the macronutrient protein. Expectant mothers should be eating an extra 300 calories of quality foods (for a single birth) in order to gain an appropriate amount of weight to sustain healthy fetal development. And by eating every three hours, mom-to-be can avoid the feeling of being overly hungry. And specific calorie amounts can also vary depending on the mother’s pre-pregnancy weight, activity level and whether she is carrying one baby or more.

JP: A full-term pregnancy requires at least 80,000 calories. Moms-to-be need to eat a lot! In the first trimester, calorie needs are relatively similar to prenatal needs (2,200 to 2,500 calories per day), and in the second trimester they bump up a bit by 340 calories daily. The third trimester requires an additional 450 to 500 calories above prenatal needs. Adequacy of caloric intake is extremely important as restriction can lead to prematurity, low infant birth weight, developmental delay, loss of maternal muscle mass and bone density, as well as miscarriage. Attention to macronutrient intake is also important (proteins, carbohydrates, fats). Micronutrient needs, such as vitamins and minerals, are higher in pregnancy. Vitamins and minerals of specific concern for mom include folic acid, calcium, vitamin D, vitamin C, magnesium, zinc, vitamin A and iron. 

What foods should women have when they’re feeling nauseous or bloated (and are there specific ones that help)?
JH: Fiber and fluids, along with mobility, can help the normal bowel movements and moving foods through the digestive tract in a manner to avoid bloating and constipation symptoms. It can also be helpful to avoid carbonated beverages and gum, which introduce air into the gut and enhance the feeling of fullness/bloating. Avoid fatty, fried foods and caffeine, as it will help minimize nausea and staying well-hydrated with clear liquids. Eating five to six small meals daily and taking a prenatal multivitamin (which has vitamin B6 and magnesium) will help quell nausea symptoms.

JP: For nausea, extra B-complex vitamins and supplemental vitamin C may be helpful. Limiting sources of high-fat foods, such as fried foods, may also assist in decreasing symptoms. Small, frequent meals can be beneficial as hormones associated with pregnancy increase nausea even more on an empty stomach. Lying down after eating may also exacerbate symptoms. Dry foods such as crackers or bread, or high protein snacks, such as cheese or lean meats, may help some moms feel better. Overall, it is a good idea to eat whatever you can tolerate as elevated progesterone and estrogen during pregnancy can cause intense food aversions which may make nausea worse if mom forces herself to eat unappealing foods. Bloating may be caused by constipation or fluid retention. Aim for at least 2 to 3 quarts of water and fiber intake greater than 28 grams per day if constipation is a concern. Fluid retention can improve with increased physical activity or a decrease in any excessive sodium intake. Other gastrointestinal concerns may be due to food imbalances or intolerances, elevated hormone levels or a compressed digestive system due to a growing uterus, and concerns should be addressed on an individualized basis, based on unique nutritional concerns. Overall, a diet rich in whole, plant-based foods can promote good digestion and decrease bloating. 

And what about pregnancy cravings? What do you do when you truly crave something?
JH: Cravings are real—pregnant or not. Usually there is a micronutrient (think vitamins and minerals) or macronutrient (think protein, fat or carbohydrate) you are deficient in, which is causing the craving. Pregnancy cravings can be unusual but as long as the should-be-avoided foods are not eaten as part of your indulgence, it is important to listen to your body and try to give it what it tells you it needs. A good example is if you’re craving sweets, you may not be getting enough healthy carbohydrates from fruits and whole grains, so try having these foods before going straight for an ice cream sundae. If you have a piece of fruit (always have a protein source with it such as cottage cheese, peanut butter, almonds, etc. to avoid a blood-sugar spike) and are still craving the ice cream one hour after you’ve eaten the fruit and snack, get yourself a small portion of ice cream and enjoy every bite. It also helps to have your kitchen stocked with healthy options and not junk food. If all you have are chips and candy, that’s all you will eat. If you have baby carrots and hummus, you have a healthy snack waiting for when hunger strikes.

JP: “Pregnancy cravings” are very real. We can thank changing levels of hormones, increased sense of smell and exaggerated emotions and fatigue for the unique power and desire of mom’s cravings. Also, increased calorie, macro and micronutrient needs that aren’t being met can manifest themselves as cravings for high-calorie foods. Our bodies tell us to reach for hyper-palatable and high-calorie foods when we are in a state of deprivation. To help control cravings, the first thing mom can do is look at current intake to ensure she is eating enough, often enough and in a balanced way. Cravings may also be telling her that she is over-tired, stressed, frazzled or otherwise in need of something that food can’t provide. When we are fatigued or stressed, for example, we are more likely to reach for a high-sugar food for a surge of quick energy and dopamine. Making sure mom’s basic needs are being met goes a long way to controlling cravings. But also, mom should remember pregnancy is also a time to nurture herself, her growing body and her baby. Allowing ourselves to eat what it is we desire is part of self-compassion and self-care.

Are there any myths you would like to address about dietary limitations, needs, etc. during pregnancy?
JP: I’ve noticed some recent information circulating regarding moms-to-be and sushi, alcohol and dieting. For example, a client informed me that her midwife advised her to “eat a high protein, low carbohydrate diet for collagen production to reduce the risk of tearing during labor.” There is no evidence for this, and it would be imbalanced and unnecessarily restrictive. Sushi containing raw fish always carries risk of infection. Mom needs to weigh the risk-reward benefit of consuming during gestation, because any maternal infection impacts fetal growth. And the biggest myth I’ve heard floating around is that alcohol is now OK in moderation. Clients have noted that even some physicians are now saying a glass of wine a week is OK when pregnant. The research for this assertion just isn’t there. We just don’t know of any safe level that won’t cause some amount of harm to a growing fetus.

Is there anything else expectant mothers should know about eating while pregnant?
Being healthy encompasses diet, exercise, sleep and stress reduction. It is important to maintain a regular routine of buying nutritious, whole foods and prepping meals for the week, as well as having a plan for eating out and special occasions. You are not trying to lose weight while you’re pregnant, but you should be choosing a balance of complex carbohydrates, lean proteins and heart-healthy fats at each mealtime. Staying hydrated with water and caffeine-free teas, as well as finding activities you enjoy to keeping you moving on a daily basis and ensuring you get a good night’s rest are all vital in a healthy pregnancy. These tips will carry you into postpartum habits that you can pass on to your new family member(s)!

JP: Pregnancy is a beautiful growth period in a woman’s life. It isn’t a time to scrutinize changes in our body or needlessly restrict intake. It is unquestionably beneficial, however, to monitor weight and avoid excessive gain ( greater than 40 pounds). By exercising most days of the week in a not-too-strenuous and enjoyable activity, providing enough variety of fresh, diverse foods, allowing adequate rest and practicing stress reduction, mom will have a vibrant and enjoyable experience and a healthy and robust baby.

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