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Food for Thought Food for Thought

Eating For Two

January 16, 2013

By Julie Redfern, R.D. L.D.N.
Brigham and Women's Hospital

Congratulations! Your doctor has just confirmed that you are pregnant! You're happy, nervous, excited and feeling responsible for your baby's future. Instead of being worried about eating perfectly, read on for a helpful overview of the most important nutrients you need in pregnancy.

Newer fields of research are focusing on the importance of the fetal experience in preventing chronic disease. Through the studies of such researchers as David Barker, M.D. from Southhampton University in England, it's becoming more apparent that the fetus' environment can have long-term effects on the quality of its adult life, in terms of preventing adult health problems. What you eat, your hormones, and any environmental stresses during pregnancy can influence the quality of your baby's adult life. If these thoughts actually add to your stress, relax! Being informed is more helpful than being anxious.

Eating when pregnant should be a positive experience. As always, you should aim to eat an optimum diet. The good news is that you have some choices about how to eat healthfully for your baby.

Here are some important things to consider.

How Much Weight Should I Gain?

There is a healthy range of total weight gain during pregnancy based on your height and pre-pregnancy weight.

Pre-pregnancy weight
Suggested weight gain
Normal weight 25 to 35 pounds
Underweight 28 to 40 pounds
Overweight (>20% ideal body weight) 15 to 25 pounds

Your rate of weight gain also can influence the long-term health of your baby. An adequate rate is four to six pounds during the first trimester, and about one pound each week during the second and third trimesters. To achieve this weight gain, eat an additional 300 calories a day. You can easily obtain these extra calories by adding a couple of healthy snacks during the day. For example, 4 ounces of yogurt, one slice of whole-grain bread and one tablespoon of peanut or almond butter would be about 300 calories altogether.

While calorie needs increase about 20% in pregnancy, some nutrient needs can increase by 50% to 100%. You need a relatively small increase in quantity of food, but a large increase in quality. We recommend you eat more “nutrient-dense” foods, those packing more nutrients in each calorie. Foods with excessive calories and very little nutrition, such as tonic, sweets, etc., should be limited.

Target foods containing nutrients needed for an optimal pregnancy, such as protein, calcium, folic acid, iron and Vitamin C.

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Consider the Power of Protein

Proteins are the building blocks of your baby’s cells. Complete proteins (sources with all amino acids) are recommended. These include meat, poultry, fish, eggs, milk, cheese, yogurt, and soy. Protein is needed for the baby’s growth, as well as for the developing placenta. Protein needs increase by 10 to 15 grams a day. As a reference point, there are 8 grams of protein in 1 ounce of meat or cheese, 2 tablespoons of peanut butter, 8 ounces milk or yogurt, 1/3 cup of most nuts, and ½ cup of beans. Just the addition of two or three high-quality snacks each day, can give you your needed protein.

A word about fish and pregnancy: Fish is an excellent source of not only protein but also omega-3 fatty acids. These are essential fatty acids that cannot be made in our body and must be obtained from our diet. Omega-3s are needed for optimal fetal brain, retinal, and motor development, especially in the third trimester. However, there are some cautions about eating fish in pregnancy. Fish can contain unsafe levels of the natural but toxic element mercury. Mercury is higher in waterways near industrialized cities. High amounts of mercury can cause neurological problems in fetuses and breast-feeding babies. Current recommendations by the Massachusetts Department of Public Health and the U.S. Food and Drug Administration are to limit your intake to 12 ounces per week of safe fish. Safe fish include flounder, shrimp, cod, haddock, mullet, scallops, whitefish, pollack, tilapia, salmon, sole, mussels, and canned light or chunk light tuna. Avoid swordfish, shark, king mackerel, tilefish, fresh tuna steaks, bluefish, lobster and saltwater bass. In addition avoid any freshwater fish caught in Massachusetts' streams, rivers and lakes.

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Figure in Folic Acid

Folic acid is a B vitamin that's essential for a growing baby. Needs increase in pregnancy, and deficiencies have been associated with problems of the central nervous system such as neural tube defects, especially spina bifida. Since these problems can occur in the first few weeks of pregnancy, it's now advised to increase folic acid when planning a pregnancy.

Food sources of this B vitamin include enriched cereals, black and navy beans, black-eyed peas and lentils, asparagus, avocado, orange juice and sunflower seeds. Since your body doesn't store this critical vitamin, it's advised to take a folic-acid supplement of 600 micrograms per day. Many prenatal vitamins include 800 microgram to 1 milligram per day. This is a safe amount of folic acid that you can add to your food sources. Women who have previously had a child with neural tube defects may be on therapeutic doses of folic acid. Try to increase this vitamin by adding beans to salads, soup or pasta dishes. Drink fruit smoothies made with orange juice.

A recent study suggests that women of reproductive age shouldn't wait until they are thinking about pregnancy to take folic acid. Women who took a daily folic acid supplement for one year prior to conception reduced their risk of delivering a premature baby by 50% to 70%. Because pregnancy is often not planned, ideally you should start taking folic acid when you become sexually active. Standard multiple vitamins contain the 400 micrograms you need.

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Count on Calcium

Calcium is needed in pregnancy to support the baby’s skeletal and teeth development. If not enough is available, your growing baby pulls calcium from your bones. Teeth and bones begin to develop from the second month and double their growth by the sixth month, with large increases by the third trimester. You don’t have to be a dairy lover to achieve the recommended needs of 1,200 milligrams per day. Here are your best bets:

Food sources Serving Size Calcium in mg.
Yogurt 1 cup 350 to 400 mg
Milk 1 cup 300 mg
Cheese 1 ounce 200 mg
Cottage cheese 1 cup 150 mg
Firm tofu 1 cup 200 mg
Almonds 1/4 cup 75 mg
Broccoli 1/2 cup 50 mg

If you have trouble tolerating dairy products due to lactose intolerance or allergies, or you just don’t like them, you have a wide choice today from many “designer” milks available. Milk can be lactose free, full fat, low fat, soy, etc. For the most part, the amount of calcium and protein in these products is excellent. However, soy-based milks and yogurts need to be enriched with extra calcium.

Other notable nutrients for pregnancy are iron, vitamin C, vitamin A and zinc. By including many of the foods already mentioned, you will be on your way to increasing these nutrients in your diet as well.

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Take Baby Steps

Remember, this should be a positive experience, a time for change with a new future ahead.

Take small steps to improve your present diet and incorporate the added nutrients needed for your future family member. Try not to be worried or stressed about eating well, especially when nausea and fatigue take over. For more information about nutrition and pregnancy consider the following books:

  • Expect the Best: Your Guide to Healthy Eating Before, During, and After Pregnancy by the American Dietetic Association, John Wiley & Sons, 2009
  • The Harvard Medical School Guide to Healthy Eating During Pregnancy by by W. Allan Walker, McGraw-Hill, 2006.
  • Managing Morning Sickness, by Miriam Erick, M.S., R.D., R.D. Bull Publishing Co., Boulder, Colo., 2004.

If you have special nutritional needs, for example if you are carrying multiples or following a vegetarian diet, you may want to seek advice from a registered dietitian who specializes in obstetrical nutrition.

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Julie Redfern, R.D., L.D.N., is a registered dietitian in the nutrition consultation service at the Brigham and Women's Hospital. She specializes in nutrition counseling for the Obstetrics and Gynecology Department. She is a graduate of the University of Vermont, and completed her internship at the University of Cincinnati Medical Center.

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