A Healthier You - Nutrition While Pregnant

Whether pregnant or not, women of childbearing age should take prenatal vitamins if becoming pregnant is possible. A prenatal vitamin containing folic acid helps an expectant mom get enough vitamins and minerals for a healthy pregnancy.   

After pregnancy, a health care provider may recommend switching to a multivitamin supplement instead.   

Here are some important nutrients for pregnancy:  

• Iron intake needs to increase during pregnancy to account for the increase in blood volume. Iron is important for fetal growth and neurological development. Good iron sources are meats, fortified cereals, dried fruits and dark green vegetables. 
  ​
• While calcium needs do not increase during pregnancy, most women do not get the calcium their body needs preconception. Eating a calcium-rich diet during pregnancy can prevent your body from drawing calcium out of the bones. This can help prevent osteoporosis later in life. Good calcium sources are dairy and dark green vegetables.  
  ​
• Folic acid intake needs increase during the first trimester of pregnancy to support the development of the baby's neurological system. Folic acid helps prevent birth defects of the brain and spinal cord when taken preconception and during early pregnancy. Good sources are fortified cereals, orange fruits, beans and dark green vegetables.  

All pregnant women should engage in healthy eating guidelines from the start of their pregnancy. There are no additional caloric requirements in the first trimester. As the pregnancy progresses into the second and third trimesters, women should engage in healthy eating guidelines from MyPlate, a U.S. Department of Agriculture food guidance system, which helps calculate the proper nutrient and calorie plan based on information entered on the website.  

As recommended by MyPlate, pregnant and breastfeeding (also known as chestfeeding) women should eat a diet high in fruits and vegetables, whole grains, low-fat dairy or soy alternatives, nuts, protein foods, lean meats and fish. Meals, beverages and snacks should have limited added saturated fat, sugars and salt (sodium).  

The human body cannot make essential fats needed for a baby’s brain development. The most common of these omega-3 fats are docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). The best way to get these essential fats is by eating fish. Eating fish twice a week, or about 12 ounces each week, allows mothers to get the proper omega-3 needs. However, fish can also have high levels of methylmercury, which should be avoided, so you want to focus on fish and seafood that are low in methylmercury. Seafood low in methylmercury includes salmon, cod, shrimp, canned light tuna and catfish. Albacore tuna (white tuna) is safe to eat once a week, or a 6-ounce portion per week. Larger fish, including shark, swordfish, king mackerel and tilefish have high levels of methylmercury and therefore should be avoided during pregnancy. Freshwater fish can also contain mercury. If no local advice is available, it is safe to eat local fish once a week, or a 6-ounce portion of fish per week. 

Some women choose to get essential fats from supplements instead of eating fish. There are two types of supplements: fish oil supplements and omega-3 fatty acid supplements. Fish oil supplements may contain methylmercury, so it is important to research the contents of it. Omega-3 supplements are safer because they do not contain mercury. However, both supplements can increase the risk of bleeding, which can be dangerous during labor. Speak with your doctor before starting any new supplement. 

Because pregnant mothers and their children are at greater risk of foodborne illness or food poisoning, they should practice safe food handling and follow these tips:   

• Always wash vegetables and fruit   
• Only eat foods cooked to the proper internal temperature 
• Avoid soft cheeses made from unpasteurized/raw milk 
• Avoid cold deli meats or raw hot dogs 
• Avoid unpasteurized milk and juices 
• Avoid raw sprouts 

Learn more about what foods to avoid at FoodSafety.gov.   

Staying hydrated can help prevent constipation and dehydration. The amount of blood volume increases during pregnancy, thus increasing fluid needs. Fluids help transport everything from vitamins to proteins throughout the body. They also help in excreting waste products, such as removing ammonia in our urine. 

Important fluids to consume during pregnancy include water, decaffeinated and sugar free soda, soup, milk and decaffeinated tea and coffee.  

The adequate fluid intake for pregnant women is 100 fluid ounces per day which correspond to 12 to 13 8-ounce cups. Fluids can also be found in moisture-rich fruits like watermelon and some meats, like a juicy piece of chicken. The moisture in foods can account for up to 20% of total fluid intake. 

People who exercise or live in hot climates, like summers in Arkansas, may need to increase their fluids. Generally, if a mother is thirsty, their body needs more fluids. However, not everyone gets thirsty, so keeping up with how much water can be tricky. Counting how many glasses or water bottles you drank each day can help. The lighter color your urine is, the more hydrated you are.  

The topic is still under debate from a scientific standpoint. The current recommendation is pregnant women should limit their intake of caffeine to less than 200 mg per day, about two cups of coffee (6 ounces each), according to the American College of Obstetricians and Gynecologists.  

The main sources of caffeine are in coffee, tea, soda and energy drinks. Herbal products may contain caffeine; however, the exact amounts are unknown. Caffeine is also in foods like chocolate, but the caffeine amount is much less than in caffeinated drinks. It can also be in some cold and pain medications. 

Caffeine increases the heart rate and blood pressure for both mother and baby. Later in pregnancy, the baby may have noticeable trouble falling asleep. Caffeine also can increase contractions and the risk of preterm labor. It does this by dehydrating your body and by stimulating all muscles (including uterine muscles) to contract. At very high levels, caffeine intake during pregnancy can cause birth defects or stillbirths.  

The main types of sugar substitutes are saccharin, aspartame, sucralose and stevia. According to the American Pregnancy Association, all substitutes are generally safe to eat in limited amounts, such as one to two packets per day. For larger quantities, like in a piece of sugar-free pie, it is likely safer to simply eat regular food with sugar. Avoid aspartame if your baby is at risk for phenylketonuria (PKU). Consult your doctor to discuss any individual risks of consuming sugar substitutes.

Weight gain is meant to help a baby grow strong and healthy, and create a safe birth for the mother. Here are some average estimations about where the weight goes by the end of the pregnancy:  

• Baby: 7 ½ pounds 
• Placenta: 1 ½ pounds 
• Amniotic fluid, breasts and uterus: 2 pounds each 
• Body fluids, blood: 4 pounds each 
• Maternal stores of nutrients: 7 pounds 

Have you heard the saying about "eating for two" during pregnancy? It's a myth.   

The National Academy of Science advises on proper weight gain during pregnancy based on a mother’s weight before pregnancy.   

During the first trimester, expectant mothers do not need to boost their calorie intake, and the recommendation is to be weight stable (0-2 pounds fluctuation). During the second and third trimesters, there is a need to increase calorie intake as most of the pregnancy weight gain comes from a growing fetus, the placenta, fluids and the increased amount of blood circulating. Women with a healthy pre-pregnancy weight should eat an additional ~ 300 calories of nutrient-dense foods during their second trimester and an additional ~400 calories of nutrient-dense foods during their third trimester. More information is available through the Dietary Guidelines for Americans, 2020-2025.  

Babies born to mothers who gain the recommended weight tend to be healthier at birth. Babies born to mothers who gain too much weight can be large, making labor more difficult. Babies born to mothers who do not gain enough weight tend to be smaller and may have difficulty starting to chest feed, have an increased risk for illness and may experience developmental delays, according to the Centers for Disease Control and Prevention (CDC).  

According to the American College of Obstetricians and Gynecologists, total weight gain based on BMI is: 

• Less than 18.5 BMI, 28-40 pounds  
• 18.5-24.9 BMI, 25-35 pounds 
• 25-29.9 BMI, 15-25 pounds  
• 30 or greater BMI, 11-20 pounds 
  

Here is a breakdown of approximately how much weight should be gained by weeks of gestation. Speak to your healthcare provider about healthy weight gain goals. Arkansas Children's Nutrition Center adapted data from national recommendations:   

Women with a pre-pregnancy BMI of 18.5-24.9:   

• Five weeks: 0-2 pounds  
• 10 weeks: 2-6 pounds  
• 15 weeks: 4-10 pounds  
• 20 weeks: 9-15 pounds  
• 25 weeks: 13-20 pounds  
• 30 weeks: 17-25 pounds  
• 35 weeks: 21-30 pounds  
• 40 weeks: 25-35 pounds  
  
  

Women with a pre-pregnancy BMI of 25.0-29.9:  

• Five weeks: 1-3 pounds 
• 10 weeks: 2-6 pounds 
• 15 weeks: 4-9 pounds 
• 20 weeks: 6-12 pounds 
• 25 weeks: 8-15 pounds 
• 30 weeks: 11-19 pounds 
• 35 weeks: 13-22 pounds 
• 40 weeks: 15-25 pounds  
  
  

Women with a pre-pregnancy BMI of more than 30.0:   

• Five weeks: 0-2 pounds  
• 10 weeks: 1-4 pounds  
• 15 weeks: 2-6 pounds  
• 20 weeks: 4-9 pounds  
• 25 weeks: 6-11 pounds  
• 30 weeks: 8-14 pounds  
• 35 weeks: 9-17 pounds  
• 40 weeks: 11-20 pounds  

Most women can start trying to actively lose weight about six weeks after delivery. Obtain your doctor's approval before making any diet or exercise changes. Try to choose foods rich in whole grains, fruits, vegetables, low-fat dairy and lean meats. Watch portion sizes since your calorie needs will decrease from your pregnancy needs.  

Morning sickness, severe nausea or vomiting, during the first trimester can be especially difficult for pregnant women and can last throughout pregnancy for some women. Prescribed medications by a health care provider can help control nausea.   

With morning sickness, nutrition can be trial and error, as some things may not work for everyone. Pregnant women should eat healthy and pick foods they are able to keep down, and limit foods that trigger nausea. Eating something small, like crackers, before getting out of bed in the morning can help. Also, eating smaller meals and drinking caffeine-free liquids between meals may improve feelings of nausea. Staying hydrated with water or flavored water is vital, especially with morning sickness.   

Aline Andres, Ph.D., R.D., associate director for the Arkansas Children’s Nutrition Center and professor of Pediatrics at the University of Arkansas for Medical Sciences, said if a pregnant woman cannot keep any food down and/or cannot stay hydrated, they must seek medical care.  

"It's dangerous for them and their baby if they can't eat or keep food down. It requires management by their health care provider," Andres said. "There are options to help maintain their nutritional status, an example are the high calories or high protein shakes."  

Speak to your healthcare provider for guidance about food and hydration if morning sickness limits your ability to eat and drink. Do not try a protein shake meant for bodybuilding, but one that is a nutritionally balanced supplement recommended by a health care provider, like Ensure.  Consult your healthcare provider for help. 

One common problem toward the end of pregnancy is heartburn. Long-term damage can occur when stomach juices go into a person's esophagus. Modifying food type and amount can relieve heartburn.  

• Follow a low-fat diet with smaller meals and snacks, as high-fat meals slow down digestion  
• Consume liquids between meals 
• Avoid spicy foods which can exacerbate heartburn 
• Avoid tension and stress during meals, as it can prevent food from being properly digested 
• Wear loose-fitting clothing, as tight pants can compress your stomach and worsen heartburn 
• Sit upright at least one hour after eating; laying down relaxes the muscle at the top of the stomach, causing stomach contents to go up into the esophagus and cause heartburn 

Consult a doctor if there are symptoms of heartburn. These symptoms will likely disappear right after birth.  

Constipation is common in the first trimester due to hormone changes. Later in pregnancy, it is often from the baby compressing the intestines. Drink plenty of caffeine-free fluids, 12 to 13 eight-ounce cups per day. Examples include: water, flavored water, sparkling water, caffeine-free coffee and tea, milk and fruit juices. Eating foods with adequate fiber from whole grains, fruits and vegetables can also help relieve constipation. Some women may need a fiber supplement. Consult your healthcare provider if symptoms of constipation persist. 

About 6 to 8% of pregnancies result in gestational diabetes or high blood pressure. These complications affect both you and your baby. Your healthcare provider can help detect and manage these. 

• Gestational Diabetes: This occurs only during pregnancy and often resolves within minutes after giving birth. It is normally diagnosed in the second trimester by an oral glucose tolerance test. The most important thing is for mothrs to control their blood sugars. This can typically be accomplished by eating smaller meals and several snacks daily. Medications are sometimes needed.
   
• High Blood Pressure or Hypertension: Hypertension during pregnancy often resolves within days of giving birth. It is normally diagnosed by measuring and tracking your blood pressure at doctor’s visits. It can lead to pre-eclampsia or preterm delivery.  

Smoking increases the chance of a low birth weight and a higher rate of infant mortality. Women who smoke should look for a program to help them quit when they find out they are pregnant.  

• How to find help: The Arkansas Department of Health’s Arkansas Tobacco Quitline (1-800-QUIT-NOW) or visit bewellarkansas.org/resources 
  

Alcohol consumption during pregnancy increases the risk of fetal alcohol spectrum disorders (FASDs), including fetal alcohol syndrome (FAS), alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD). These disorders can be mild to severe. FASD is preventable by excluding alcohol from the diet during pregnancy. Alcohol is broken down more slowly for a baby in utero due to the immaturity of the fetus. This means that the alcohol level will remain higher for longer for a baby compared to its mother.  

How to find help: Contact the Arkansas Alcohol and Drug Abuse Prevention Program at 501-686-9168 or visit the Arkansas Take Back program website, artakeback.org