How should your intake differ during pregnancy? Here we’ll discuss the ins and outs of navigating pregnancy nutrition.
From the minute you find out you’re pregnant to the day of your delivery, as an expecting mother you’re bombarded with an abundance of confusing information. Whether it’s how to deal with swollen feet or the best home remedies for morning sickness, the amount of information and varying opinions can be overwhelming.
When it comes to navigating pregnancy nutrition, we want to make it as easy as we possibly can for you: what you should be eating, what you shouldn’t be eating, and why it’s necessary.
Pregnancy And Nutrition
The human body is an amazing machine, one that’s capable of creating another human all on its own. But in order for the body to do this, it needs to be supplied with the proper tools — this is where nutrition comes in.
First and foremost, I want to preface this by saying your health care team is your number one resource for all of your pregnancy needs. Each woman’s pregnancy is completely individual, therefore the nutrition implications are individual as well.
Be sure to consult your doctor and Registered Dietitian before making any significant changes or adjustments to your diet. The guidelines and recommendations presented below will reflect those for a complication-free singleton pregnancy.
Weight Gain During Pregnancy
We all know that pregnancy undoubtedly signifies an increase in weight, but what is the purpose of the weight gain and where exactly is the weight being gained?
In addition to the weight of the actual baby:
the mother’s placenta (essentially the “gatekeeper” between the mother and the baby all nutrients travel through this to the baby)
amniotic fluid (fluid surrounding the baby)
additional fat stores
increased blood volume
uterus and breast size all contribute to the total amount of weight gained during pregnancy (1).
On average, this amounts to about 25-35 pounds.
With that being said, it’s important to note that your pre-pregnancy weight is the greatest indicator of how much weight gain is expected or recommended for you. You can check out the Mayo Clinic’s general guidelines for weight gain here.
So why am I telling you all of this? In order for the body to create these changes, gain an appropriate amount of weight, and make a happy home for the baby, an adequate amount of nutrients must be readily available.
How Much Should I Be Eating?
You just found out you’re pregnant, so that means you can start doubling your portion sizes to feed both you and the baby, right? Not quite.
Surprisingly enough, the first trimester of pregnancy does not require any additional caloric intake. It’s the second and third trimesters where the increase in calories really starts to happen.
Generally speaking, an increase of about 340 calories per day during the second trimester and about 450 calories per day during the third trimester is recommended (2). Physical activity levels and personal needs must also be considered before making specific recommendations.
Macronutrients During Pregnancy
Now that we know how much you should be eating, let’s talk about what those calories should be made up of.
Adequate protein intake is vital for a healthy pregnancy. It’s particularly important for new tissue synthesis in both you and the baby. Proper amounts of protein will aid the production of the baby’s brain in addition to your breast and uterine tissue (3).
As calorie intake increases with the start of the second trimester, protein intake should increase as well. An increase from 0.8g/kg/day to 1.1g/kg/day (based on pre-pregnancy weight) is recommended (4). In other words, if you up your daily intake of protein by about 25g, you’ll be good to go.
If it’s a part of your diet, animal-based protein is recommended. It has a complete amino acid profile (food sources contain all 9 amino acids) and higher bioavailability (they’re essentially absorbed and digested a little easier) (5).
If you’re a vegetarian or a vegan — don’t worry! You can optimize your amino acid profile by consuming a variety of plant-based protein sources rather than sticking to just a few. Check out some of our favorite plant-based protein options here!
In a complication-free pregnancy, the primary concern is to ensure the mother is consuming carbohydrates from all the real stuff — whole grains, vegetables, fruit, and legumes.
Carbohydrates become a greater concern if gestational diabetes occurs. Taking place in about 7% of all pregnancies, it usually arises during the second half of the pregnancy and resolves itself as soon as the baby is born (6). In the case of gestational diabetes, it’s best to utilize your health care team, work with your registered dietitian to create a specific plan for you.
We know that healthy fats are important for a normal diet, but what about during pregnancy?
Fat is especially important in the context of pregnancy nutrition, particularly omega 3 fatty acids. DHA and EPA (two out of the three omega 3 fatty acids) are helpful for proper brain development and retinal function in the baby (7). Fatty fish, walnuts, and flaxseeds are all great sources of these fats.
Monounsaturated fatty acids (think olive oil and avocados) are just as good for you when you’re pregnant as they are when you are not — so add those in too!
Micronutrients During Pregnancy
Our micronutrients are all of the vitamins and minerals we need to support a healthy body. In the case of the pregnant body, there are a few micronutrients that deserve a bit of extra attention.
Calcium is one of the micronutrients that does not require an increase of intake due to pregnancy (8). As long as the mother is getting the recommended amount of calcium (1,000 – 1,300 mg/d depending on age), the baby will receive enough calcium as well. Perfect, right?
There’s just one caveat. The mother really needs to get the recommended amount of calcium. If you don’t have enough calcium to spare, your body unfortunately ends up pulling the needed calcium from your bones.
Moral of the story, make sure you’re thinking about calcium in your diet. You can find calcium in dairy products, dark leafy greens, sesame seeds, bread, fish and almonds. If calcium intake is a concern for you, talk to your Registered Dietitian about possible supplementation.
Have you ever heard of choline? Despite its importance, choline is often overlooked in relation to prenatal nutrition.
Choline is a water-soluble micronutrient that’s vital for an abundance of adolescent functions. For example, visual memory can be improved through adequate choline intake during pregnancy. Higher gestational choline intake has even been associated with improved visual memory when the child is 7 years old (9).
This particular micronutrient is also essential for the proper development of the baby’s central nervous system and cognitive function. To properly aid this process, adequate choline intake is especially needed in the third trimester (10). Research has shown that by supplementing with choline in the third trimester, infant information processing speed will be improved (11).
So how much choline are we talking? Currently, pregnant women are recommended to consume at least 450 mg/day of choline (12). Unfortunately, research has shown that this is particularly difficult for women to meet.
The Dietary Guidelines Advisory Committee has just recently met to evaluate its recommendations for 2020. Their report shines a light on the significance of choline intake, particularly in pregnant women. They found that despite its importance, only 8% of pregnant women are currently meeting choline intake recommendations. This is due in part to the lack of choline intake through food, but also through prenatal supplements (13).
This makes it especially important to ensure your prenatal supplement includes choline. If this is something you need assistance with, always be sure to contact your Registered Dietitian.
Iron is a very important part of red blood cells, which are very important for the creation of blood. Because a pregnant body requires an increase in blood volume, this results in an increased need for iron as well. If you don’t have enough iron, this may result in iron-deficiency anemia.
To help prevent this, about 27mg of iron is recommended daily (14). We consume iron in two major forms – let’s break those two forms down.
First, we have plant-based iron (otherwise known as non-heme iron or ferric iron). Plant-based iron is a little bit harder for the body to absorb and utilize, but consuming it with vitamin C makes absorption easier.
Next, we have animal-based iron (otherwise known as heme iron or ferrous iron). Because this form of iron is not as difficult to utilize, the addition of vitamin C is not needed.
Folate And Folic Acid
It’s especially important to consume adequate amounts of this micronutrient both before and during pregnancy. Folate and folic acid help prevent neural tube defects and other fetal abnormalities.
So what’s the difference between folic acid and folate?
Folate is the naturally occurring form found in food, while folic acid is the synthetic form found in fortified foods and supplements. Surprisingly enough, the body is actually able to digest and absorb folic acid easier than folate. Because of this, you should try to consume about 400mcg/d of folic acid and 200 mcg/d of folate during pregnancy (15).
Vitamin A needs are slightly increased during pregnancy to about 750-770mcg/day (depending on your age) (16). While receiving adequate amounts of this vitamin are important for fetal development, we also want to make sure you’re not getting too much.
Excess amounts of vitamin A through the form of retinol or retinoic acid (think skincare products) have been linked to complications and abnormalities in the baby. Give your products a look to make sure they don’t contain these ingredients.
Prenatal Supplements During Pregnancy
Nutrition during pregnancy not only involves food intake, but also supplementation.
The purpose of a supplement is to bridge the gap. It’s used to ensure adequate intake of all essential nutrients, regardless of food intake or preferences.
More often than not, there are at least a couple of nutrients that are particularly difficult for pregnant women to consume through food alone. Choline is a perfect example of this. With only 8% of women currently meeting the recommended guidelines, a prenatal supplement containing this nutrient is often a recommended choice.
Whenever you’re looking for a multivitamin, be sure to research their products, how to use, choose if they’re right for you, and where to find them. At Nutrition Stripped in our nutrition practice, we’ve been recommending One A Day® products because they put their multivitamins through 100 rigorous quality checks to ensure consistency and accuracy.
In addition, their experts have been formulating their vitamins for more than 75 years and the brand does a great job of reflecting the latest science. Their products are free from high fructose corn syrup, artificial flavors and sweeteners, and synthetic colors.
We recommend One a Day® Prenatal Advanced Complete Multivitamin with Brain Support.* for those who are pregnant or breastfeeding women, which is the #1 OB/GYN recommended prenatal vitamin brand with three brain-building essential nutrients, including choline (110 mg), folic acid (800 mcg), and DHA (200 mg).* It has twice the amount of choline compared to other leading prenatal multivitamin brands. Choline plays an essential role during the prenatal period by helping to support a baby’s cognitive development.*
Prenatal vitamins are almost always recommended to ensure the mother is getting all that she needs. Work with your health care team to determine what nutrients you may be missing from your diet and which prenatal supplement is right for you.
Food Items to Avoid or Limit During Pregnancy
Now that we know what to eat, let’s talk about what to avoid.
There are two sides to the fish equation. The first tells us that pregnant women need to consume 8 – 12 ounces (or 2-4 servings) of fish per week to support fetal growth and development (17).
The other side tells us that pregnant women need to avoid fish high in mercury such as shark, swordfish, king mackerel, and tilefish. It also tells us to avoid all undercooked fish and shellfish in addition to cold-smoked fish.
So where does that leave us? Fish that are safe to consume when pregnant are fully cooked and lower in mercury. Possibilities include shrimp, canned light tuna, tilapia, cod, and catfish.
While the placenta acts as the “gatekeeper” between the mother and the baby, it, unfortunately, doesn’t have the ability to stop alcohol from passing through. When you drink alcohol, the baby will receive it as well.
Alcohol consumption during pregnancy has been linked to Fetal Alcohol Syndrome, low birth weights, and many other abnormalities. Because of this, the avoidance of alcohol is recommended throughout pregnancy (18).
One of the most important questions of all — can I still drink coffee?
Current recommendations suggest up to 300mg/d (or about 3 cups of regular coffee) is acceptable during pregnancy.
The need for this limitation stems from the fact that pregnant women digest caffeine a bit slower than the average person, so its effects can last longer than normal. It’s also important to note that caffeine crosses the placenta just like alcohol. While the baby is able to metabolize caffeine, it isn’t metabolized well until after three months of gestation (19).
Keep in mind that caffeine is found in other products besides just coffee — chocolate, especially dark chocolate has caffeine as well.
Food Borne Illnesses During Pregnancy
During pregnancy, the mother’s immune system is slightly reduced. This, unfortunately, puts both the mother and baby at a higher risk for foodborne illness. Listeria monocytogenes, Salmonella, and Toxoplasma gondii more so than others.
To reduce your risk of developing a foodborne illness, you should avoid (20):
All raw seafood
Cold smoked fish
Unpasteurized juice or cider
Soft cheese and cheese made from unpasteurized milk
Pre-made meat or seafood salads
Undercooked meat and poultry
Cold hotdogs and lunch meats
Meat spreads or pate
Cleaning cat litter boxes
How To Put Pregnancy Nutrition Into Practice
It all comes down to real, whole foods and variety. With so much to think about it’s easy to stress over what you’re eating. My best piece of advice is to utilize your resources.
Work with a Registered Dietitian such as a Wellness Coach on our team, create a plan, and make it easy for yourself. The more you plan ahead, the less you have to worry about what you’re eating and whether or not you’re getting what you need.