Many of our patients are concerned about what to eat in pregnancy and this is a great time to reconsider some of our unhealthy eating habits and make well thought out choices about what we are putting in our bodies. There are very few rules about what to eat in pregnancy that don’t apply outside of pregnancy. The things that are good for your baby are generally also good for you, so most of this is common sense.
The most common food related problem that American women experience, both in and out of pregnancy, is overeating. In pregnancy, “eating for two” will certainly get you in trouble, since the baby does not eat that much, and only an extra 300 calories a day on average throughout the pregnancy is needed to avoid excess weight gain. So if you already have a healthy diet, adding a couple of small snacks will cover it. If your diet is not so healthy, then this is a good time to fix it.
Eating three small balanced meals a day, each including a protein component (lean meat, fish , chicken, eggs, nuts, tofu, beans or dairy) and fresh fruit and vegetables, as well as two small snacks is a healthy lifestyle choice for any human, pregnant or not. For an average weight woman, the recommended weight gain is 25-35 pounds for a full term pregnancy. About 5 pounds in the first trimester (13 weeks) and a pound a week after that will get you there. For overweight patients the recommended weight gain is lower (15-25 pounds) and for underweight women or women carrying twins, the recommendation is higher (35-45 pounds).
In the first trimester we may experience nausea or food aversions that make it difficult to eat healthy. It is common to crave carbohydrates and avoid protein and vegetables in the early weeks of pregnancy, and we generally recommend that patients follow their cravings (within reason) and eat whatever they can keep down. If we are eating only carbohydrates (bread, rice, potatoes) we can suffer from vitamin deficiency and it is important to try to get the prenatal vitamin in if possible, even if we need to find a chewable or liquid form. A few weeks of protein deficiency is not harmful to the baby and can be made up for later when the nausea has resolved.
Few food need to be avoided altogether in pregnancy, but certain foods should be approached with caution. It is known that large fish such as tuna, king mackeral, shark and swordfish can accumulate high levels of mercury from exposure to pollution over their lifespan. The FDA recommend limiting consumption of these high mercury fishes to 12 ounces a week or less. Canned tuna is low in mercury and does not have to be avoided. Uncooked fish can carry worms and parasites and is recommended to avoid. In reality, high quality sushi restaurants in Houston have an extremely low risk of having parasites and worms in their fish, but order cooked sushi if you want to be on the safe side.
Another uncommon food born infection in the US is caused by Listeria, which is occasionally found in unpasteurized milk and cheeses (especially overseas), and has also been reported in other foods such as packaged hot dogs and deli meats. Although it is impossible to avoid all foods that may be contaminated, infection is rare and avoiding the more common culprits such as unpasteurized milk and cheeses makes sense. Eating deli meat that has been handled and prepared properly is very unlikely to be unsafe.
Most of us know that alcohol should be completely avoided in pregnancy since no safe limit of alcohol has been established. Consuming a normal amount of alcohol in the first few weeks of pregnancy prior to recognition of pregnancy is not harmful, but alcohol should be abandoned as soon as the diagnosis is made. Large amounts of caffeine can increase the risk of miscarriage and decrease blood flow through the placenta. How much is too much is up for debate, but clearly 200 mg of caffeine (which is found in the average cup of coffee or a coke), is well below the dangerous level, and one caffeinated beverage a day is certainly safe.
Many of our patients are vegetarian and have questions about the safety of a vegetarian (including eggs and dairy) or vegan diet (no animal products including eggs and dairy) in pregnancy. There is no evidence that pregnancy outcomes are adversely affected by avoiding animal products, in fact many of our healthiest patients have adopted animal-free diets. A common misconception held by meat eaters is that vegetarians suffer from protein deficiency. This is not true, as many excellent protein sources come from vegetables, nuts and beans.
Like all pregnant women, vegetarian women need to focus on eating healthy protein with each meal. A protein intake of about 70mg daily has been recommended in pregnancy, which is easy to reach by incorporating eggs, dairy, beans, nuts, or soy into each meal. Since vegans avoid milk, an alternate calcium source must be incorporated daily, with excellent sources being found in dark green leafy vegetables such as bok choy, kale, mustard greens and turnip greens as well as tofu and soy milk.
If you have questions about your diet in pregnancy or otherwise, let us know and we are here to help!
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