Nutrition in Pregnancy (Q & A)

Nutrition in Pregnancy (Q & A)

What is the best diet in pregnancy?
There is no single diet for women during pregnancy yet, eating well-balanced, healthy foods is important for your health as well as your baby. The baby inside you needs a lot of nutrients to grow and to attain normal development. Regardless of what diet you choose, it should contain a lot of vegetables, fresh fruits, whole grains, lean meat and low-fat dairy products.

What are the recommended servings for carbohydrates, protein, fruits, vegetables and dairy in pregnancy?
The recommendations may vary slightly depending on what sources you are looking at. Generally, about 9 servings of carbohydrate, 3 or more servings of protein, 2 or more servings of fruits, 3 or more servings of green vegetables, and 4 servings of dairy products are recommended during pregnancy. Limit fat consumption to about 2 servings per day and try to drink 8 glasses of water a day.

Do I need extra calories during pregnancy?
Yes, women need to consume more calories to support the growing baby during pregnancy. Daily calorie intake needs to be increased by 300 kcal per day in second trimester (4-6 months) and over 400 kcal per day in third trimester (7-9 months).

How much weight do I need to gain during pregnancy?
The amount of weight you need to gain during pregnancy varies and it depends on your weight before pregnancy. Check with your obstetrician about how much weight you should put on in your pregnancy. The following is a recommended weight gain for general population:

BMI before pregnancy Recommended weight gain during pregnancy

Underweight (BMI of less than 18.5) 28-40 pounds
Normal weight (18.5 and 24.9) 25-35 pounds
Overweight (BMI of 25 to 29.9) 15-25 pounds
Obese (BMI of 30 or greater) 11-20 pounds

Why should I monitor my weight gain?
We encourage women to have better control over their weight gain during pregnancy to prevent large infant, preterm birth and post-term birth. Overweight and obese women are at higher risk for developing gestational diabetes (high blood sugar during pregnancy) and preeclampsia (high blood pressure in pregnancy). Babies are also at higher risk for birth defects and birth-related injuries.

What foods should I eat to get the extra calories?
The extra calories should come from various food sources such as carbohydrates, protein and low-fat dairy products. You can get carbohydrates from whole grain products, cereal and starchy vegetables. Protein is also essential nutrient for fetal growth and development especially in the second and third trimester. Your diet should include more lean meat found in poultry and fish (certain types), tofu, dried beans and peas. Protein can be obtained from dairy products such as egg, milk, yogurt and cottage cheese as well.

What are good sources of protein if I am a vegan?
Soy products, beans, peas and peanut butter are rich in protein.

What is folic acid?
Folic acid or folate is vitamin B that prevents neural tube defects (defects of brain and spinal cord). Brain formation occurs as early as four weeks after conception. You can find folic acid in fortified cereals, green vegetables (spinach, broccoli, asparagus, okra and brussel sprouts), dried beans, peas and citrus fruits (orange, grapefruit, papaya and strawberry).

Can I take folic acid supplement?
Yes, you can take 400 to 800 mcg (micrograms) of folic acid daily. Some prenatal vitamins contain folic acid but the amount varies among different brands. Let your doctor know if you are taking medications for seizure, diabetes, asthma, lupus or inflammatory bowel disease. You may need a higher dose of folic acid. You will be given a higher dose of folic acid if you had a baby with brain or spinal cord defect or you have a family member with spinal bifida. In that case, the doctor will prescribe you 4000 mcg of folic acid daily, which is ten times higher than the normal dose.

When should I start taking folic acid supplement?
Even when you are just planning to get pregnant, you should start eating healthy foods and take multivitamin with folic acid (400 to 800 mcg daily). Brain and spinal cord form very early on in pregnancy before most women find out they are pregnant. On the other hand, neural tube defects are very much preventable with folic acid during pregnancy.

What other vitamins and minerals do I need during pregnancy?
During pregnancy, women need increased amount of iron, calcium and vitamin D. If you are a vegan, you may also need vitamin B12 supplement as well as iron, calcium and vitamin D.

What is iron for?
Iron is part of the red blood cells and red blood cells carry oxygen to the brain, organs and tissues. Your body demand for iron is higher in pregnancy since your baby also produces his or her own blood supply.

What is anemia?
Anemia is a condition where you do not have enough red blood cells to carry oxygen to the organs and tissues. During pregnancy, iron-deficiency anemia is more common and it is due to inadequate iron to make red blood cells. Common symptoms include fatigue, weakness, pale skin and headache.

What types of food are rich in iron?
Iron is found in meats, iron-fortified cereal, spinach, beans and nuts.

How much iron do I need daily?
You need 27 milligrams of iron daily and most prenatal vitamin supplements contain iron.

What are calcium and vitamin D for?
Calcium and vitamin D are needed for bone formation and to strengthen bones.

What foods are rich in calcium and vitamin D?
You can get calcium and vitamin D from milk, yogurt, cheese, eggs, spinach, asparagus, broccoli, cereal and fortified orange juice. Vitamin D is also from sunlight through your skin.

How much calcium do I need daily?
You need 1000 milligrams of calcium daily. If you are a teen mom, you need 1300 milligrams of calcium daily.

How much vitamin D do I need daily?
You need 600 IU (international unit) of vitamin D daily.

Can the daily requirements of iron, calcium and vitamin D be fulfilled by taking prenatal vitamins?
No, prenatal vitamins are supplement to your diet. You still need to eat nutritious foods to meet your daily requirements of iron, calcium and vitamin D. Most of them do not contain 1000 milligrams of calcium.

Are there any foods I must avoid during pregnancy?

Yes, there are certain categories of food you must avoid during pregnancy. Those include fish with high mercury content, raw meat, some seafood, unpasteurized milk and cheese products.

What types of fish are high in mercury?
Fish with high mercury content are found to be associated with central nervous system damage and those include swordfish, tuna steaks, mackerel and shark.

What fish are safe to eat during pregnancy?
It is safe to eat canned light tuna, salmon, tilapia, catfish, crab and shrimp up to two times a week.

What other seafood do I need to avoid?
You should avoid oysters and clams as well as sushi that are made with raw fish.

Can I eat organ meats?
No, because they contain too much vitamin A, which are toxic for the fetus.

What foods should I avoid to prevent myself from bacterial food poisoning?
You can get bacterial food poisoning from raw, undercooked meat and poultry and it can be harmful to your baby. If you eat processed deli meats and eggs, make sure they are cooked thoroughly. It may be wise to avoid eating raw sprouts such as clover, radish and alfalfa because it is impossible to wash out the bacteria inside the seeds.

What other hygiene should I adapt to prevent myself from food-borne illnesses?
Always rinse the vegetables and fruits thoroughly before eating. Make a good habit of washing your hands before and after handling foods.

What is listeriosis?
Listeriosis is a condition caused by bacteria called listeria. While it causes mild-flu-like symptoms such as headache, fever, nausea and vomiting in a mother, it is more fatal to the fetus. It can cause miscarriage and stillbirth.

What foods should I avoid to prevent myself from listeriosis?

You must avoid unpasteurized milk or juice, soft cheese, foods that are made from unpasteurized milk, raw or undercooked meat, poultry and smoked seafood. Soft cheese includes Camembert, feta, Brie, blue cheese and Mexican-style cheeses (fresco, queso, blanco and panela).

Can I have caffeine during pregnancy?
Some studies suggested that too much caffeine is associated with miscarriage and preterm birth but not enough evidence to support it. However, it is recommended that pregnant women should consume less than 300 mg of caffeine, which is about two cups of coffee a day.

Are herbal products safe to consume during pregnancy?
We have limited data to support whether herbal teas and products are safe to consume or not. Thus, you should stay away from herbal products during pregnancy.

What other lifestyle modifications do I need to adapt in pregnancy?
As we all know that alcohol causes fetal alcohol syndrome (mental retardation and developmental problems), pregnant women must avoid all alcoholic beverages including wine. In addition, quit smoking if you smoke. Try to exercise for 30 minutes a day as many times as you can in a week.

Contributed by Patricia Hsiao M.D.

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