As a follow up to my previous post about radiation exposure in pregnancy, I will cover several more pregnancy topics. For today’s post I will discuss nutrition and healthy weight gain in pregnancy. This is an important part of pregnancy that is modifiable by each pregnant woman. Complications can arise from both poor nutrition and weight gain as well as excessive weight gain. I plan to specifically discuss exercise during pregnancy in a separate post-- stay tuned!

Thinking About Baby

Healthy nutrition during pregnancy starts prior to conception by eating healthy, exercising regularly, maintaining a healthy weight, and taking a prenatal vitamin containing at least 400mcg of folic acid.

First Trimester

During the first trimester many women will have food aversions, morning sickness, or nausea throughout other parts of the day. During this time it is ok if women do not gain weight or increase caloric intake. However, it is important to eat small and frequent meals to avoid an empty stomach, and to stay well hydrated.

I recommend to my patients that if they are having problems eating, that they eat what sounds good to them (in moderation if particularly unhealthy), and to not force themselves to eat three large meals. Rather, women should try to eat smaller meals and snacks about every 2-3 hours. At this early point in pregnancy the fetus can grow and develop even without a perfectly balanced diet. Bland foods like toast, crackers, rice, and potatoes are often tolerated without difficulty.

Second & Third Trimesters

After the first trimester women should increase caloric intake by about 300-450 calories per day above their pre-pregnancy diet (450 calories in the third trimester), and aim to gain about a pound per week. But, this does not mean eating “for two!” Women should try to eat fruits, vegetables, whole grains, low fat dairy, and a variety of proteins. The extra calories can be added to a daily diet by healthy snacks. Here are a few examples:

How Much Weight Gain is Normal?

The amount of weight gain recommended is personalized for each woman and depends on her pre-pregnancy body mass index (BMI). The Institute of Medicine has made the following recommendations for pregnancy:

Physician’s will track weight gain at each prenatal visit and can follow the weight gain trend to help patients stay on track. Physicians will follow weight gain over time as well as fundal height (measurement of the top of the uterus once it is past the belly button) to assess fetal growth. When weight gain is under or over the expected weight gain, a growth ultrasound can be done to estimate fetal weight.

Pregnancy is not a time to diet, but it is still very important to keep weight gain in the appropriate range to avoid complications such as gestational diabetes, labor difficulties, c-section wound infections, postpartum obesity, and even health complications for the infant and future child. Pregnancy is a great opportunity to make lifestyle changes and eat a healthy diet with the motivation of growing a healthy baby.

Frequently Asked Questions:

Are there foods that I can’t eat?

Yes, you should avoid raw fish such as sushi and smoked fish, as well as undercooked meats, cold deli meat and hot dogs, and raw eggs.
Fully cooked seafood, meat, and heated deli meats will help to avoid exposure to bacteria and parasites.
You should avoid unpasteurized cheeses and juice, and raw sprouts as well.

Can I drink coffee?

Yes, but try to limit to less than 200mg/day.
One 8oz cup of brewed coffee has 100-200mg of caffeine (NOTE: tall size at Starbucks is 12oz!). 1oz espresso 30-90mg. 8oz brewed tea 40-120mg.

Is it ok if I’m vegetarian?

Yes as long as you maintain a well balanced diet.

What fish can I eat and how much?

You can follow FDA guidelines for best choices of fish, but if you are eating fish that is low in mercury, 2-3 servings per week is safe to eat.
Best choices of fish include cod, shrimp, salmon, tilapia, tuna, trout, oysters, and clams.
Fish to avoid include shark, swordfish, king mackerel, and orange roughy (due to high mercury levels).

If I change my diet can I prevent my child from having food allergies?

There is not good evidence that avoidance of certain foods during pregnancy will prevent allergies (for example avoiding, peanuts, milk, or eggs etc).
Breastfeeding may help prevent child allergies, however.

Can I take herbal supplements?

Herbal supplements are not FDA approved and are not studied for safety in pregnancy.
Thus, supplements are not recommended due to potential risk in pregnancy.

What if I have twins?

You should increase your caloric intake by about 600 calories per day and expect a 30-50 pound weight gain for the pregnancy (or about 1.5lb per week) if pre-pregnancy BMI is in the normal range.

Special diets and certain medical conditions may require consultation with a nutritionist or specific laboratory testing and supplements. For instance, if a patient has had a history of gastric bypass, she will likely need more vitamin supplements than a prenatal vitamin.

If you are pregnant and think you need specific counseling and recommendations for your diet, talk to your OB/gyn or a nutritionist. Further reading can be found here as well: https://wicworks.fns.usda.gov/wicworks/Topics/PregnancyFactSheet.pdf

References:
American College of Obstetricians and Gynecologists. Weight gain during pregnancy. Committee Opinion number 538. January, 2013.

By Dr. Loriana Soma - Expert OB/GYN