Which food and how much to eat when pregnant

Throughout the ages, women have received “advice” about which foods to eat and how much to eat when pregnant or expecting. Many of these “recommendations” are based in, and at many times a combination of cultural traditions, religious beliefs and science passed on over time. More recently though, your doctor’s advice would be based on your particular health habits, your size, weight, and whether you are carrying more than one baby.

For the pregnant mom, a well-balanced diet that is low in fat and high in fiber is generally better for your health as well as your baby’s health. You want to make sure you eat adequate protein as protein is being used in a lot of your body’s functions. The fiber helps to reduce your chances for constipation and hemorrhoids, and a low-fat diet keeps your heart healthy and reduces the extra weight gain which may be difficult to shed postpartum. Controlling weight gain also helps reduce the chances of developing stretch marks. If you follow this type of diet, with limited sugar, then your diet would not change much during pregnancy.

How much calories to eat when pregnant

For the mom who is considered normal weight, you would need an extra 300 calories on average.  These calories should be made up of nutritional foods and supplemental vitamins and minerals. If your doctor determines that you are underweight, your recommended caloric intake would be a bit higher and if you are overweight it would be a bit lower.

• First Trimester: You should average about 1800 - 2000 calories a day,
• Second trimester: Increase your intake by 300 - 350 calories up to 2200 calories a day.  This can be an extra bowl of oatmeal or a couple glasses of skimmed milk.
• Third trimester: An extra 450-500 calories a day is needed - about 2400 calories. 
• If you are carrying multiples: You need an additional 300 calories per day for each baby.

Which food and how much to eat when pregnant

No single food or food group will satisfy all of your nutritional needs. For more information, you should reference this food guide, but in general here are the foods you should eat when you’re pregnant:

Grains and Starchy Carbohydrates

Whole grains are foods that contain the entire grain kernel, including the outer protective coat of the grain and the germ or base of the grain.  Some examples of whole grains are wheat, oatmeal, barley whole cornmeal and brown rice. So foods made with whole grains are usually more nutritious as they have higher levels of fiber and vitamins like vitamin B and E. Refined grains - which include white flour, white bread, white rice and many pastas - have many of these nutrients removed. So especially when you’re pregnant, opt for whole grain versions of bread, cereals, pasta and other grain products every day.

Carbohydrate-rich foods provide you with energy.  These are especially important when you’re pregnant. Starchy carbohydrates include potatoes, rice, pasta and bread, so make sure you incorporate them into your pregnancy diet.

Vegetables

Vegetables are a good source of vitamins A and C, folic acid, iron, and magnesium. They are divided into five groups and have high nutritional content. These are:

• Dark green vegetables: spinach, dark green leafy lettuce, romaine lettuce, broccoli, kale, turnip greens, watercress
• Orange vegetables: carrots, pumpkin, sweet potato, acors, butternut squash, hubbard squash
• Dry beans and peas: pinto, black, garbanzo, kidney, navy, soy, and white beans; split peas; lentils and tofu
• Starchy vegetables: Potatoes, corn, green peas, green lima beans
• Other vegetables: cabbage, cauliflower, iceberg lettuce, green beans, celery, green and red peppers, mushrooms, onions, tomatoes, asparagus, cucumbers, eggplant

As a pregnant woman, you should eat 2.5 to three cups (or 4 or 5 servings) of vegetables a day. Half of your plate should be covered with vegetables with at least two servings coming from green, leafy vegetables. Use a variety of the vegetables listed above or pure vegetable juice to achieve this goal. For example, consider carrot or wheatgrass for dense nutrition.

Fruits

Fruits are a good source of vitamins, minerals. They are also a good source of fiber, which is important to help reduce constipation.  Fruits contain healthy amounts of vitamins A and C as well as potassium.  So eating a variety of fruits is an important part of your diet.

You should eat two to 2.5 cups of fruit a day.  These can be fresh, frozen, canned or dried.  Fresh and frozen (if frozen soon after they have been picked) fruits usually have higher levels of vitamins and other nutrients. Make sure you eat plenty of vitamin C-rich foods, like citrus fruits, melons, and berries. Because of the amount of sugar, you should limit how much fruit juice you drink. 

In general, you should aim to eat five portions of fruits and vegetables a day.

Oils and Fats

Oils are fats that remain liquid at room temperature, like olive or vegetable oils.these fats are mostly unsaturated and are the healthiest type of fats to eat. Nuts, avocados, fish and olives are naturally high in unsaturated fats as well, which is why they are more healthy to eat. Butter, lard, margarine and shortening are called solid fats, because they are solid at room temperature.  These fats are higher in saturated fats. Trans fats are a type of saturated fats that have been associated with obesity and heart disease. These occur in processed foods such as baked goods like cakes and cookies, shortening, microwave popcorn, fried foods, non dairy coffee creamer and others.

In general, your daily caloric intake from these sources should be less than 20 to 35%, with less than 10% from saturated fats and avoiding trans fats all together. Researchers from the University of Illinois reported that a high-fat diet may genetically program the baby for diabetes in the future.

Milk Products

Foods in this group are great sources of calcium.  They include milk, yogurt and cheeses, except soft cheeses. It’s best to focus on the low-fat milk products if you are required, for medical reasons, to limit calories and cholesterol. An average sized woman should consume about three cups of milk and milk products a day.

Meat and Beans

This category includes lean or low-fat meats, poultry and fish, as well as dry beans, nuts, legumes, seeds, nut butter, tofu and soy products. They are all good sources of protein and iron. Baking, broiling and grilling are the healthiest ways to cook these foods. Quinoa is also a good option - it is known as a “complete protein,” as it contains all the essential amino acids.

You should eat five to seven ounces from the category daily.

Fish

Fish, which is rich in DHA (the omega-3 fatty acids that helps with your baby's brain development), is a great meal choice. According to the FDA, you can enjoy up to 12 ounces a week (roughly two meals) of lower-mercury fish such as salmon, catfish, pollack, shrimp, haddock, cod, catfish, flounder, sole, tilapia, scallops and canned light tuna. Of those 12 ounces, only 6 should come from canned "white" albacore tuna, which tends to contain more mercury than light tuna. If you're eating fish caught in local waters, check online for local health advisories for safety levels (if you can't find any information, limit yourself to 6 ounces). Most important is to make sure that the fish comes from a reliable source and that it is stored properly.

Zinc

Zinc is a vital trace element that plays a major role in normal growth and development, cellular integrity, and several biological functions including nucleic acid metabolism and protein synthesis. So it is important in the development of the fetus.

The best sources of zinc are chicken, turkey, ham, shrimp, crab, oysters, meat, fish, dairy products, beans, peanut butter, nuts, sunflower seeds, ginger, onions, bran, wheat germ, rice, pasta, cereals, eggs, lentils, and tofu.

A word on Artificial Sweeteners

Artificial sweeteners are used to replace sugar in food and beverages without all of the calories.They satisfy no nutritional requirements and though they are safe during pregnancy, some people have reported sensitivities to many artificial sweeteners.  If any adverse reactions occur, consult your doctor or nutritionist.

• Though Aspartame, found in Equal, NutraSweet and Nutra-Taste is safe for both you and your baby, it is recommended that you take more than two servings of aspartame containing foods.
• Stevia, used in Sweet Leaf and Truvia, is made from plants.  This is also safe to consume during pregnancy.
• Sucralose in Splenda is a low-calorie chemical modification of table sugar that is also safe for you and your baby.
• CAUTION: Saccharin found in Sweet’N Low should not be used during pregnancy.  It is a weak carcinogen that crosses the placenta.

What to eat when you're pregnant and nauseous

If you’re  experiencing nausea and can’t eat a well-balanced diet, you may be wondering whether you’re getting enough nutrition for you and your baby.  You can actually go several weeks without eating a balanced diet and not have any ill effects on your baby. You may only be able to tolerate many foods but it’s more important to keep something down rather than starving. If you feel like eating potatoes, or bread or pasta, then go right ahead.

Nutritional supplements during pregnancy

As pregnancy progresses your body needs extra fluids. If you don’t drink enough you may feel weak or faint. In the later stages of pregnancy dehydration can lead to premature contractions. Make sure you drink at least eight glasses of water (or milk) a day, more if you are carrying multiples.

If you are eating an optimal, healthy and balanced diet, you can get most of the vitamins and minerals you need naturally - with the exception of iron, folic acid and calcium. However, to ensure that you get all that you need, including iron, calcium and folic acid, taking prenatal vitamins is usually required. Just be careful - you may have to experiment with different brands as some may not be as easy to tolerate as others. So you may have to try a few different ones before you find one that works for you.

Iron

During pregnancy, both you and your baby are making extra red blood cells every day. On average, you need 30 milligrams (mg) of extra iron each day - the amount found in most prenatal vitamins.  Your blood cell count can drop significantly during pregnancy because your body is making more plasma (the fluid in blood) and less red blood cells. This is why you need to take an iron supplement.

Foods rich in iron include: chicken, fish, read meat, green leafy vegetables and whole grain breads and cereals.

Calcium and Vitamin D

Daily requirements for calcium and vitamin D for pregnant women are: 1,200 milligrams of calcium and 2000 units of vitamin D.  Most women actually get much less (The U.S. recommended daily allowance (USRDA) for women in general is 1,000 mg). The calcium requirements for your developing baby can make it much worse as the fetus is able to extract the calcium it needs from your bones. So it is very important to get all the calcium and vitamin D (which helps your body store calcium) that you need when pregnant.

Prenatal vitamins only provide some of the calcium (200-300mg) you need. Your diet therefore becomes very important to provide the remaining calcium for you and your growing baby. Milk, yogurt, cheese, green leafy vegetables and canned fish with bones are all excellent sources of calcium.  There are also lactose free products, available in supermarkets, that are high in calcium. You can get 1 serving (300mg of calcium) from

• 1 8-ounce glass of milk
• 4 ounces (½ cup) of cooked broccoli
• 4-5 ounces of canned salmon with bones
• 1.5 to 2 ounces of cheese (not cottage cheese)
• 8 ounces (1 cup) of yogurt

Other sources of calcium include:

• Greens (such as mustard and turnip greens), bok choy, kale, and watercress.
• Seeds and nuts (almonds, tahini/sesame butter)
• Tofu that is "calcium-set."
• Calcium-fortified soy and rice beverages.
• Canned fish with bones (such as salmon and sardines).
• Cooked beans, legumes, and lentils.

BONUS TIP: Antacids like Tums contain quite a bit of calcium, and at the same time help relieve pregnancy heartburn.

What can’t you eat when pregnant

Many pregnant women ask about which foods they should not eat. Here is a list of items you should avoid or be careful of:

Cheeses from unpasteurized or raw milk

Unpasteurized or raw milk can contain listeria, monocytogenes, salmonella and E. coli.  Listeria in particular has been linked to pregnancy complications such as premature labor or even miscarriage. Soft cheeses like feta, goat cheese, Brie, Camembert, blue cheese, and Mexican queso fresco or queso blanco are more often made with unpasteurized milk than harder cheeses like cheddar or Swiss. So there is a higher chance that these soft cheeses could contain listeria, which would otherwise be killed during pasteurization. 

The FDA and Health Canada require that cheeses to be sold to the public be made from pasteurized milk, or aged for at least 60 days. So cheeses bought at supermarkets should be safe to consume. Just check the label to be sure.

Caffeine

Whether it’s coffee, an energy drink, tea, or diet cola, now that you’re drinking for two. Drinking stimulants like caffeine can be tricky. There is no consensus on how much caffeine is safe but it is known that caffeine crosses the placenta, and your baby's developing systems can't handle the caffeine. Many of the studies and books that recommend a certain amount of caffeine as being safe, have been determined from studies on animals. An August 2020 review therefore in the journal BMJ concluded that no amount of caffeine is safe. The observational study found that maternal caffeine consumption to be “associated with increased risk for the four outcome categories -  miscarriage, stillbirth, low birth weight and/or small for gestational age, and childhood acute leukaemia."

Alcohol

Alcohol is another substance that crosses the placenta. Drinking alcohol during pregnancy can lead to Fetal Alcohol Syndrome (FAS), which causes mental retardation and a host of abnormalities. Even moderate drinking may lead to more subtle physical and mental damage. And because no one knows exactly what amount of alcohol causes FAS, it's best to steer clear.

Cigarettes

The CDC states that using substances such as tobacco or marijuana may impact your pregnancy and your baby’s health, and even developmental problems in adolescents. These health problems include preterm birth, low birth weight, and birth defects of the mouth and lip. Smoking during and after pregnancy also increases the risk of sudden infant death syndrome (SIDS). Nicotine, which is the addictive substance found in tobacco products (including e-cigarettes) is dangerous for you and your developing babies as it can damage your developing baby’s brain and lungs. 

Saccharin 

Saccharin found in Sweet’N Low should not be used during pregnancy, or at all really.  It is a weak carcinogen that crosses the placenta. The other sweeteners, that is, those made with aspartame and sucralose, like Equal, NutraSweet, and Splenda, are safe, according to the Food and Drug Administration (FDA). However, you do not want to be consuming these all day long as they are not healthy options. You should also limit things like diet sodas (some of which may contain saccharin) – you're sipping fake everything instead of something actually nutritious.

Raw or rare meat

The concern around eating raw or rare beef and pork is that it contains bacteria such as listeria, or parasites such as toxoplasma. These bacteria and parasites can cause pregnancy complications or even miscarriage as mentioned earlier. Adequately cooking these meats kills both of these bacteria and parasites, so make sure you cook your meat medium-well to well done.

Liver

Liver contains ten times the recommended daily allowance of vitamin A for pregnant women. The recommended daily allowance for pregnant women is 2500 international units (IU). A study has shown that eating more than 10,000 IU of vitamin A has been linked to birth defects. So be sure you check the labels on your prenatal vitamins and find substitutes for your liver cravings. Eating liver once or twice a month may be ok depending on the amount of vitamin A you consume otherwise.

Nitrate-rich foods

Many pregnant women worry about eating smoked meats and fish because they’ve heard that these foods are high in nitrites or nitrates. Foods such as hot dogs (which should always be eaten cooked) and cured meats such as bacon and sausage contain nitrates, additives that have been linked to brain tumors and diabetes. These foods aren't great nutritional choices anyway. Although these foods do contain these substances, they won’t hurt your baby if eaten in moderation.

Diet sodas are also considered safe during pregnancy and, beyond not being a stellar nutritional choice, there's no scientific evidence that they cause harm.On the downside, at least one artificial sweetener (saccharin) that's often found in diet sodas does cross the placenta and is not safe for your developing baby, and artificially sweetened drinks are usually low in nutritional value. So limit these types of drinks whenever possible.

Raw fish or fish high in mercury

Sushi and Sashimi: 

Raw fish (except raw shellfish) contain bacteria and microbes, and has a risk of a parasitic infection, whether you’re pregnant or not (less than the risk of getting sick from eating improperly cooked chicken!). Pregnancy doesn’t increase the danger, and your fetus is unlikely to suffer any harm from such an infection.If you do get infected by a parasite, besides being unpleasant, it's harder to treat in pregnancy. The parasite can also take vital nutrients away from your growing baby. 

So don’t eat raw-fish sushi, but rolls made with fully-cooked fish are OK. Sushi made with eel, crab, or anything done tempura-style (which means it's been battered and fried) is safe to eat.  California rolls are also safe, as are veggie rolls, like avocado or cucumber.

High Mercury Fish

Certain fish – mostly big, top-of-the-food chain types – contain high levels of mercury. Whether you’re pregnant or not, this isn't good for your health and they can be particularly harmful to a baby's developing nervous system, lungs, kidneys, vision, and hearing. These fish include shark, swordfish, tilefish, king mackerel, orange roughy, grouper, tuna steaks, saltwater bass, and canned solid white albacore tuna (which is bigger, and so has more mercury than the smaller tunas used in the kind labeled "chunky” or “light").

Getting enough DHA (from seafood and flaxseed) is very important for your and your developing baby's health. So you can’t give it up completely. Make sure you eat safe fish sources. 

Special Dietary Considerations

Vegetarians and Vegans

If you’re a vegetarian,  you CAN produce a healthy baby without eating steak. But you will have to plan your diet more carefully. 

Vegetables, whole grains, and legumes (peas and beans) are rich in protein, but most don’t have complete proteins (all the essential amino acids that your body can’t produce by itself). To get all the necessary protein, you must combine various proteins -, whole grains with legumes or nuts, rice with kidney beans, or even peanut butter with whole- grain bread. They don’t have to occur at the same meal, but on the same day. A good rule of thumb is to try to get some protein with each meal. 

If you don’t eat any animal products, including milk and cheese  (that is, you’re vegan), your diet may not provide enough of six other important nutrients: vitamin B12, calcium, riboflavin, iron, zinc, and vitamin D. In this case, you should consult a nutritionist. 

Diabetes

If you’re diabetic or if you develop diabetes during pregnancy, adjust your diet so that it includes specific quantities of proteins, fats, and carbohydrates to ensure that you maintain a normal level of blood glucose (sugar). A nutritionist can also help.

If you were diabetic and controlled your glucose levels before conceiving, you can have a normal pregnancy without problems.  Your doctor may monitor you and your baby a bit more closely, but that’s expected to maintain your and your baby’s health.

Two to three percent of pregnant women develop gestational diabetes. If you have gestational diabetes and you don’t control your glucose levels, your baby’s blood sugar levels will be high too. And high blood sugar levels cause the baby to produce hormones that stimulate fetal growth, which may cause it to grow too large. If the fetus has high blood sugar levels while still in the uterus, it may have temporary problems with sugar regulation after birth. If the mother’s (and baby’s) glucose levels are controlled during pregnancy, the risk of these complications drops dramatically.

Constipation

Progesterone, a hormone that circulates freely through your body during pregnancy, can slow down your digestive system and cause constipation. Together with the extra iron from your prenatal vitamin, it makes constipation worse. Women who are on bed rest because of pregnancy complications are at particular risk because they’re so inactive.

To counteract constipation you can drink plenty of fluids, eat adequate fiber (in the form of fruits, vegetables, beans, bran, and other whole grains), and, if possible, get exercise every day. Some women, however, experience abdominal discomfort, bloating, or gas from eating too much of foods high in fiber, so you may have to use some trial and error to see which fiber-rich foods you tolerate best. If constipation bothers you, your doctor may recommend a stool softener.

Conclusion

Eating a well-balanced, low-fat, high-fiber diet is important for your and your baby’s health. Adequate protein is also important because protein carries out many of the body’s functions. Fiber in your diet helps to prevent or reduce constipation and hemorrhoids. And by not consuming too much fat, you keep your heart healthy and avoid putting on extra pounds that may be difficult to shed. Avoiding excessive weight gain also decreases your chances of developing stretch marks. 

If your diet is balanced and not too heavy in sugar or fat, you don’t need to modify the way you eat dramatically. During pregnancy, you should take in roughly 300 extra calories a day, on average. That means that if you’re at a healthy weight and you’re taking in 2,100 to 2,400 calories per day, which is ideal for pregnancy (perhaps a little less during your first trimester and a little more during your third trimester).

Filling these additional requirements with nutritious foods is key. Increase your caloric intake by eating a hot fudge sundae every day, or other low nutrient food, is not healthy or ideal. Your healthcare practitioner will also likely advise you to take some supplemental vitamins and minerals, too.