Pregnancy, Childbirth, and the Newborn: The Complete Guide, 4th Ed.

CHAPTER 6 Eating Well

The quality of the foods you eat before and during pregnancy has a huge impact on your health and on your baby’s development and long-term well-being. But which foods should you eat to ensure the best possible pregnancy? How much of them should you eat? How much weight should you gain? What about salt, food cravings, and morning sickness? Over the years, health care professionals have given different answers to these and other nutrition questions. Some advice is based on accurate information; some isn’t. This chapter provides the most accurate, up-to-date recommendations so you can make choices that best fit your lifestyle and food preferences.

image

In this chapter, you’ll learn about:

• Recommended food groups and eating habits

• Essential nutrients for a healthy pregnancy and baby

• How much weight to gain

• Food safety and common concerns

• Special circumstances that require especially good nutrition

Good Nutrition during Pregnancy

For good nutrition during pregnancy, your daily diet should be varied and include plenty of fresh fruits and vegetables, whole grains, low-fat dairy products, foods that contain protein, and about 2 quarts of liquids. By eating small, frequent meals each day (for example, three small main meals and three light snacks), you help keep your blood sugar level stable throughout the day, reduce morning sickness in the first trimester, and reduce heartburn in the third trimester.

During the first trimester, you don’t need to eat more than you did before you became pregnant. Beginning in the second trimester, however, you need to consume about 200 extra calories each day (assuming you exercise daily for thirty to sixty minutes). Two hundred calories isn’t a lot—just two glasses of nonfat milk, one chicken drumstick without skin, or 2 tablespoons of peanut butter.

In the third trimester, you need to consume about 400 more calories than you did before pregnancy. Ideally, these additional calories should come from high-protein, high-calcium, and iron-rich whole foods—not from foods lacking in nutrition, such as chips, cookies, candy, and soft drinks.

Whenever you consider what to eat, make the best possible choice at the time. Don’t feel that your diet must always be perfect. Some days, it may be hard to get the healthful food you need. Other days, it may be impossible to resist treating yourself to a favorite junk food. Just be aware of what you eat and try to eat healthfully whenever possible.

Always keep in mind that your baby benefits from any healthy changes you make to your diet. To analyze your diet, visit our web site, http://www.PCNGuide.com, to download a food diary so you can keep track of what you’re eating. After recording what you ate for a week, look at the nutritional balance of your food choices and make plans to improve your nutrition for the next week.

A NOTE TO FATHERS AND PARTNERS

You may be surprised to learn that most of the information in this chapter also applies to you. Even though you’re not growing a baby, you can still use these forty weeks to begin eating a well-balanced diet and maintaining a healthy weight and activity level. By making these healthful lifestyle changes, you increase the likelihood that you’ll have a longer, healthier life to share with your child. You’ll also model the healthful choices you want your child to make.

Although recommendations for specific amounts of nutrients are for pregnant women, this chapter directs you where to find information specific to your needs.

THE FOOD PYRAMID

In 2011, the U.S. Department of Agriculture (USDA) developed MyPlate (http://www.myplate.gov), a food guidance system designed to provide customized information for specific audiences—including pregnant and breastfeeding women—based on current dietary and physical activity recommendations known to promote health.

image

Sample Daily Menu during Pregnancy

When you get up for the day

• Peppermint tea (or other decaffeinated tea)

• 6 whole-wheat crackers (that include 2 grams protein)

Breakfast

• Oatmeal (1 cup cooked oatmeal with ¼ cup raisins, ¼ cup chopped walnuts, 1 teaspoon sugar, and ½ cup nonfat milk)

• Orange juice (½ cup)

Morning snack

• Mini bagel with low-fat cream cheese

• Water

Lunch

• Southwestern salad (¾ cup black beans, ½ cup brown rice, ½ cup corn, ½ cup tomato, and cilantro, with 1 tablespoon lime juice and canola oil dressing) served over 1 cup romaine lettuce

• 2 flour tortillas

• Nonfat milk (1 cup)

Afternoon snack

• Light microwave popcorn (1 cup)

• Water

Dinner

• Stir-fry (4-ounce chicken breast, 1 carrot, ½ cup broccoli, ¼ red pepper, 6 snap peas, and spices), cooked in 1 tablespoon olive oil

• White rice (1 cup)

• Nonfat milk (1 cup)

• Fortune cookie

Evening snack

• Smoothie (8-ounce nonfat yogurt with sweetener, 1 banana, 6 frozen strawberries)

To analyze your own daily diet, visit http://www.mypyramidtracker.gov. Enter the foods you’ve eaten in a day, and the program calculates how many servings you’ve had in each food group and how much of each nutrient you’ve consumed.

image

MyPlate describes five food groups and suggests what to eat each day; for example, “Make half your plate fruits and vegetables.” Visit our web site, http://www.PCNGuide.com, to download our food diary so you can track your consumption of foods from each of these groups.

Grains

This group includes any food made of wheat, rice, oats, cornmeal, barley, or rye. Grains contain iron, B vitamins, minerals, and fiber; some are fortified with folic acid. Try to make half your grains whole.Whole grains contain the entire grain and all its nutrients. Try to limit refined grains; these grains have been processed, which creates a softer, less chewy texture but removes nutrients. Often, refined grains are enriched (have vitamins and minerals added back in, but not fiber).

Whole grains include brown rice, oatmeal, popcorn, barley, millet, quinoa, spelt, buckwheat, bulgur, and wild rice. Some prepared foods include whole grains; check whether the package ingredients list whole-wheat flour, whole oats, and so on. Refined grains include white rice, white flour, and most prepared grain-based foods (such as bread, tortillas, noodles, crackers, pretzels, cereal, grits, couscous, and pastries).

Vegetables

Vegetables are rich sources of fiber, vitamins, and minerals. Try to vary your veggies. Different vegetables have different nutrients, so eating a variety of vegetables ensures that you and your baby get all the nutrients you need. Here are examples of the different types of vegetables:

Dark green vegetables—Bok choy, broccoli, greens (collard, mustard, turnip, chard, and kale), lettuce (dark green leafy lettuce and romaine), spinach, and watercress

Orange vegetables—Carrots, pumpkin, squash, sweet potatoes, and yams

Dried beans and peas (legumes)—Black beans, black-eyed peas, garbanzo beans (chickpeas), kidney beans, lentils, pinto beans, soybeans and soy products, split peas, and white beans (These foods also belong in the Meats and Beans category; see page 113.)

Starchy vegetables—Corn, green peas, and potatoes

Other vegetables—Artichokes, asparagus, beets, Brussels sprouts, cabbage, cauliflower, celery, cucumbers, eggplant, green beans, mushrooms, okra, onions, peppers, tomatoes, vegetable juice, turnips, and zucchini

Fruits

Apples, pears, peaches, plums, bananas, citrus fruits (such as oranges, grapefruit, lemons, and limes), tropical fruits (such as papaya, mango, and guava), melons, berries, and more are rich in fiber, potassium, vitamin C, and folate. Eat a variety of fruits.

Milk (and Milk Products)

Dairy products provide the calcium you and your baby need for strong bones. They’re also good sources of protein, potassium, and vitamins A, B, and D. To minimize your saturated fat intake, choose low-fat or nonfat milk products.

Tips for Choosing and Preparing Fruits and Vegetables

Choose organically grown fruits and vegetables whenever possible. Some types of produce are especially likely to have pesticide residue when conventionally grown. These include apples, bell peppers, celery, cherries, imported grapes, nectarines, peaches, pears, potatoes, red raspberries, spinach, and strawberries.1 To minimize the amount of chemicals and preservatives you may consume, choose organically grown varieties of this produce, if you can.

Choose fresh local produce that’s in season, when it’s cheapest and at its peak flavor. The more recently produce was picked, the more nutrients it has. If you can’t get fresh produce, frozen is next best, then dried or canned (but avoid those with added sugar and salt).

Raw fruits and vegetables have a higher nutrient content than cooked produce does. If you cook produce, the following methods are ordered from best to worst for preserving nutrients: steaming, microwave cooking, stir-frying, roasting, baking, and boiling.

MyPlate Food Groups and Servings2

Food Group

• Grains

• Vegetables

• Fruits

• Milk

• Meat and beans

What Equals a Serving?

• 1 slice bread; 1 cup dry cereal; ½ cup cooked cereal, rice, or pasta; ½ bagel; 1 pita; 1 tortilla; 1 potato

• 1 cup raw or cooked vegetables; 2 cups raw leafy vegetables; ¾ cup vegetable juice

• 1 cup chopped fruit; 1 orange; 1 apple; 1 banana; ½ grapefruit; ⅛ cantaloupe; 1 handful grapes; 1 cup 100-percent fruit juice

• 1 cup milk, cottage cheese, or yogurt; 1½-inch cube hard cheese

• 1 ounce meat, poultry, or fish; 1 egg; ½ cup tofu; ¼ cup cooked beans; ¼ cup nuts or seeds; 1 tablespoon peanut butter

Recommended Daily Servings*

• 9 servings

• 3½ servings

• 2 servings

• 3 servings

• 6½ servings

These serving sizes are based on the assumption that you’re choosing only foods that are low fat and without added sugar. You may also consume up to 410 “discretionary” calories per day from foods that contain oils, fats, or sugars. You may choose to eat foods that have a higher fat or sugar content, such as whole milk instead of nonfat, or sweetened cereal instead of unsweetened. Or you may choose condiments or foods that contain mostly fat or sugar, such as salad dressing, jelly, gravy, potato chips, or candy bars.

* Amounts are for a 2,600-calorie diet, appropriate for the second trimester of a 25-year-old, 5-foot 4-inch woman who weighed 160 pounds before pregnancy and exercises 30 to 60 minutes each day. For recommendations customized to you, visit http://choosemyplate.gov.

If you don’t like milk—Try yogurt and cheese, or you may prefer foods made with milk, such as cream soups, custard, pudding, and ice cream.

If you’re lactose intolerant—Try lactose-free milk or take a lactase enzyme before eating dairy products. Try cultured forms of milk, such as cheese, yogurt, or acidophilus milk. Your body may tolerate digesting several small servings of dairy instead of a few large servings.

If you choose not to consume milk products—Other sources of calcium include canned fish with bones; dark green leafy vegetables; dried beans; nuts and seeds; tofu with calcium sulfate; and calcium-fortified juice, soymilk, or rice milk. Your caregiver may recommend supplements such as calcium, vitamin D, potassium, and magnesium.

Meats and Beans

Meats and beans contain protein, which builds muscles, skin, enzymes, hormones, and antibodies. They also contain B vitamins, vitamin E, iron, zinc, and magnesium.

Making healthy choices about meat and fish—Use food safety practices (see page 120). To minimize your intake of saturated fat, choose the leanest cuts of meat, trim away extra fat, and drain off grease after cooking. When buying prepared meats, check the ingredients label on the package and choose meats that don’t include excess salt and fat. Eat fish twice a week. Choose seafood that’s low in mercury and high in omega-3 fatty acids. (See page 121).

If you choose not to eat meat or fish—Get the protein you need from eggs, dairy, beans, nuts, seeds, and tofu. You might not get enough iron, calcium, vitamin B12, or zinc unless you closely monitor your intake of those nutrients. If you’re vegan, health care professionals typically recommend that you take a daily supplement of at least 1 microgram of vitamin B12.

Fact or Fiction?

To ensure you get the best nutrition, you should eat fortified food products that have been scientifically designed to meet all your nutritional needs.

Fiction. Nutrition is an inexact science, and researchers are still learning about the components of a healthy diet. If you consider all the advice that nutritionists have given over the last fifty years, it’s amazing to see how much of it was based on faulty reasoning or incomplete information!

The best advice for optimal health is to eat a wide variety of real food that has been processed as little as possible. To learn more about the importance of eating whole foods, read the books In Defense of Food: An Eater’s Manifesto (2008) or Food Rules: An Eater’s Manual (2009) by Michael Pollan.

Empty Calories

Some foods, such as candy and soda, provide calories but no nutrients. Other foods, such as sweetened applesauce, fried chicken, or sugary cereals, contain some nutrients but also contain empty calories from solid fats and added sugars. Minimize your intake, or choose lower-fat, lower-sugar options.

Nutrients

Certain nutrients are particularly important for ensuring a healthy pregnancy. The following sections discuss these nutrients.

For a complete summary of the functions and sources of all major nutrients, along with recommendations for daily intakes, visit our web site, http://www.PCNGuide.com.

Protein

Protein builds all your body’s cells. During pregnancy, your protein requirement increases to 71 grams (about 23 grams more than your prepregnancy requirement). Your growing volume of blood and amniotic fluid, plus the rapid growth of your placenta, uterus, and baby, are the reasons for the increased requirement.

You should get protein only from food sources. Prenatal vitamins don’t supply protein, and protein supplements can lead to nutritional imbalances.

Fats

Healthy fats are essential for your baby’s brain growth, nervous system development, and aiding the absorption of vitamins A, D, E, and K. The healthiest fats are omega-3 fatty acids. Sufficient levels of these essential fatty acids in a pregnant woman’s diet may help reduce preterm labor, hypertension, and depression. You can get omega-3 fatty acids only from your diet; your body can’t synthesize them. The major sources are flaxseed oil and fish (see page 113). You can also find them in soybeans, walnuts, pumpkin seeds, pecans, hazelnuts, and omega-3 eggs. Omega-3 supplements from fish oil or flaxseed oil are also good sources.

After omega-3 fatty acids, the next best fats are unsaturated fats from plants, such as nuts and vegetable oils (canola, corn, safflower, sunflower, and olive). You can eat these fats in moderation.

Whether you’re pregnant or not, your total fat intake each day shouldn’t make up more than 30 percent of your diet and shouldn’t exceed 85 grams. Limit your intake of saturated fats from animal food sources (such as dairy products and meat) to no more than 28 grams, and avoid hydrogenated fats and trans-fatty acids. These bad fats can elevate cholesterol levels, and they may be linked to other health problems (such as obesity, diabetes, and heart disease).

Fat substitutes—Olestra is a fat substitute found in a few brands of chips and crackers. Because olestra depletes the body of the fat-soluble vitamins A, D, E, and K, foods containing olestra are supplemented with those vitamins. Although olestra causes no known risks to the baby, foods containing olestra have few nutritional benefits, and pregnant women should avoid consuming those foods.

Fluids

During pregnancy, fluids help deliver nutrients to your baby. They also help prevent constipation and urinary tract infections (UTIs). Drinking plenty of fluids doesn’t cause swollen ankles; in fact, it helps keep you from retaining too much fluid in your tissues.

Try to drink at least 64 ounces of fluids each day. You know you’re drinking enough fluids when your urine is pale yellow.

The healthiest fluid to drink is water, but some of your fluid intake can come from milk, juices, soups, and decaffeinated teas and coffees. Caffeine is a diuretic, which means it increases the amount of fluid in your urine (and decreases fluid retention in your body). As a result, you can’t record the entire volume of caffeinated beverages in your daily liquid log. (For example, you can’t attribute all the 12 ounces in a 12-ounce caffeinated beverage as part of your 64-ounces daily goal.) For more information on caffeine intake during pregnancy, see page 79.

You may find it difficult to drink enough fluids if doing so isn’t a habit. To help make fluids (especially water) enjoyable to drink, find some favorite ways to prepare them. Here are some options to try: over ice cubes, at room temperature, warmed, or with a squeeze of lemon or lime juice. You may also try different ways to drink fluids, such as through a straw or from a water bottle, to discover which ways help you drink more.

Common Q & A

Q: I’ve heard that bottled water is safer than tap water for me and my baby. Is this true?

A: Not necessarily. In the United States, municipal water systems are tightly regulated and monitored, making their water supplies safe for consumption. Bottled water may lack healthful minerals, which were filtered out before the water was bottled. In addition, there’s some concern over whether plastic bottles leach harmful chemicals into the water. Unless you’re opposed to additives (such as fluoride) or dislike the taste, you may benefit (and save money) from drinking tap water.

Carbohydrates and Sugars

Carbohydrates (also called “carbs” or starches) are your main source of energy. The 200 grams (or more) of carbohydrates you consume each day make up 45 to 70 percent of your total calories. The majority of your carbohydrate intake should come from foods containing complex carbohydrates. Examples include whole grains, legumes, starchy vegetables, citrus fruits, and nuts. Some of the carbohydrate intake can come from foods containing simple carbohydrates, such as fruit, dairy products, and unsweetened but refined cereal, bread, and pasta.

Minimize your consumption of sugars. Excess sugar may lead to tooth decay, obesity, decreased immune function, diabetes, and osteoporosis. Eat foods with sugar that are lower on the glycemic index; they won’t rapidly raise your blood sugar level (causing a “sugar rush”). Here’s a list of the glycemic load of the various sugars, ordered from best to worst:

1. Fructose, sugar alcohols (sorbitol, xylitol, erythritol, and mannitol)

2. Lactose in milk products

3. Less refined sugars: honey, molasses, maple syrup, date sugar, and fruit juice concentrate

4. Refined sugar (table sugar, brown sugar, turbinado sugar, corn syrup, and glucose syrup)

5. High-fructose corn syrup

Sugar substitutes (artificial sweeteners)—You can find low-calorie sugar substitutes in diet soft drinks, chewing gum, desserts, and in individual packets on restaurant tables. The U.S. Food and Drug Administration (FDA) has approved five sweeteners for use in foods: aspartame (Equal and NutraSweet), saccharin (Sweet’N Low), sucralose (SPLENDA), acesulfame-K, and neotame. Several extensive studies show that these artificial sweeteners appear safe for consumption by pregnant and breastfeeding women; however, anyone who has phenylketonuria (PKU) should avoid aspartame because it may cause severe health problems.

What about Prenatal Vitamins?

Eating a varied, high-quality diet is the best way to ensure you get all the vitamins and minerals you need. If your diet is excellent, you might not need prenatal multivitamin supplements. However, most caregivers recommend that pregnant women take a daily multivitamin supplement to help ensure they get the required nutrients. This recommendation may be especially important for women who are underweight, have poor eating habits, or avoid many kinds of food.

Talk to your caregiver about prenatal vitamins. If he or she recommends that you take them, choose one that meets all your nutritional needs. Don’t take several different kinds of multivitamins-doing so may lead to an accidental overdose of one or more nutrients. During pregnancy, avoid taking more than 100 percent of the recommended daily allowance (RDA) of any nutrient, unless your caregiver specifically recommends you do so.

Visit our web site, http://www.PCNGuide.com, for more information on recommended nutrients.

Although caregivers may prescribe sugar substitutes for women who have diabetes or need to restrict calories, most advise pregnant women to minimize their intake of sugar substitutes as well as sugar.3

Salt

For years, caregivers told pregnant women to restrict their intake of salt, based on the mistaken assumption that salt and water retention caused high blood pressure. Experts now know that gradual, moderate water retention in pregnancy is not only normal, but the extra fluid is necessary for an adequate volume of blood and amniotic fluid.

During pregnancy, consuming an adequate amount of salt helps maintain your fluid balance. Feel free to salt your food to taste.

Folate and Folic Acid (Vitamin B9)

Folate is a B vitamin that’s found naturally in foods such as leafy green vegetables and some fruits. It’s essential for your baby’s normal growth, and it’s especially important in early pregnancy to prevent certain birth defects. Folate helps form blood cells and promotes the normal development of your baby’s brain and spine. Folate that’s produced synthetically is called folic acid. Caregivers recommend a daily folic acid supplement of 400 micrograms (0.4 milligram) for all women of childbearing age and 600 micrograms (0.6 milligram) for pregnant women.

Calcium

Calcium is important for the growth of your baby’s bones and teeth. It’s especially vital in the third trimester, when your baby requires about two-thirds more calcium than he did earlier in his development. Calcium is also stored in your bones as a reserve for breast milk production. Caregivers recommend that pregnant women consume 1,200 milligrams of calcium each day.

Iron

Iron is required for the production of hemoglobin, which carries oxygen through your bloodstream to your baby and your cells. During the last six weeks of pregnancy, your baby stores enough iron to supplement her needs for the first three to six months after the birth. Caregivers often recommend that pregnant women take a daily iron supplement of 30 to 60 milligrams. Foods rich in vitamin C (such as citrus fruits and tomatoes) enhance iron absorption, while some antacids and caffeine interfere with it.

Iron supplements can cause nausea or constipation in some women. To relieve these unpleasant side effects, try taking the supplements with food, or try a different brand of supplement that doesn’t cause constipation. You may also want to try reducing the dosage of the supplements and taking them more often throughout the day.

Vitamin A

Vitamin A helps form and maintain healthy teeth and bones, soft tissue, mucous membranes, and skin. It also promotes good vision.

During pregnancy, getting too little vitamin A (less than about 770 micrograms per day) can lead to preterm birth and an underdeveloped baby. However, getting too much vitamin A (more than 3,000 micrograms per day) in the first seven weeks of pregnancy can lead to a higher incidence of birth defects.

Weight Gain during Pregnancy

A common question women ask during pregnancy is how much weight they should gain. The answer varies because no single amount is appropriate for every woman. The proper amount of weight to gain depends on a woman’s prepregnancy weight and height, the quality of her diet before and during pregnancy, her ethnic background, and the number of previous pregnancies she has had.

RECOMMENDATIONS FOR YOUR WEIGHT GAIN4

How can you determine the proper amount of weight to gain during pregnancy? First look at the chart at right to figure out your prepregnancy Body Mass Index (BMI), which takes into account your height and prepregnancy weight to gauge your total body fat. For example, let’s say your height is 5-feet 4-inches and your prepregnancy weight was 160 pounds. By looking at the chart, you can see that your prepregnancy BMI is 28. The chart shows the results of a mathematical formula (rounded to the nearest whole number), in which BMI equals weight multiplied by 703 and divided by height in inches squared.

After you’ve figured out your prepregnancy BMI, look at the table to determine the amount of weight you should gain.

These recommendations are guidelines. Many women gain more or less weight during pregnancy, and they and their babies are fine. However, women who gain too little weight increase their risk of having a premature baby or one with low birth weight. Women who gain too much weight increase their risk of developing preterm labor, gestational diabetes, high blood pressure, or macrosomia (large baby that can be difficult to deliver vaginally). These women also find it harder than usual to lose the extra weight after the birth.

image

 

Prepregnancy BMI

Total Weight Gain

Underweight

Less than 18.5

28 to 40 pounds

Normal Weight

18.5 to 24.9

25 to 35 pounds

Overweight

25 to 29.9

15 to 25 pounds

Obese

More than 30

11 to 20 pounds*

* For women who are obese when pregnancy begins, some researchers argue for limiting weight gain to just ten pounds.5

Where Does That Extra Weight Go?

Here’s a breakdown of the weight distribution in a pregnancy with an average weight gain:

Baby

7 to 8½ pounds

Placenta

1 to 1½ pounds

Uterus

2 pounds

Amniotic fluid

2 pounds

Breasts

1 pound

Blood volume

2½ pounds

Fat

5 to 8 pounds

Tissue fluid

6 pounds

Total

27 to 31½ pounds

Your caregiver will likely monitor your weight gain at each prenatal visit. In early pregnancy, you’ll gain weight slowly, typically just 1 to 5 pounds by the end of the first trimester. Beginning in the second trimester, as your baby grows and your amniotic fluid and blood volume increases, you’ll gain weight more rapidly—up to 1 pound per week. (An overweight or obese woman may need to gain only ½ a pound per week).

Although a minor increase or decrease in your weight may be a sign that you’ve eaten more or less than usual, a sudden, excessive change can be a sign of illness or preeclampsia (see page 140), especially if accompanied by other symptoms (such as sudden swelling).

Health care professionals stress that pregnant women should avoid losing weight or overeating; instead, they should concentrate on eating a high-quality diet in appropriate amounts and maintaining an active lifestyle that includes moderate exercise. If you follow that advice, you’ll gain weight in the amount that’s right for you.

WEIGHT LOSS AFTER THE BIRTH

You’ll lose some of the weight you gain during pregnancy within a few weeks after the birth. By eating sensibly and exercising adequately, some women can lose most of the remaining weight over the following months. For other women, losing the extra weight takes longer.

image

Breastfeeding promotes weight loss because milk production burns calories. The fat stored during pregnancy provides some of these calories; the food you eat provides the rest. Until your breastfed baby weans, your body may naturally hang on to a few pounds of fat as a way to ensure your baby is well nourished should you experience a food crisis. This extra weight is typically easy to lose after weaning.

Common Concerns

During pregnancy, normal changes in hormone production, plus the increased size and weight of the uterus, can cause digestive and other problems. The following sections discuss these problems, their causes, and treatments.

Tips for Managing Nausea

• Eat several small meals a day to prevent an empty stomach and to keep your blood sugar level stable. Include a protein-rich food with each meal.

• Don’t drink a lot of fluids with meals. Instead, drink between meals.

• Keep a bland food (such as crackers) by your bed and eat some just before getting up.

• Trust your food preferences. If something sounds good to eat, you’ll probably tolerate it.

• Identify and avoid odors that make nausea worse. Try smelling peppermint oil or fresh lemon slices to ease nausea. (Drinking peppermint tea may also help.)

• Caregivers often recommend ginger (but not supplements of dried, powdered ginger root). You can eat ginger in foods, eat candied or pickled ginger, or drink ginger tea or natural ginger ale.

• Increase your intake of foods rich in vitamin B6 (pyridoxine), such as whole grains and cereals, nuts, seeds, and legumes. Vitamin B6 supplements may reduce nausea. Your daily intake should never exceed 100 milligrams; discuss safe amounts with your caregiver.

• Use acupressure wristbands, which are marketed to relieve motion sickness.

• Know that the nausea and vomiting usually passes within 3 to 4 months.

On rare occasions, nausea and vomiting are severe and a woman becomes dehydrated, loses a lot of weight, and can’t keep down any food. This condition (called “hyperemesis gravidarum”) may require medications (such as Zofran) or even hospitalization. (See page 129.) Because these medications cross the placenta and their safety for the baby hasn’t been established, take them only if your caregiver prescribes them.

NAUSEA AND VOMITING

During pregnancy, nausea is also called “morning sickness.” But for many women, morning sickness isn’t limited to the morning; they experience nausea at any time throughout the day.

What causes nausea? As production of the hormones that support pregnancy increases, you may feel nauseated until your body adjusts to the increased levels. (Some women also experience diarrhea in early pregnancy, which may be due to hormones or dietary changes.) In the first trimester, nausea is common in women who haven’t eaten for several hours, who smell certain odors, or who encounter other triggers. Nausea is neither abnormal nor a sign that you’re unconsciously rejecting your baby. See above for tips on managing nausea.

If your nausea leads to vomiting, you may worry about your baby’s health. But unless severe and unusually frequent, vomiting doesn’t harm your baby. Studies show that a woman who’s healthy when she conceives has sufficient reserves to nourish her growing baby, even if she can’t eat well for the first several months of pregnancy.

HEARTBURN

Heartburn is a condition in which you burp up stomach acid, causing a burning feeling in your chest or throat. In late pregnancy, many women experience heartburn. Its cause is a combination of increased pressure from the growing uterus and hormonal effects that relax the muscular opening at the top of the stomach and cause the stomach to empty more slowly. To help ease or prevent heartburn, follow these tips:

• Avoid eating fatty foods, spicy foods, and foods that produce gas or heartburn.

• Eat several small meals a day. Drink only a small amount of fluid with meals.

• Eat slowly and avoid eating just before bedtime.

• To decrease discomfort when in bed, semi-sit rather than lying flat on your back.

• Taking antacids or other medications sometimes controls heartburn, but you should take them only if necessary. Ask your caregiver for recommendations.

CONSTIPATION

During pregnancy, food moves through your intestines more slowly to let your body absorb more nutrients and water. This slowdown sometimes causes constipation, and pressure from your growing uterus on the large intestine magnifies the problem. Constipation can also aggravate hemorrhoids. Some tips to avoid constipation include the following:

• Exercise regularly and consume plenty of fluids and high-fiber foods, such as fruits and vegetables, whole grains, bran, and prune juice. An easy way to increase your fiber intake is to add a tablespoon of flax meal to your food.

• If proper diet and exercise don’t prevent constipation, try an over-the-counter high-fiber product such as Metamucil or Fiberall. Such products are safe and effective; however, avoid taking intestinal stimulants (laxatives). Your body may become dependent on them.

• If you’re taking an iron supplement and you think it’s causing the problem, ask your caregiver about changing to one that causes less constipation.

FOOD CRAVINGS AND PICA

Pregnant women frequently crave specific foods in large quantities. Sometimes, women eat foods they rarely ate before pregnancy, such as hot peppers or other spicy foods, one flavor of ice cream, potatoes, or pickles. Although health care professionals don’t know why pregnant women crave certain foods, the cravings are usually harmless unless they interfere with good nutrition.

Also common during pregnancy is pica (craving and eating nonfood items). Pregnant women have reported craving ice, baking soda, flour, cornstarch, dirt, clay, cigarette ashes, and other nonfood substances. They’ve also described cravings to smell such substances as gasoline, fingernail polish remover, bleach, and ammonia.

Eating nonfood products and smelling substances can cause mild to severe side effects in both the mother and baby. While many women worry about these side effects, they’re reluctant to share their concerns with their caregivers. They may be confused or ashamed by their behavior, or they may worry that their caregivers will advise them not to satisfy the craving.

If you have nonfood cravings, have your caregiver or a counselor help you determine whether satisfying them is harmful to you or your baby. If it is, he or she can help you find ways to cope with the cravings and avoid the harmful substances.

Food Safety

Some forms of bacteria and environmental contaminants can harm babies’ development in the womb. Although the risk of harm is small, pregnant women should take precautions to prevent exposure. The following sections discuss ways you can limit your exposure. For more information on food safety, visit http://www.fda.gov/Food/ResourcesForYou/HealthEducators/ucm081785.htm.

MERCURY

Mercury is a metallic element that can harm your baby’s developing brain and nervous system. It’s found in large, long-lived fish, which is regrettable because fish are a great source of essential nutrients, including omega-3 fatty acids. As long as the fish has low levels of mercury, it’s better to eat it in moderation than to stop eating fish entirely.

Here are amounts of fish that pregnant women can safely eat, based on mercury levels. The asterisked items are highest in omega-3 fatty acids.

Up to 12 ounces per week—Anchovies*, catfish, clams, cod, crab, flounder, herring*, oysters, pollock, salmon*, sardines*, scallops, shrimp, sole, tilapia, and trout*

Up to 6 ounces per week—Halibut, snapper, lobster, tuna, and mahi-mahi

Avoid completely—Shark, tilefish, king mackerel, swordfish, grouper, marlin, and orange roughy6

FOOD-BORNE BACTERIA

Pregnant women are more susceptible to listeriosis, salmonella, and toxoplasmosis bacteria than other people are. These bacteria can sicken pregnant women and cause miscarriage, preterm labor, and stillbirth. These bacteria live in undercooked meat, fish, and eggs; unpasteurized milk and cheeses; and unwashed fruits and vegetables. Although the chance of exposure is small, the effects can be grave. Use the following food safety practices to prevent exposure. (See page 132 for more information on infections in pregnancy.)

Keep things clean.—Before and after handling food, wash your hands thoroughly with warm soapy water. Rinse raw fruits and vegetables thoroughly. Separate raw meat, poultry, and seafood from ready-to-eat foods. After using cutting boards, knives, and plates to prepare raw meat, poultry, or seafood, wash the items thoroughly in hot soapy water before using them to prepare other foods.

Cook meat, fish, and eggs thoroughly.—In addition, before eating hot dogs and luncheon meats (such as ham, turkey, bologna, salami), heat them until they’re steaming. Cook refrigerated smoked seafood (such as Nova-style lox salmon) before eating.

Store foods well.—Set your refrigerator to 35°F to 40°F (2°C to 4.4°C) and your freezer to 0°F to 4°F (-18°C to –16°C). Regularly clean the interior of your refrigerator, and discard all food that’s past its expiration date.

Use the two-hour rule.—Discard any food that’s prone to spoilage if it’s been left out at room temperature for more than two hours.

Be smart about takeout foods, delivered foods, and restaurant leftovers.—Eat hot foods as soon as possible after purchasing. Eat cold foods within two hours. Refrigerate restaurant leftovers within an hour and eat within two days. Eat delivered foods within two hours.

Avoid eating unpasteurized foods and some raw foods.—It’s fine to eat foods that contain pasteurized milk, cooked fish, shelf-stable smoked seafood, and canned pâtés and meat spreads. But it’s best to avoid eating the following foods:

• Unpasteurized milk products, including soft cheeses made from unpasteurized milk (such as Brie, Camembert, blue cheese, feta, and Mexican fresh cheese)

• Raw fish, especially raw shellfish

• Refrigerated pâtés or meat spreads

• Raw vegetable sprouts (such as alfalfa sprouts and bean sprouts)

Nutrition for Special Circumstances

In certain cases, having good nutrition is especially important during pregnancy. If one or more of the following sections describe your situation, be particularly conscientious about eating nutritious foods. Seek nutritional counseling from your caregiver or a nutritionist.

PREGNANT WITH MULTIPLES

If you’re pregnant with twins, increase your prenatal vitamin dosages by 50 percent and consume an extra 600 calories each day. You should try to gain 35 to 50 pounds. If you’re pregnant with triplets or more, ask your caregiver for nutrition advice.

When pregnant with multiples, it’s important to gain at least 24 pounds by the twenty-fourth week of pregnancy to help reduce the risk of preterm birth and babies with low birth weight.

TEENAGE PREGNANCY

A pregnant teenager needs to eat particularly well to promote her own growth while nourishing her baby. If you’re a pregnant teenager, make sure to consume enough calcium, phosphorus, and magnesium.

PREGNANT WITHIN A YEAR OF GIVING BIRTH

Pregnancy can temporarily deplete your reserves of certain nutrients such as calcium and iron. If you become pregnant within a year of your last birth, you may need extra calories and nutrients. The time needed between pregnancies to correct deficiencies depends on your overall nutritional status and the quality of your diet. Talk with your caregiver about your needs.

FOOD ALLERGIES

If you have significant food allergies, eliminating problem foods can lead to an inadequate diet. You may need a nutritionist to help you plan a healthful pregnancy diet.

ANOREXIA AND BULIMIA

If you have a history of anorexia or bulimia, you may have difficulty accepting the weight gain and body changes that occur with pregnancy. In addition, your low weight and poor nutritional status may harm your and your baby’s health during pregnancy. Psychological and nutrition counseling may help you, as may anorexia and bulimia support groups.

HIGH BLOOD PRESSURE

Developing high blood pressure during pregnancy—or gestational hypertension—isn’t always preventable. But by eating a healthful diet, drinking plenty of fluids, exercising regularly, and avoiding alcohol and caffeine, you may reduce your risk of severe complications. Although research hasn’t yet found a single nutrient that prevents gestational hypertension, several nutrients may reduce the risk, including protein, calcium, magnesium, zinc, vitamins C and E, and omega-3 fatty acids. Make sure your diet includes healthy amounts of these key nutrients. (See page 140 for more on high blood pressure.)

DIABETES IN PREGNANCY

Whether you have diabetes or are at high risk for developing diabetes, carbohydrates shouldn’t make up more than 40 percent of your daily caloric intake. Avoid eating more than 30 to 45 grams of carbohydrates at one meal. Complex carbohydrates are much better for you than simple carbohydrates.

Keep your fat intake to less than 30 percent of your daily caloric intake, and increase your protein intake to 75 to 100 grams. Eat at the same times every day, and eat several small meals each day to keep your blood sugar level stable. (See page 134 for more on diabetes.)

LOW INCOME

If you’re pregnant and have a low income, you may find it difficult to obtain the proper nutritious foods. Here’s a list of resources that can help you:

• WIC (Women, Infants, and Children) provides supplemental food and nutrition education to low-income families. To find out if you’re eligible for these services, visit http://www.fns.usda.gov/wic.

• You can use government food stamps to purchase food. To find out if you’re eligible, visit http://www.fns.usda.gov/fsp.

• Food banks provide supplemental foods. Check a phone book or search online to find a local food bank.

Key Points to Remember

• Eat a well-balanced diet that includes lots of whole grains, vegetables, and fruits. Choose low-fat milk products, meat, and fish. Eat a variety of beans and legumes. Drink plenty of liquids, and salt your food to taste. Don’t try to achieve perfection—just make the best choices you can each day.

• Talk with your caregiver about supplementing your diet with a prenatal vitamin or specific nutrients. (Visit our web site, http://www.PCNGuide.com, for a chart of recommended nutrients.)

• Gain an amount of weight that’s appropriate for you by considering your prepregnancy weight and height, and the quality of your diet before and during pregnancy.

• Normal changes in hormone production, plus the increased size and weight of the uterus, can cause nausea, vomiting, constipation, and other problems that can be treated.

• Although the chance of harm to you and your baby from food bacteria and contaminants is small, take precautions to prevent exposure.

• Good nutrition is especially important in certain cases, such as teenage pregnancy or pregnancy with multiples. Seek nutritional counseling from your caregiver or a nutritionist.