The Do’s and Don’ts of Prenatal Nutrition
Whether you're about to start a family or already expecting, you’ll get advice from all who want to offer you words of wisdom. And nutrition is one of those topics. In my pregnancy journey, I’m blessed to have had the nutrition knowledge to support me and my growing baby, but I’ve also learned some helpful tools for managing different symptoms. Here I want to give you a general overview of nutrition considerations for the prenatal phase, recommendations for managing gastrointestinal complications, the importance of finding that right prenatal, and other supplements that may be beneficial to you.
How to eat for two
It’s important to note that yes, your caloric intake and fluid needs do increase, but don’t necessarily double. The phrase “eat for two” is absolutely appropriate when considering how the quantity and quality of the mom’s diet can impact a baby’s growth and development. There are key nutrients of focus and some general calorie guidelines per trimester.
Calorie increases per trimester
Let’s start with the basics of calories. For the first trimester it's recommended to keep your calories at baseline. However, I can think back to my first trimester and at times my appetite was greater than currently in my third. What I’d recommend to all you first trimester moms out there is listen to your body while also creating balance. Aim for 3 daily meals with protein, carbs, both simple and complex, and fat from as many food groups as possible, and a snack or multiple snacks per day with at least 2 different food groups, such as fruit and protein. This regimen supports honoring and managing this hunger rather than bouts of hangry combined with not being satisfied after eating because we’ve gone too long without fuel.
Within the second trimester (13-26 weeks) your baseline calories should increase by 340 per day. This can be met in different ways: adding in another snack with 2-3 food groups, adding an extra food group to a snack or two per day, i.e. instead of 2 different food groups aim for 3-4, or by increasing the portion of 1-2 food groups on your plate at 2 meals per day. Here’s one example snack idea: fruit paired with 1-1.5 tablespoons of nut butter and 1 serving of whole grain crackers.
Third trimester (27 weeks on) increases should be 450 calories per day above baseline.
If you are carrying twins your second trimester calories should increase by 500-600 per day above baseline, and 900 or more the third. Work closely with your health care team if you have multiple as this may take a more individualized approach.
Meeting hydration needs
While your food is increasing, your fluids intake should follow. I recognize this could be frustrating at times as the baby grows bigger it tends to add more pressure to the mom’s bladder causing an increase in urination. Try a small amount of fluids at a time rather than all at once. Aim for the fluid goal of 1 milliliter per calorie consumed. Another simple breakdown is 8-12 cups per day. Fluids can include water, coffee, tea, soda, milk, and juice.
Nutrients of importance
Eating a variety of foods while honoring cravings and finding the regimen that works for you in pregnancy is key to supporting you and your baby. There are some important micronutrients of focus to support the baby’s neural tube formation, brain development, and overall growth. Below are these plus daily amounts recommended by the American College of Obstetricians and Gynecologists.
Folic acid- 600 micrograms
Vitamin B6- 1.9milligram (mg)
Vitamin B12- 2.6 micrograms
Vitamin D- 600 international units
Calcium- 1000 mg for ages 19 to 50 and 1300 mg for 14 to 18 years old
Vitamin A- 750 micrograms for 14-18 years old and 770 for ages 19-50
Iron- 27 mg
Choline- 450 mg
Vitamin C- 80 mg for ages 14-18 and 85mg for 19-50 years old
Iodine- 220 micrograms
Another nutrient of importance is omega 3 fatty acids, more specifically docosahexaenoic acid (DHA) and alpha-linolenic acid (ALA). Aiming for 200-300mg per day of DHA in a daily prenatal or at minimum 8-12 ounces of low-mercury containing fish per week will meet your pregnancy needs.
It is highly recommended for pregnant women and women trying to conceive to take a daily prenatal. When searching for the right prenatal, take into consideration the values of each micronutrient above, make sure to choose an option with DHA, incorporate choline into this multi or as a separate supplement, and look for options that are third party tested. Check out my past blog Dietary Supplements: What They Are and How to Choose One for guidance with finding a reputable supplement brand. Always communicate closely with your healthcare team about the options available to you and as you decide to start any new medication or supplement regimen.
Foods to avoid
Below are a list of foods and beverages that are not recommended in pregnancy:
Alcohol
Caffeine should be limited
Raw or undercooked meats, poultry and fish
Undercooked eggs
Unpasteurized dairy or egg products
Cured meats i.e. luncheon meats and sausage: these can be consumed if cooked before consumption
Fish with a high mercury content: tilefish, king mackerel, shark, swordfish, and bigeye tuna. Albacore and white tuna, typically what’s found in canned tuna, and yellowfin are safe to consume in smaller quantities. Per the FDA and EPA, 1 canned tuna serving per week, about 4oz, is safe and recommended for pregnancy. The overall recommendation for fish is 2-3 servings per week, or 8-12 ounces, with options low in mercury.
Caffeine, okay or not?
Caffeine while pregnant is safe in moderate amounts. Limiting caffeine to 200 milligrams (mg) per day is recommended. Chocolate, soda, coffee, and tea all contain varying amounts of caffeine. A standard cup of tea, from 1 tea bag, is approximately 30-50 mg per serving. One 6-8 fl oz cup of coffee is about 75-100 mg. A shot of espresso is anywhere from 50-75 mg. Energy drinks can vary greatly, sometimes as much as 300 mg per can so note these may need to be avoided in pregnancy. If you’re used to consuming greater than 200 mg of caffeine per day, try weaning off your favorite beverages with decaf options or slowly cutting back within the appropriate range.
Managing gastrointestinal complications in pregnancy
Considering the amount of gastrointestinal complications that can accompany pregnancy, meal and snack timing may have to look a little different. If you're experiencing nausea, heartburn, and/or acid reflux, aim for 4-6 smaller meals and snacks per day rather than larger meals. Below are some other food tips and supplement recommendations that may ease the discomfort.
Acid reflux or heartburn: Limit greasier, high fat meals, high acidic foods like oranges/orange juice or tomatoes especially on an empty stomach, and coffee. Avoid eating within 1-2 hours of lying down and try sleeping with your head propped. Tums and pepcid are safe supplements that help neutralize stomach acid to improve symptoms.
Nausea: Ginger chews, lemon water or tea, peppermint tea, chicken broth, small amounts of crackers or white toast are some natural remedies for reducing nausea. Supplementing with vitamin B6, or pyridoxine, at a dose of 10-25 mg 1-2 times per day, has also been shown to improve nausea in pregnancy.
Constipation: Ensure you’re getting enough fiber, especially from soluble fiber sources like oats, beans, sweet potatoes and some other vegetables, some fruits, nuts and seeds. Women should aim for 25-28 grams (g) of fiber per day, or another way to look at this as calories increase in pregnancy is 14 g for every 1000 calories consumed. Prune juice and apple juice are other natural remedies. Fiber supplements such as metamucil (psyllium husk), the osmotic laxative miralax, stool bulking agents like colace, and magnesium citrate are common over-the-counter supplements that help with relieving constipation and are safe for pregnancy.
Diarrhea: Food and hydration recommendations for constipation can also apply to managing intermittent diarrhea. Definitely ensure you are hydrating well. If diarrhea persists multiple days in a row, consider the BRAT diet, bananas, white rice, applesauce, and toast, if it’s ongoing with no improvements and incorporate electrolyte rich fluids such as gatorade or pedialyte. For medication support, the anti-diarrheal Imodium is safe to take while pregnant.
Nutrition while pregnant increases in importance compared to just nourishing your body for one. The variety and quantity of what’s consumed can directly impact a baby's growth and development, and eating for two applies in this way rather than having to double your intake. First trimester calories and fluids don’t require an increase, but appetite may be greater so be gentle with yourself in properly planning meals and snacks and honoring your hunger. Second trimester calories increase by 340 per day above baseline, then 450 calories per day above baseline in the third, and with twins or multiples calorie increases are even greater. Aim for 1 milliliter per calorie of fluids, or approximately 8-12 cups at minimum per day. Note the micronutrients of importance in pregnancy and the recommendations for omega-3 fatty acid intake daily from low mercury fish options. Taking a daily prenatal can be a vital part of meeting your nutritional needs and baby’s. If you’re experiencing gastrointestinal issues that can accompany pregnancy, such as heartburn/acid reflux, nausea, or differences in stool patterns, you may have to trial different meal and snack combinations, aiming for 4-6 smaller meals per day, and/or a supplement regimen. Always talk with your health care team first prior to starting any new supplement while pregnant.
Still have questions after this blog? Reach out to us at Enhance Nutrition and we can give you support with meeting your prenatal food and beverage needs.
Resources
https://www.acog.org/womens-health/faqs/nutrition-during-pregnancy
https://www.who.int/tools/elena/interventions/vitaminb6-pregnancy
https://starkist.com/faq/#:~:text=The%20FDA%20and%20EPA%20have,a%20week.