Craving What’s Good for You(r Baby)

Nutritional Guidelines for Pregnancy

You may not like that your OBGYN is so keenly interested in the seemingly boring details of nutrition and weight during your pregnancy, but as your baby grows, you can be certain that you will be put up on the scale each and every time you have a prenatal checkup. You will also be asked many questions regarding the content and quality of your diet.

While pregnancy is to be enjoyed, many women believe that they can eat without regard to calorie count. Some women may want to remain thin and eat too little nutritious food. Others may feel it is their right to feast on sweets any time they feel the urge.

Maintaining proper nutrition and weight throughout pregnancy is very important. However, it is a daunting task to try and rummage through the plethora of nutritional information available. A well balanced diet, proper weight gain and special consideration to the individual’s needs will contribute greatly to the well being of both the mother and child. The mother’s adaptation to the hormonal and physical changes of pregnancy is aided by a proper diet. Similarly, the rapidly developing fetus needs the proper nourishment provided by the mother’s well balanced diet to allow proper organ and brain development.

Recommended Weight Gain in Pregnancy

The intent of this article is not to cause undue worry… but to simply offer a few guidelines regarding what researches have found to be true regarding weight, the size of your own pre-pregnancy physique, and the healthy development of your baby during pregnancy.

Pregnant women should have a 25–40 lbs. gain depending on their pre-pregnancy weight. The pre-pregnancy weight gain is calculated as BMI (Body Mass Index). the definition is weight (pounds) divided by height (inches) squared an then multiply by 703.

To determine BMI (Body Mass Index):

Divide weight (pounds) by height (inches) squared and multiply by 703

e.g.(140 lbs/(68 inches x 68 inches) x 703 = 21.3

BMI Chart (Body Mass Index)

BMI less that 19.8	28–40 lb.
BMI 19.8–26	25–35 lb.
BMI 26–29	15–25 lb.
BMI greater than 29	at least 16 lb.
Twin Pregnancies	25–45 lb.

Multiple Pregnancies (based on pregravid weight)

underweight	50–62 lb.
normal weight	40–54 lb.
overweight	38–47 lb.
obese	29–38 lb.

Other:

Young adolescents and black women should aim for gains at upper end of range.

Short women should aim for gains at lower end of range.

Weight gain in early pregnancy is due to increased blood volume and deposition of maternal fat. In the second and third trimesters weight gain is related to growth of the fetus, placenta, and to an increase in amniotic fluid volume.

Maternal weight gain should be monitored throughout the pregnancy, as adequate gain is generally an indicator of proper nutrition.

The Baby’s birth weight is directly related to birth weight of the mother. Both excessive and insufficient weight gain can lead to pregnancy complications and affect the health of the growing fetus and newborn baby.

Excessive weight gain in pregnancy can increase a mother’s chances of developing gestational diabetes, pre-eclampsia. It also can lead to difficult deliveries, birth trauma and a higher incidence of cesarean deliveries. Overweight women are also at a higher risk of infection in the postpartum period

Inadequate weight gain puts a baby at risk of reduced birth weight, intrauterine growth retardation (developmental delays), and higher risk of pre-term delivery. Short women should aim for gains at lower end of range.

Energy

Pregnant women should increase their caloric intake by anywhere from 300 to 700 calories a day. The total number of calories should probably range from 2200 to 2900 calories per day. However, due to individual differences in basal metabolic rate and energy output the range of acceptable intakes is vast.

In general the extra energy needed:

1st Trimester calories are not increased from pre-pregnancy needs.

2nd Trimester add approximately 340–360 calories per day.

3rd Trimester add approximately 452 calories per day.

Fluids

Drinking 8 to 10 cups of fluid a day will maintain adequate hydration. Some of the fluid needs are met through milk, juice and the water in foods such as fruit and vegetables.

Supplements

1. Folic Acid: 400 μg synthetic folic acid daily from fortified foods or supplements in addition to 200 μg food and beverage forms of folate in a varied diet.
2. Fortified foods (must state on the label): breakfast cereals, rice, noodles, and bread. Food/beverage forms: liver, mushrooms, spinach, asparagus, lean beef, potatoes, orange juice and dried beans.
3. Iron: 27 mg iron daily is recommended. Anemic women may need 60 mg a day until the anemia is resolved. In addition, for optimal absorption, the iron supplement should ideally be taken between meals and not with milk, coffee or tea but with a beverage containing vitamin C as it enhances absorption of the iron.
4. Vitamin D: Supplementation with amounts greater than the RDA of 200 IU/d does not appear to provide additional benefit to pregnant women.
5. B-12: vegans and some vegetarians should take a B-12 supplement if they don’t already.
6. Multivitamin vitamin: The Institute of Medicine has not found sufficient evidence to recommend routine use of most vitamins except for those with high-risk pregnancies (e.g., undernourished females, teenagers, females with substance abuse problems, females with a short interval between pregnancies, females with history of delivering low body weight infant, females with multiple gestation).

Alcohol

Should be avoided by pregnant women or women who may become pregnant.

Caffeine

Pregnant women should limit caffeine intake to below 300 mg a day. Caffeine content :

16 ounce coffee—range from 143–564 but the average is 188 mg

12 ounce can of soda—18–48 mg of caffeine

Herbal/Botanical/Alternative Remedies

There are very few randomized clinical studies that have examined the safety and efficacy of alternative therapies during pregnancy. All women, especially pregnant women, should Inform their health professionals of any supplements that are being taken that the doctor has not prescribed.

Food Borne Illness

Pregnant women and their fetuses are at a higher risk of developing food borne illness. The pathogens of particular concern are Listeria monocytogenes, Salmonella and Toxoplasma gondii. Pregnant women should adhere to the following guidelines:

• Do not eat or drink unpasteurized milk or milk products including soft cheeses, raw or undercooked meat and poultry, unpasteurized juice, raw sprouts, raw or undercooked fish or shellfish and raw or partially cooks eggs (or foods containing raw eggs).
• Avoid cold smoked fish and cold deli salads.
• Eat only deli meats, luncheon meats, bologna and hot dogs that have reheated to steaming hot.
• Do not handle pets when preparing food and keep them out of the food preparation areas. Do not clean cat litter boxes or wear plastic gloves when cleaning litter boxes.
• Do not eat shark, swordfish, king mackerel or tilefish. Consuming twelve ounces or less per week of fish and shellfish lower in mercury (such as shrimp, canned tuna, salmon, pollock and catfish) is safe. Limit albacore “white” tune to 6 ounces or less per week. Also, check local advisories about safety of fish in bodies of water.

Nutritional counseling can be helpful in establishing dietary guidelines. This is particularly helpful in the following categories:

• Overweight and underweight women
• Women with known food allergies
• Those with dietary restrictions (i.e. vegetarians)
• Women who suffer from specific medical problems (i.e. diabetes)
• Young women and adolescents with poor dietary habits.
• Pregnant women who suffer from nausea and vomiting and thus unable to maintain a normal diet.

A registered dietician should be consulted regarding the need for nutritional advise, especially in women with any of the the above named problems. In addition, more individualized plans can be seen on “My Pyramid for Moms” at www.mypyramid.org

Guidelines regarding specific foods

Pregnant women and their fetuses are at a higher risk of developing foodborne illness. The pathogens of particular concern are Listeria monocytogenes, salmonella and Toxoplasma gondii. Pregnant women should never handle pets when preparing food . animals should be kept away from food preparation areas. In addition, pregnant women should either not clean cat litter boxes or wear plastic gloves when cleaning the litter boxes.

Pregnant women should adhere to the following guidelines:

1. Fish and Shellfish: Due to the accumulation of mercury and other toxins, consumption of fish should be reduced during pregnancy and limited to no more than two weekly servings.
   • Avoid fatty fish that harbor high levels of mercury and other toxins. Avoid swordfish, shark, tilefish, king mackerel, striped bass, and bluefish.
   • Eat no more than 6 oz. of albacore white tuna, tuna steak, and halibut.
   • The following fish have lower levels of toxins and should be consumed preferentially; cod, flounder, salmon, light canned tuna, sardines, pollack, shellfish, atlantic mackerel, and haddock.
   • Avoid raw fish and shellfish due to the risk of bacterial contamination.
   • Avoid cold smoked fish and cold deli salads
2. Calcium and Vitamin D intake: Increase intake of calcium to about 1,000–1,300 mg per day. Vitamin D supplements should be approximately 800 IU to 1,000 IU per day.
   • Insufficient calcium and vitamin D can effect childhood skeletal development. Calcium and vitamin D are important building blocks for the developing fetal skeleton.
   • Proper calcium levels are essential for maintaining a normal pregnancy and can reduce the risk of pre-eclampsia and prematurity.
3. Milk and cheese: Dairy products are an excellent source of protein and calcium.
   • Avoid unpasteurized milk or milk products including soft cheeses due to the risk of Listeria, a bacteria that can have devastating effects on the growing fetus.
   • Some dairy products are high in fat and their consumption should be monitored.
4. Eggs, Poultry and Meat,etc.:
   • Avoid raw and undercooked eggs, poultry and meat due to the risk of Salmonella. Undercooked meat can harbor Listeria.
   • Eat only deli meats, luncheon meats, bologna and hot dogs that have been reheated to steaming levels.
   • Raw sprouts and unpasteurized juices should be avoided also.
5. Alcohol: Alcohol consumption has been linked to a condition, fetal alcohol syndrome that is characterized by facial anomalies, mental retardation and learning disabilities. This condition can occur even in women who consume small quantities of alcohol. Therefore there are no “safe” levels of alcohol allowed during pregnancy. Alcohol therefore should be avoided completely during pregnancy.
6. Caffeine: Excessive consumption of caffeine has been linked to low birth weight and miscarriage. Drinking more than two cups of coffee per day (more than 300 mg of caffeine) should therefore be avoided.
   • 16 ounce coffee—range from 143–564 but the average is 188 mg.
   • 12 ounce can of soda—18–48 mg of caffeine.
7. Fat Consumption: Trans-fats found in processed foods and junk food can decrease the levels of “good” cholesterol and increase the bad cholesterol. This will block the transport of omega 3 fatty acids across the placenta and affect the growing fetus
8. Folate supplementation: Folate is an important vitamin and its consumption must be monitored carefully during pregnancy. Low folate levels are linked to neural tube defects (spina bifida etc.)

   Dietary sources of folate include green leafy vegetables (spinach), asparagus, liver, mushrooms, lean beef,potatoes, beans,whole grains, nuts, and oranges. Fortified foods (must state on the label) include breakfast cereals, rice, noodles, and bread. Synthetic supplements are inexpensive and guarantee appropriate dosages

   • High risk (prior history of neural tube defect): 4 mg daily.
   • Low risk 0.8 to 1.0 mg daily.
9. Iron Supplementation: Iron rich foods are important to prevent low birth weight infants. Recommended amounts are 18–27 milligrams—generally the amount found in prenatal vitamins. Anemic women may need 60 mg a day until the anemia is resolved. Sources of iron include spinach, strawberries, eggs, meats, sardines, scallops, shrimp, and turkey. For optimal absorption the iron supplement should be taken between meals and not with milk, coffee or tea but with a beverage containing vitamin C since it enhances the absorption of the iron.
10. Prenatal Vitamins: Due to the fact that most diets do not provide adequate amount of most vitamins, supplements are recommended in pregnancy.
    • DHA and Omega-3 fatty acids
    • Iron
    • Folic Acid
    • Calcium
    • Vitamin D
    • Vitamin B-1
    • Vitamin B-2
    • Vitamin B-6
    • Vitamin B-12—vegans and some vegetarians should take this.
    • Vitamin C
    • Vitamin A
    • Zinc
    • Magnesium
    • Niacin

Of note: The Institute of Medicine has not found sufficient evidence to recommend routine use of most vitamins except for those with high-risk pregnancies (e.g., undernourished females, teenagers, females with substance abuse problems, females with a short interval between pregnancies, females with history of delivering low body weight infant, females with multiple gestation).

Herbal/Botanical/Alternative Remedies

There are very few randomized clinical studies that have examined the safety and efficacy of alternative therapies during pregnancy. All women, especially pregnant women, should Inform their health professionals of any supplements that are being taken that the doctor has not prescribed.

References

Position of the American Dietetic Association:Nutrition and Lifestyle for a Healthy Pregnancy Outcome. J Am Diet assoc. 2008;108:553–561

Jessica Shapiro MS, RD is a Clinical Dietitian at Montefiore Medical Center in New York City working in the Cardiology and Cardiac Care Units. She received her Masters of Science from NYU and is a member of both The American Dietetic Association and The Greater New York Dietetic Association. In addition to her work at the medical center she has a private practice in New York City and can be reached at JessicaShapiroNutrition@gmail.com.

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This entry was posted on Tuesday, April 20th, 2010 at 1:13 pm and is filed under Nutrition & Exercise. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.