Top Tips for Pregnancy Nutrition

Which vitamins and nutrients are key to your baby's health?

By Elizabeth M. Ward, MS, RD
FROM THE WEBMD ARCHIVES

Good nutrition during pregnancy improves your chances of

having a healthy baby. It may even reduce the risk of
certain chronic conditions in your child, long after he has
grown.

Eating for Two During Pregnancy

Whether you waited months for a positive pregnancy
test or this pregnancytook you by surprise, you'll probably
need to make over your eating habits. Many women begin
pregnancy with shortfalls of nutrients central to a healthy
pregnancy, including iron, calcium, and brain-building fats.
"Never in a woman's life is nutrition so important as when
she's pregnant and nursing," says Elizabeth Somer, MA,
RD, author of Nutrition for a Healthy Pregnancy.
Indeed. Research suggests that, along with other healthy
habits during pregnancy, eating right influences a child's
well-being at birth, and beyond.
"We've discovered that a child isn't only what she eats, but
also what you ate during pregnancy, and possibly what
your mother ate," says Randy Jirtle, PhD, a researcher in
the field of epigenetics. Increasingly, research shows that
mom's lifestyle affects her baby's chances for conditions
such as obesity, diabetes, and heart disease.

Focus on Folic Acid During Pregnancy

Getting adequate folic acid is one way of helping your child
become the healthiest person possible. During the first
month of pregnancy, folic acid reduces the risk of neural
tube defects, including spina bifida.
Be sure to take a daily multivitamin with 400 micrograms
folic acid until you replace it with a prescription prenatal
vitamin and mineral supplement. Choose grains fortified
with folic acid, including breakfast cereals, breads, rice,
and pasta, every day too.

Multivitamins Have Multiple Effects During

Pregnancy
Multivitamins do more than supply the necessary folic acid
for growing babies, according to a population study
conducted at the University of Pittsburgh.
Researchers there found that women in early pregnancy
who took a multivitamin or prenatal vitamin regularly
reduced their risk of preeclampsia by 45%. Preeclampsia,
which causes elevated blood pressure and protein in the
urine, is a leading cause of premature delivery and fetal
death.
Despite the benefits, you may find swallowing
pregnancy supplements difficult. The pills are often large,
and they contain high doses of iron that can irritate
your stomach and cause constipation.
"If you find yourself having trouble taking prenatal
vitamins or you're having unwanted side effects, talk to
your doctor about other, safe options," advises Jennifer
Shu, MD, pediatrician and co-author of Heading Home with
Your Newborn: From Birth to Reality.
And always tell your doctor or midwife about all the dietary
supplements you take, including herbal remedies.

Make Calories Count During Pregnancy

During the first few months of pregnancy, you may not
notice a big weight gain.
Some women may even lose weight during the first
trimester of pregnancy because of queasiness that
prevents them from eating and drinking normally. Tell your
doctor if you experience persistent vomiting or nausea –
you may become dehydrated. So-called morning
sickness can last for the entire pregnancy, but it typically
starts to dissipate after about 13 weeks.
As your baby begins growing, you'll need to make sure
your extra calories are nutritionally rich. Pregnancy is not a
license to overeat, however. A pregnant woman only
needs an additional 300 calories a day. "Three hundred
calories sounds like a lot, but it's about the amount in two
large apples," Somer says.
Of course, it's OK to splurge on a hot fudge sundae on
indulge pregnancy foodcravings from time to time. On a
daily basis, here's how to make those 300 additional
calories matter most:

 16 ounces 1% low fat milk

 2 slices bread; 2 ounces chicken; 1 teaspoon reduced
fat mayonnaise
 8 ounce vanilla non-fat yogurt mixed with 1/2 cup
fruit and 1 ounce whole grain crunchy cereal

Weighty Matters During Pregnancy

Gaining the recommended number of pounds limits
pregnancy and delivery complications and ensures a
healthy infant. Women who start pregnancy at a normal
weight can expect to put on between 25 and 35 pounds.
For twins, expect to gain between 34 and 45 pounds.
Underweight women may need to gain more,
while overweight moms may be advised to put on fewer
pounds.
In addition, "Overweight women tend to have heavier
babies that are more difficult to deliver,"
says obstetrician Erin Tracy, MD.
Overweight moms should not diet during pregnancy. Work
closely with your health care provider and a registered
dietitian to determine a pregnancy eating plan tailored to
your needs.

More Nutrients of Note During Pregnancy

Every nutrient that's important to you as a woman is
necessary for your baby's growth and development. Yet,
certain nutrients stand out as particularly important to
your child, especially as pregnancy progresses.
Protein is the structural material of every cell in
Protein:
your baby's body.
Insufficient protein during pregnancy restricts fetal growth.
And it may even affect your child's chances for high blood
pressure later in life, according to a study in The New
England Journal of Medicine.
Pregnancy protein needs climb 25 grams a day above what
was needed before you were pregnant, for a total of about
70 grams -- the amount found in three eight-ounce
glasses of milk or about seven ounces of cooked meat,
chicken, or seafood.
Iron:You require about 50% more iron when you are
pregnant. Iron is important in the formation
of hemoglobin, which is the oxygen-carrying protein on
red blood cells. In pregnancy your need for iron and
hemoglobin goes up, especially in the second and third
trimesters.
Iron-deficiency anemia during pregnancy can
cause fatigue in mom, and possible problems for baby.
"Some studies show severe iron deficiency anemiain mom
is linked to low birth weights and iron-deficient infants,"
says Tracy.
Calcium: The baby needs calcium for development. If you
don't consume enough calcium, your body will take it from
your bones. This can cause a decrease in bone mass and
increase your risk for osteoporosis.
Docosahexaenoic Acid (DHA):DHA is important
for brain and eyedevelopment. Fish harbors this omega-3
fatty acid, but there's a catch.
Women in their childbearing years, and pregnant and
nursing women, should steer clear of shark, swordfish,
king mackerel, and tilefish because of methylmercury, a
heavy metal that's toxic to a developing baby's
neurological system. Safer DHA-rich sources include
salmon and fortified eggs. Ask your doctor whether you
may need a DHA supplement.

Rethink Your Drink During Pregnancy

Pregnant women require about 10 cups of fluid every day.
Although plain water is preferable, milk and juice count
toward your fluid quota too.
Beer, wine, and spirits work against a healthy baby,
however. Drinking alcohol during pregnancy promotes
physical and mental birth defects.
"There is no known safe level for alcohol when you are
expecting, so the best thing to do is avoid it," Tracy says.
If you're worried about taking a drink before you knew you
were expecting, talk with your doctor or midwife about
your concerns.
What about caffeine? Its effects on developing babies is a
subject of debate. Limit coffee to one or two eight-ounce
cups a day to be on the safe side, advises the March of
Dimes.
Juice seems like a healthy alternative to soft drinks, and it
is. However, juice is laden with calories that can cause
unwanted weight gain. Other soft drinks, such as soda,
supply about as many calories as juice, and may also
contain caffeine.

Your Pregnancy Eating Plan

Prescription prenatal pills may provide what your diet lacks
on any given day, but when you're pregnant, healthy
eating takes center stage. A balance of nutrients is key,
according to Jirtle.
"Just because a little of something is good does not mean
a lot is necessarily better," Jirtle says.
Moderately active women who start pregnancy at a healthy
weight need about 2,400 calories a day. Here are some
ideas of what to include on a daily basis:
Grains:8 servings, such as 1 slice whole wheat bread, 1 cup
whole grain cereal; 1/2 cup cooked pasta or rice. (Choose
high fiber whole grains often to reduce
pregnancy constipation.)
Vegetables:4 or more servings, such as 2 medium whole
raw carrots; 1 cup dark leafy greens; 1 cup cooked
broccoli or cauliflower.
2 to 4 servings, such as 1 small apple, orange, pear,
Fruits:
or banana or 1 cup berries.
3 servings, such as 8 ounces milk or yogurt or 1 1/2
Dairy:
ounces hard cheese.
2-3 servings, such as
Meat, poultry, fish, eggs, nuts, and beans:
2-3 ounces cooked meat, poultry, or seafood.
Fats, oils and sweets: sparingly.
WebMD Feature Reviewed by Louise Chang, MD on October 01, 2008
What Not to Eat When You're Pregnant

Pass Up Soft Cheeses

Enjoy some grated Parmesan on your pasta -- but pass up
the cheese dip. Soft cheeses made with unpasteurized milk
can harbor listeria bacteria, which can be dangerous or even
life-threatening for you and your baby. It’s best to avoid
brie, Camembert, feta, blue cheese, queso blanco, queso
fresco, and panela -- unless the label says it's pasteurized.
When in doubt or dining out, ask before you eat.

Skip Undercooked
Meat
Now is the time to order all steaks and burgers fully cooked.
Raw or undercooked meat can harbor toxoplasma and other
bacteria. When dining out, make sure your meat is steaming
hot and thoroughly cooked. At home, the temperature
should reach at least 145 F for whole cuts, 160 F for ground
meats like hamburger, and 165 F for chicken breasts.

Beware Fresh Juice

Fresh-squeezed juice in restaurants, juice bars, or farm
stands may not be pasteurized to protect against harmful
bacteria, including salmonella and E. coli. Some markets also
sell raw, unpasteurized juice in the refrigerated case -- look
for the required warning label, and steer clear. Pregnant
women should opt for juice that is pasteurized. Juice in
boxes and bottles on your supermarket shelf is also safe.
 Sayonara, Sushi
Sorry, sushi fans, but it's time for a 9-month hiatus from this
treat. Although seafood is a great source of
protein, raw seafood can be a source of harmful parasites
and bacteria. The FDA recommends pregnant women only
eat fish and other seafood that has been cooked thoroughly.

Raw Cookie Dough

When you're baking cookies, you may be tempted to pop a
bit of raw dough in your mouth. But if the dough contains
raw eggs, even a taste could pose a risk. The CDC estimates
one in 20,000 eggs is tainted with salmonella bacteria. To be
safe, resist tasting unbaked cookie dough, batter, or filling
made with raw eggs. The good news: Store-bought cookie
dough ice cream is safe.

Homemade Caesar
Dressing
Raw eggs are also used in many homemade dressings and
sauces, such as:

 Caesar salad dressing

 Béarnaise sauce
 Hollandaise sauce
 Mayonnaise

Opt for store-bought versions, which are made with

pasteurized eggs.
Homemade Tiramisu
Many homemade desserts, including mousse, meringue, and
tiramisu, also contain raw eggs. If a store-bought version
won't do, there is a safe way to prepare your favorite recipe.
Some supermarkets sell pasteurized eggs, which are OK to
eat raw. Make sure the label on the eggs specifically states
"pasteurized."

Fresh Pre-Stuffed
Poultry
A pre-stuffed turkey or chicken offers a great short-cut when
you're pressed for time. But the juice from fresh, raw poultry
can mix with the stuffing and create a great place for
bacteria to grow. Cooking usually offers protection, but
pregnancy makes it harder to fight off infections. A safe
alternative is buying frozen pre-stuffed poultry. Be sure to
cook it directly from frozen -- don't let it defrost first. The
thigh meat should hit 180 F.

Fish With Mercury

Fish is good for you and your baby, but make smart choices
about the fish you eat. Swordfish, tilefish, king mackerel,
and shark contain high levels of methylmercury. This metal
can be harmful to your baby. You can safely eat up to 12
ounces of seafood a week, so choose fish that are low in
mercury: catfish, salmon, cod, and canned light tuna. If you
like albacore (white) tuna, limit yourself to 6 ounces per
week. Check with your doctor before taking fish oil or any
other supplements while pregnant.

Deli Meats
Unlike many other food-borne germs, listeria can grow at the
temperatures inside your fridge. For this reason, you should
avoid perishable, ready-to-eat meats, such as cold cuts and
hot dogs, when you're pregnant. You can make these foods
safe by heating them until they are steaming hot and eating
them right away.

Pâtés or Meat Spreads

Pâtés contain perishable meats, so they may harbor listeria
as well. Keeping your fridge at or below 40 F will slow the
growth of this bacteria but won't stop it completely. Because
pregnant women are particularly vulnerable to listeria, it's
safest to avoid all refrigerated meat spreads. Spam lovers
are in luck. Canned meat spreads are OK -- if not exactly
healthy -- during pregnancy.

Unwashed
Fruits/Veggies
Now is the time to load up on fruits and veggies! Just be
sure to rinse them thoroughly under running water. A
parasite called toxoplasma can live on unwashed fruits and
veggies. It causes an illness called toxoplasmosis, which can
be very dangerous to your baby. Don't use soap to wash
produce. Instead, scrub the surface with a small vegetable
brush. Cut away any bruised areas, because these may
harbor bacteria. To avoid the listeria bacteria, scrub and dry
cantaloupe before slicing it.

Raw Sprouts
Don't eat any raw sprouts, including alfalfa, clover, and
radish. Bacteria can get into the seeds before the sprouts
begin to grow, and these germs are nearly impossible to
wash away. At the deli, check sandwiches to make sure they
don't contain raw sprouts. At home, cook sprouts thoroughly
to destroy any bacteria.

Smoked Seafood
When you're expecting, it's best to skip the lox on your
morning bagel. Like ready-to-eat meats, refrigerated
smoked seafood is vulnerable to listeria. This includes
smoked salmon (often labeled nova or lox), as well as
smoked trout, whitefish, cod, tuna, and mackerel. It's safe to
use smoked seafood in a cooked meal, such as a casserole.

Raw Shellfish
Raw shellfish is one of the top causes of illness from seafood.
The culprits include parasites and bacteria that are generally
not found in cooked seafood. So skip the oysters on the half
shell. As long as you cook shellfish thoroughly, it's safe to
eat during pregnancy. Cook oysters, clams, and mussels
until the shells open. If any don't open, throw them away.
Fish From Local
Waters
Unless you know your local streams, bays, and lakes are
unpolluted, avoid eating fish you catch yourself. Some lakes
and rivers are contaminated with industrial chemicals.
Locally caught bluefish, striped bass, salmon, pike, trout,
and walleye may be affected. Check with your state's fish
and wildlife department for more information.

Potluck Foods
You may not want to insult your friends by avoiding their
potluck offerings. But there's reason for concern if the food is
left unrefrigerated for too long. Follow the 2-hour
rule: Don't eat potluck dishes that have been sitting at room
temperature for longer than 2 hours. When temperatures
are above 90 F, the cutoff should be 1 hour.

Unpasteurized Milk
Have you ever dreamed of visiting a farm and tasting milk
fresh from a cow? Wait a while. Freshly collected milk has
not yet been through the pasteurization process that
protects it from listeria. That can be dangerous for you and
your baby. Buy milk, cheese, or dairy products from a local
farm only if the label says "pasteurized."

The Caffeine Question

Good evidence now shows that a moderate amount of
caffeine is safe during pregnancy. But the jury is still out on
whether higher amounts of caffeine can increase the odds of
a miscarriage. The March of Dimes recommends women who
are pregnant or trying should limit caffeine to 200 milligrams
per day. That's one 12-ounce cup of coffee. But remember,
caffeine is also found in soda, tea, chocolate, and many
energy drinks.

Alcohol
You already know that heavy drinking during pregnancy can
lead to serious birth defects. What you may not know is that
even small amounts of alcohol could be harmful. No amount
of drinking has been found to be safe during pregnancy, so
it's best to avoid all forms of alcohol. This includes wine,
beer, coolers, and traditional eggnog, which contains alcohol
and raw eggs.

Doggie Bags
Unless you're headed straight home from the restaurant,
don't ask for a doggie bag. The inside of your car can get
warm quickly, allowing bacteria to multiply. If you do take
home leftovers, put them in the fridge within 2 hours of
when the meal was originally served.
Your Baby's Growth:
Conception to Birth
You're pregnant. Congratulations! Are you curious how big
your developing baby is, what your baby looks like as it
grows inside you, and when you'll feel it move? Take a peek
inside the womb to see how a baby develops from month to
month.

Conception
Fertilization happens when a sperm meets and penetrates an
egg. It's also called conception. At this moment, the genetic
makeup is complete, including the sex of the baby. Within
about three days after conception, the fertilized egg is
dividing very fast into many cells. It passes through the
fallopian tube into the uterus, where it attaches to the
uterine wall. The placenta, which will nourish the baby, also
starts to form.

Development at 4
Weeks
At this point the baby is developing the structures that will
eventually form his face and neck. The heart and blood
vessels continue to develop. And the lungs, stomach, and
liver start to develop. A home pregnancy test would show
positive.
Development at 8
Weeks
The baby is now a little over half an inch in size. Eyelids and
ears are forming, and you can see the tip of the nose. The
arms and legs are well formed. The fingers and toes grow
longer and more distinct.

Development at 12
Weeks
The baby measures about 2 inches and starts to make its
own movements. You may start to feel the top of your
uterus above your pubic bone. Your doctor may hear the
baby's heartbeat with special instruments. The sex organs of
the baby should start to become clear.

Development at 16
Weeks
The baby now measures about 4.3 to 4.6 inches and weighs
about 3.5 ounces. You should be able to feel the top of your
uterus about 3 inches below your belly button. The baby's
eyes can blink and the heart and blood vessels are fully
formed. The baby's fingers and toes have fingerprints.

Development at 20
Weeks
The baby weighs about 10 ounces and is a little more than 6
inches long. Your uterus should be at the level of your belly
button. The baby can suck a thumb, yawn, stretch, and
make faces. Soon -- if you haven't already -- you'll feel your
baby move, which is called "quickening."

Time for an Ultrasound

An ultrasound is usually done for all pregnant women at 20
weeks. During this ultrasound, the doctor will make sure that
the placenta is healthy and attached normally and that your
baby is growing properly. You can see the baby's heartbeat
and movement of its body, arms, and legs on the
ultrasound. You can usually find out whether it's a boy or a
girl at 20 weeks.

Shown here is a 2D ultrasound (inset) contrasted with a 4D

ultrasound, both at 20 weeks.

Development at 24
Weeks
The baby weighs about 1.4 pounds now and responds to
sounds by moving or increasing his pulse. You may notice
jerking motions if he hiccups. With the inner ear fully
developed, the baby may be able to sense being upside
down in the womb.