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During pregnancy you are eating for two. The daily requirement for all nutrients increases, both for maintaining the health and stamina of your own body and for the growth of your baby. You need an additional 300 calories each day (during the second and third trimesters), your iron and folic acid requirements double, and you need 25–50% more of other vitamins and minerals. With the exception of iron and folic acid, you can get all the nutrients you need from a balanced diet (Ellyn Satter, R.D., M.S., M.S.S.W.).

Eat Well for Both of You
Proper nutrition is the best way to ensure that you have a healthy, sufficient placenta for your baby. The placenta works as the baby’s stomach, liver, kidneys, and lungs until the moment of birth. Three hundred quarts of blood circulate through it daily, which is the reason for an increase in blood volume during pregnancy.

After you eat a meal, the food is digested, absorbed, and passed into the liver, which then releases essential nutrients into the blood stream. Nutrients from your blood pass through the placental membrane and into the baby’s circulation.

It is an unsubstantiated idea that the placenta can draw what the baby needs from your body even when you do not eat a balanced, nutritious diet. The baby is in competition with all of your tissues, which require continuous nourishment. Even moderate malnutrition can decrease placental size, which means a decreased surface area available for transfer of nutrients. Good nutrition is also responsible for secure implantation of the placenta to the uterine wall.

Poor eating habits impair your body’s antibody responses and natural defenses. Common infections, for example, are more likely to develop into more serious ones among people who are malnourished, because bacteria are allowed to enter through the skin, respiratory tract, and intestinal tract. When the natural defenses do not work well, white blood cells cannot fight germs effectively. A well-nourished mother who gets a minor infection usually recovers from it more quickly than a malnourished mother.

Nutrition During the Final Eight Weeks of Pregnancy
The infant’s growth and nutritional needs are great throughout pregnancy. An important but overlooked period is the last eight weeks of pregnancy. During this time, the baby gains one ounce per day, often doubling in weight by the time of delivery. Brain development also occurs at its most rapid rate.

This critical phase of the baby’s development can be seriously disrupted by inadequate nutrition. This is not the time to cut back in your diet because of earlier excess weight gain.

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Practical Nutrition Advice

During pregnancy, DO:

• Eat a variety of foods from all the food groups, including breads and cereals, vegetables and fruits, dairy products, and proteins; if you crave one certain food, talk to a registered dietitian about it so she/he can suggest a way to balance the food you crave with other foods
• Eat a lot of fresh fruits and vegetables, whole grain breads, and cereals. Put your fruits with your meals when you get other protein, as they are high in natural sugar.
• Eat foods high in iron such as cream of wheat and oatmeal, prune juice, beef, any poultry, or fish, spinach, greens, dried fruits, and beans
• Drink at least ten full glasses (8 ounces) of liquid such as water, milk, gatorade, powderade, or soup each day
• Eat small meals and nutritious snacks often during the day; small meals will be easier for you to digest, and eating often will keep both you and your baby supplied with a steady stream of nutrients
• Snack on hard-boiled eggs, cheese, raw nuts, and peanut butter and crackers rather than chips, cookies, fruits or other sweets
• Take your daily prenatal vitamin/mineral supplement.
• Heat deli meats to steaming before consumption

During pregnancy, DO NOT:

• Eat “empty calories” or foods that fill you up but offer little nutritional value such as candy, potato chips, soda, and high-fat foods such as cake and cookies
• Eat foods that are over-cooked or over-processed, since a lot of their nutritional value has been lost
• Drink alcoholic beverages since alcohol may harm your baby
• Eat or drink large amounts of caffeinated coffee, tea, soda pop, or chocolate; if you must drink caffeinated beverages, limit intake to two cups per day
• Skip a meal or space your meals too far apart; skipping meals might make you feel sick to your stomach and will keep your baby from getting the nutrients it needs
• Eat something that is not food such as starch, clay, dirt, or other non-food items; a craving for one of these items is often an indication that your body needs a particular nutrient from a healthy food or vitamin

Weight Gain
The goal of weight management during pregnancy is to promote optimal nutrition for you and your child. Healthy weight gain will result in a healthy baby. Maximizing your nutrition will produce the desired healthy weight gain. The question, “What should I be eating?” should take priority over, “How much weight should I gain?” Sound nutrition is a priority at our clinic, and we have a Registered Dietitian on staff to help you with your nutrition needs.

Average weight gain is 35-40 pounds. It occurs in small increments with a few larger spurts, but usually averages out to about a pound a week.

Most weight gain will happen during the second and third trimesters; however, your body has its own wisdom about regulating food intake, and you should pay attention to it.

You will be weighed at each prenatal visit. Use the weight gain grid to chart your weight. The nurse will tell you what week of pregnancy you are in. Fluctuations and variations may appear in your weight gain, and your physician or nurse midwife will evaluate them to help determine if they are appropriate.

Most women gain weight naturally, because pregnancy stimulates the appetite. Calorie needs increase by about 130 calories per day during the first trimester and 300 calories per day during the second and third trimesters. You can get needed extra calories by choosing more foods from the basic food groups (breads and cereals, fruits and vegetables, dairy products and proteins). See the Pregnancy Food Guide for more information.

Following are some recommendations if you are gaining weight too fast:

• Decrease fried foods, gravy, sauces, dressings, and high-calorie snacks such as chips, cake, pie, candy, cookies, and doughnuts; eat fresh fruits and vegetables or low-fat yogurt and cottage cheese for snacks
• Prepare food without adding fats
• Choose baked, broiled, or roasted foods instead of fried ones
• Drink skim or 1% milk instead of whole
• Do more physical activity each day, especially if you sit a lot; walking is great for controlling weight and toning muscles

Following are some recommendations if you are having trouble gaining weight:

• Make a schedule for eating meals and snacks at set times every day, even if you don’t feel hungry
• Drink milk, chocolate milk, or fruit juice instead of soda; drink cocoa or apple cider instead of coffee or tea
• Eat healthy snacks such as pizza, toast and peanut butter, bagels with peanut butter, or English muffins with peanut butter
• If you are on your feet a lot, eat more to make up for the calories you’re burning, and find time to rest

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Nutrition and Discomfort During Pregnancy

Morning Sickness
Nausea, or “morning sickness,” is very common during the first four months of pregnancy. This can be related to changes in your hormones or to drops in blood sugar.

For nausea, or morning sickness, try the following:

• Have a spearmint starlight mint before rising
• Sit up slowly and stay in bed for a few minutes before getting up
• Eat small meals and frequent high-protein snacks
• Drink only enough to wash down your food at meal
• Avoid hunger during the day; don’t be afraid to eat
• Avoid any food, odors, or activities that make you sick

Constipation and Hemorrhoids

Constipation and hemorrhoids are common during pregnancy. Hormonal changes, the pressure of the growing baby on your intestines, and the natural slowing of your body’s functions during pregnancy are responsible for these common discomforts.
For constipation or hemorrhoids, try the following:

• Drink 7–8 glasses of water each day
• Eat plenty of fresh fruits, vegetables, grain cereals, and bread each day; eat beans several times a week
• Limit your intake of low-fiber foods (i.e., processed or convenience foods)
• Try to go for a walk every day
• Avoid mineral oil and laxatives

Bloating and Gas

Bloating and gas are common symptoms during pregnancy, especially if they were a problem before pregnancy.

For bloating and gas, try the following:

• Try to relax, especially when eating
• Eat your food slowly
• Eat six small meals each day rather than three large ones
• Avoid foods that produce gas such as beans, cabbage, and onions
• Drink spearmint tea that is just spearmint leaves and tea leaves, no herbs.

Heartburn
Heartburn is most common as the baby grows during the last few months of pregnancy. It is caused by a combination of hormonal changes and increased pressure from the growing baby on the stomach.

For heartburn, try the following:

• Do not eat fried, fatty, or spicy food
• Avoid alcohol, soda, coffee, and tea
• Eat six small meals each day instead of three large ones
• Avoid overeating
• Do not lie down after eating
• Try to wear loose clothing
• If heartburn is especially bad at night, sleep propped up by pillows
• Avoid using over-the-counter antacids because of their high sodium content
• When heartburn strikes, drink spearmint tea that is just spearmint leaves and tea leaves, no herbs.

Swelling or Water Retention
The swelling of legs or feet (water retention) is most common during the last few months of pregnancy. It can be related to your blood pressure, so be sure to mention any swelling to your doctor.

For swelling or water retention, try the following:

• Avoid foods high in salt, but don’t omit salt from your diet
• Do not stand or sit for a long time without walking
• Raise legs up to about heart level when you sit or lie down

Leg Cramps

Leg Cramps are most common during the last two months of pregnancy. The exact cause is not known, but it is often related to the need for more calcium.

For leg cramps, try the following:

• Drink at least 3–4 glasses of low-fat milk or eat 3–4 servings of low-fat dairy products every day
• Reduce your intake of foods high in phosphorus such as soft drinks and processed foods
• Be sure to eat 5 servings of fruits and vegetables every day

Vitamins and Minerals
While pregnant, as your blood volume increases, you may need supplements of essential vitamins, especially iron and folic acid. It is difficult to meet the daily requirements for iron and folic acid with regular, balanced meals alone. For this reason, at your first visit you will receive a prescription for prenatal vitamins. The prenatal vitamins contain the right amount of folic acid and iron for a healthy pregnancy. Some pregnancies may require additional supplements if anemia is a concern.

Following are some good food sources of folic acid:

• Legumes (beans, peas, lentils, and peanuts)
• Orange juice
• Fortified breakfast cereals (be sure to drink the milk, too)
• Leafy green vegetables

Following are some good food sources of iron:

• Iron-fortified breakfast cereals (be sure to drink the milk, too)
• Spinach
• Dried beans and refried beans
• Meats, including fish and poultry
• Dried fruits

Calcium
Calcium is essential for the development of the baby’s skeleton and to protect you from bone loss during pregnancy. As a pregnant woman, you need 1000 mg of calcium every day to meet these needs. Dairy products such as low-fat milk and yogurt are the best food sources of calcium. The calcium in food is better absorbed and utilized by the body than calcium from supplements. However, calcium supplements may be necessary for some individuals. Calcium carbonate is the best kind of calcium supplement to take, because your body absorbs it more readily.

In order to get the calcium you need, try eating the following foods:

• Plain low-fat yogurt with fresh fruit
• Cheese and crackers
• Low-fat pizza
• Baked potato with broccoli and cheese
• Decaffeinated latte or mocha, milkshake, or skim milk with your meal

If you are lactose intolerant, be sure to ask about alternative foods to satisfy your calcium requirements.

Protein
Protein is one of the most important nutrients to help ensure a healthy pregnancy. Protein is essential for the proper growth and development of the baby, and it helps your body support the changes it experiences as your baby grows. Because the diet of most women in the United States provides more than enough protein, pregnant women do not usually need to increase their intake of protein rich food. See the Pregnancy Food Guide for information about the daily serving suggestions for foods high in protein such as meat and dairy products. If you are vegetarian, be sure to ask about alternative foods to satisfy protein requirements.

Water
Adequate fluid intake is necessary for a healthy pregnancy. Try to drink 10 8-ounce glasses of water every day. Jazz up plain water by adding fresh lemon, lime, or orange slices. If you like carbonated drinks, try seltzer water to help meet your fluid requirements.