Pregnancy Nutrition Guidelines

From the early 1950s until the early 1970s, pregnant women were advised to gain only 10 to 15 pounds during pregnancy. Limited weight gain was thought to help keep the baby's weight low to reduce problems with delivery of a large baby and to avoid the matter of a mother having to lose weight after the birth of her child.

Concern about adequate weight gain during pregnancy was highlighted by the Task Force on Mental Retardation commissioned by President Kennedy in 1962. The task force found that prematurity and low birth weight were major factors in infant mortality (death) and morbidity (disease). Their findings led to the development of the federal Maternal and Infant Care Program, which stressed the importance of good nutrition during pregnancy.

Since that time, many researchers have focused on the relationship of prepregnancy weight and weight gain to pregnancy outcome. We now know that poor weight gain, especially in the third trimester, is associated with low birth weight and neurologic deficits in the baby. Low birth weight is associated with a higher incidence of infant mortality and morbidity, mental retardation, and learning disabilities.

Research has also shown that large women tend to produce large babies. The birth size of an infant is related to the size of the mother and is not influenced greatly by the size of the father.

How does all this information affect recommendations for weight gain during pregnancy? Advice about weight gain for pregnant women today reflects an individualized approach based on the mother's height and her prepregnancy weight, and whether the mother is a teenager or is pregnant with more than one baby.

You will be advised to gain weight during pregnancy. If you are underweight, you will probably be encouraged to gain approximately 28 to 40 pounds. If your weight is normal, you will ideally gain between 25 and 35 pounds. If you are overweight (weigh more than 35 percent above the ideal body weight), you may be urged to gain between 15 and 25 pounds. If you are pregnant with more than one baby, you will be advised to gain an even greater amount of weight. If you are a teenager, you will need special guidance to get enough calories and nutrients to satisfy your own growth needs as well as the needs of your developing baby.

Where does the weight gain during pregnancy go? Some goes to the growth of your baby and some goes to the body changes necessary to support your pregnancy.

Weight gain during pregnancy occurs in a predictable pattern. You will gain only a little weight the first trimester and will have a more rapid gain during the second and third trimesters.

Keeping track of your weight gain helps your doctor detect potential problems. If weight gain is too slow, your doctor may recommend nutrition counseling. If weight gain suddenly rises, especially in the latter part of pregnancy, it may be the result of edema (swelling), which could indicate preeclampsia (a disorder characterized by elevated blood pressure, edema, and kidney malfunction), or it may be the result of extra calorie consumption or decreased activity.

Morning sickness in early pregnancy may affect weight gain temporarily. Continued vomiting throughout pregnancy is more serious and requires treatment. Your activity level may also affect weight gain during pregnancy.

Today, an increasing number of women must worry about the effects of anorexia or bulimia on their pregnancy. Women who are or have been anorexic or bulimic may have a difficult time accepting the weight gain and body changes that are a normal part of pregnancy. Counseling can be very helpful. Most large metropolitan areas have bulimia and anorexia support groups. Since eating well is so critical during pregnancy, getting help is crucial.

There is a wide variation in weight gain and pattern of weight gain among pregnant women. The weight gain suggestions reflect average weight gain ranges and are a guide for you and your doctor. Your weight gain may not follow these guidelines, but if you are making an effort to eat a high-quality, balanced diet with adequate calories, you can feel comfortable knowing you are doing what you can to ensure both your and your baby's health. Read about good nutrition during pregnancy in the next section.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

What and how much should you eat to be healthy during pregnancy? You want to pay special attention to certain nutrients and add about 300 extra calories to your diet. The average recommended daily caloric intake varies depending on your activity level and normal weight. Your weight gain is a good guide to how well you are meeting your caloric intake.

Protein

You should increase your protein intake to 60 grams during pregnancy to provide for the growth of your baby and your breasts, uterus, and placenta; for the increased blood volume; and for the production of amniotic fluid.

Iron

Iron is an important nutrient during pregnancy for three primary reasons. First, iron is necessary for the formation of maternal and fetal hemoglobin, the oxygen-carrying component of blood. Since your blood volume increases considerably during pregnancy and your baby is manufacturing blood cells, too, your need for iron increases. Second, during the last trimester, your baby draws from you some of the iron reserves that help prevent anemia during the first four to six months of your baby's life. Third, your increased blood volume and iron stores help your body adjust (to some degree) to the blood loss that occurs during childbirth.

If your doctor recommends an iron supplement, it will probably contain 60 milligrams of iron, although the recommended amount during pregnancy is 27 milligrams a day. Because iron from supplements is not totally absorbed, you must ingest about 60 milligrams of iron to ensure that you actually absorb the recommended daily amount of 27 milligrams.

Iron supplements are best absorbed if taken with foods rich in vitamin C, such as orange, grapefruit, or tomato juice. Absorption is impaired if you take them with antacids or calcium-containing foods, such as milk and cheese. Iron supplements sometimes cause an upset stomach, constipation, or nausea. If that is the case for you, remember that you can get much of the iron you need from iron-rich foods, such as organ meats, red meat, egg yolk, and legumes (dried peas and beans). Consult your doctor before stopping an iron supplement, however.

Calcium

During pregnancy, many doctors commonly recommend that you get between 1,200 and 1,500 milligrams of calcium per day. Calcium is essential for the development and growth of your baby's skeleton, heart, muscles, and tooth buds. Inadequate intake results in depletion of your own stores of calcium.

Milk and milk products (such as yogurt and cheese) are the best sources of dietary calcium. Tofu and canned whole fish (with bones) are good secondary sources. If you are lactose intolerant, meaning you cannot digest the lactose found in milk products, try a reduced-lactose or lactose-free milk product, soy milk, acidophilus milk, buttermilk, or cultured yogurt. If all else fails, your doctor may prescribe a calcium supplement.

Vitamins

The recommended daily intake of nearly all vitamins increases 25 to 50 percent for pregnant women. The daily recommendation for folic acid (folate) doubles. A high-quality, varied diet will supply most of the vitamins you need, with the probable exception of folic acid. Folic acid supplements of 400 micrograms are usually recommended to provide for the increased folic acid requirement.

Folic acid is important for synthesis of all cells and for production of DNA and RNA, the building blocks of cells. Deficiency can cause megaloblastic anemia (development of abnormal red blood cells) in the mother and neural tube defects in the fetus.

Since adequate folic acid intake is so important for your baby and you, choose a diet high in foods containing this essential vitamin. Liver, lean beef, legumes, egg yolks, and dark green leafy vegetables are good food sources of folic acid.

General Guidelines

Use the freshest foods you can, choose a varied, high-quality diet, and prepare the foods carefully to ensure you get the most nutritional value from your food. Vitamins, especially the water-soluble vitamins (folic acid, niacin, vitamin C, and the B vitamins), are easily destroyed by overcooking. Uncooked vegetables and fruits have the highest vitamin content. Next best is to use very little or no water to cook and to cook for a very short time.

For many of us, daily meal planning takes place in the grocery store as we choose the foods that are the best buys and the most appealing. One trick to healthy shopping is to choose foods mostly from the perimeter of the store, in other words, where you find the fruits, vegetables, meats, and dairy products. The inner aisles contain the breads and grains you need, but try to avoid the heavily processed and highly salted foods you see. And remember: Often, foods that are more convenient fall short in nutrient density.

It is important to note that consuming excess amounts of supplements of certain nutrients, particularly vitamins A and D, iodine, and zinc, may produce toxic effects and congenital anomalies (birth defects).

To keep track of the foods you eat and to ensure you and your baby get all the essential nutrients you need, consider keeping a food diary periodically throughout your pregnancy. Record your daily intake of dairy, protein, grains and breads, fruits and vegetables, fats, fluids, and foods consisting primarily of nonnutritious calories (simple sugars). After several days, assess where you need to make changes in order to get the nutrients you need. If you find it difficult to eat a well balanced, healthy diet, talk with your doctor about how you can improve your eating habits, or consult a nutritionist.

Sometimes your capacity or appetite is diminished, especially during late pregnancy or if you experience heartburn or nausea. Eat several small meals during the day instead of three large meals to help you get the nutrients you and your baby need. Talk with your doctor about any concerns you have about the amount of food you need.

Some doctors prescribe prenatal vitamins, while others may prescribe only folic acid supplements or iron supplements. Remember that these supplements are not a substitute for a good diet. They supply only some of the nutrients needed for health. The rest you must get from food. There are also foods and harmful things to avoid during pregnancy. We'll learn about these in the next section.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Just as with the good foods you eat, the harmful substances you consume can get passed directly on to your unborn child. While some of the substances are obvious, like alcohol, some of them might surprise you.

Caffeine

Caffeine is a substance naturally found in coffee, tea, cola drinks, and chocolate. It is also in some medications. Read labels carefully to identify those products that contain caffeine. Caffeine readily finds its way to the fetus, and the concentration of caffeine in fetal blood will be about the same as in maternal blood. Studies have not shown an association between caffeine consumption and fetal abnormalities, but caffeine is a powerful stimulant. It also increases production of stress hormones, causing constriction of uterine blood vessels, which lessens the blood flow to the uterus and may temporarily decrease the amount of oxygen reaching the fetus.

Large amounts of caffeine cannot be good for your baby or you. However, caffeine consumption in small amounts (one to two cups of coffee per day) is considered safe during pregnancy.

Artificial Sweeteners

Although aspartame (found in NutraSweet and Equal) appears to have no effect on a developing fetus, pregnant women are advised to consume it in moderation. Pregnant women who have phenylketonuria (PKU) -- a rare, inherited disease in which the body cannot metabolize phenylalanine (an amino acid) -- or high levels of phenylalanine in their blood must avoid aspartame altogether. Aspartame contains phenylalanine, and an excess of phenylalanine in the body damages the central nervous system and can cause mental retardation.

Saccharin (found in Sweet 'N Low) should be avoided by all pregnant and breast-feeding women. Although studies linking saccharin to bladder cancer have been dismissed, it has been shown that it crosses into the placenta and may remain in fetal tissue.

Herbal Tea

Some herbs and herbal teas contain drugs. Ginseng tea contains a small amount of estrogen. Chamomile tea contains ragweed, which can cause severe allergic reactions in some people. Teas made from juniper berries may cause stomach irritation. Just because herbal teas are considered to be natural does not mean they are safe for pregnant women. So, in general, avoid herbal teas except for those teas known to be safe for pregnancy such as peppermint and raspberry leaf.

Cigarettes

Cigarette smoking poses a serious threat to the well-being of your baby. Mothers who smoke usually have babies with a lower birth weight than mothers who do not smoke, and low birth weight is the leading cause of infant death. Smoking is also associated with a greater incidence of miscarriage, prematurity, stillbirth, and death of the baby soon after birth. Smoking by mothers has also been associated with impaired intellectual and physical development in their children.

If you have smoked for many years, it may be difficult to stop during pregnancy. However, for the health of your developing baby, you should quit. If you cannot stop entirely, just cutting down is helpful since the harmful effects of smoking are related to the amount you smoke.

These tips may help you quit or cut down:

If you quit or cut down on your smoking during your pregnancy, try not to resume the habit after having your baby. Children of smokers have been shown to have a greater susceptibility to respiratory diseases, such as colds, bronchitis, and asthma; ear infections; and other, potentially serious, medical problems. Cigarette smoke is also a known risk factor for sudden infant death syndrome (SIDS).

Marijuana

Studies on the effects of marijuana use are far from conclusive. There is some evidence that marijuana use is associated with lung cancer. It has been shown to impair short-term memory and cause menstrual irregularities. Studies in animals have shown that the active ingredient in marijuana crosses the placenta and accumulates in the fetus. Some studies suggest marijuana use is associated with precipitate labor (rapid expulsion of the fetus), prolonged labor, low birth weight, prematurity, and a greater risk of fetal distress. Although there is much researchers don't know about the long-term effects of marijuana use, marijuana is a drug, and you should avoid drug use during pregnancy.

Cocaine

Cocaine has profound effects on the mother and her fetus. It causes an increase in maternal heart rate; constriction of the blood vessels of the placenta, allowing less blood to reach the fetus; increased secretion of stress hormones, which causes constriction of uterine blood vessels; and increased uterine contractility.

It has been difficult for researchers to isolate the effects of cocaine since so many users take other drugs as well. However, cocaine use is also thought to be related to a high incidence of spontaneous abortion and to placental abruption (separation of the placenta from the uterine wall). Infants whose mothers used cocaine have a difficult time adjusting to environmental stimuli after birth and may be addicted to the drug.

Alcohol

Heavy drinking during pregnancy (more than five or six drinks daily) puts the baby at risk for fetal alcohol syndrome. Affected babies are born with physical malformations, including microcephaly (abnormally small head), certain heart defects, and, often, mental retardation.

Moderate (one or two drinks per day) and social (three to four drinks per day) drinking are also associated with problems. Some research points to a higher miscarriage rate among women who drink moderately. Other studies associate this level of drinking with a more frequent occurrence of birth defects and lower birth weights. No safe level of alcohol consumption has been established. As a result, it is best to take a cautious approach during pregnancy by abstaining from alcohol.

Other Medications and Drugs

Pregnancy is a time for prudent use of all drugs. Since few drugs have been proved safe for the fetus, and some drugs have been proved unsafe, you will want to be cautious about the medications you take. Drugs and medications include any over-the-counter remedies you may buy as well as prescriptions authorized by your doctor. Your doctor can help you to decide when medications are indicated for you during pregnancy.

Remember that good health during pregnancy is not just about avoiding harmful foods and drugs, it's about taking a proactive approach toward good nutrition, and making sure that you gain enough weight to benefit the baby growing inside of you.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.