Eating For a Healthy Pregnancy July 2, 2007

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In a perfect world every pregnant mother would have three well-balanced, home-cooked meals daily, a few healthy snacks and time to put her feet up and rest. Unfortunately for most, the reality is that their time is compromised, working full-time or taking care of children. Eating nutritiously is an ongoing challenge, yet it is one of the most critical lifestyle choices for both mother's and baby's long-term health.

"With all the information available today it can still be quite a challenge to sort through what is relevant to your health. Pregnancy is no exception. Even physicians must work to keep up with new guidelines and emerging trends. But don't worry, a little common sense and due diligence go a long way," says obstetrician/gynecologist Kevin H. Brown, M.D., FACOG, with Round Rock OBGYN.

The good news is that by following some simple guidelines, pregnant women can overcome the obstacles that prevent them from eating a healthy diet.

Colors and Food Pyramids

"You should eat a balanced diet including fruits, vegetables, whole grains and protein," advises Dr. Brown. "Pregnancy is a 40-week journey. Focus on the overall picture."

Regarding advice on how to eat well-balanced meals, keep it simple. Think color when planning your meals. Your plate should feature a variety and balance of colors and fiber. If the plate is not visually interesting, then you probably need to branch out more on your food choices.

The USDA Food Guide Pyramid is a good way to keep up with the variety of foods consumed each day, although a pregnant woman should be eating about 300 calories a day more than recommended by the Pyramid. Servings should be increased to include:

  • 9-11 servings of breads, cereal, pastas and grains, preferably at least half whole grain
  • 3-4 servings from vegetable group
  • 2-3 servings from the fruit group
  • 3 servings from the dairy group
  • 2 servings from the meat group (total 5 ounces)

Pregnant women can get needed additional nutrients by choosing especially nutrient rich foods such as broccoli, cantaloupe, citrus fruits, leafy greens, strawberries, sweet potatoes, tomatoes and winter squash.

If you are a vegetarian or a vegan, talk to your doctor about a possible referral to a nutritionist, who can help you make sure you are getting enough of the nutrients essential to your baby's growth. There are many nutrients in meat, including protein, magnesium, iron, selenium and more. A diet expert can help you choose a combination of foods to make up those nutrients.

Choose Plenty of Liquids

One of the biggest changes the body makes during pregnancy is the dramatic increase (about 40-50 percent) of blood supply that is needed to help the baby grow. "Again, focus on the important things," advises Dr. Brown. "Make sure that you drink plenty of fluids and try to avoid caffeinated beverages. We are not so much afraid that caffeine will hurt your baby but rather that it tends to dehydrate you when you are working to stay well-hydrated."

Nutrients Needed During Pregnancy

"Optimally, you should seek qualified care before conception. Your obstetrician is trained to offer specific tests, vitamins, and guidelines to help improve your chances of a healthy pregnancy," continues Dr. Brown.

The following nutrients are important in pregnancy and should be consumed according to recommended daily allowances(RDA)*:

  • folate (RDA - 400 mcg.)
  • vitamin D (RDA - 10 mcg.)
  • iron (RDA - 30 mg.)
  • zinc (RDA - 15 mg.)
  • calcium (RDA - 1,200 mg.) and vitamin C (RDA - 200 mg.)
  • All are critical to baby's development and mother's long-term health.

"Most women should be taking a prenatal vitamin unless told specifically not to. They are not dangerous and are available over the counter. For example, folic acid is most useful in early pregnancy where it can help prevent birth defects such as spinal bifida," continues Dr. Brown.

"Not all vitamins are safe in pregnancy. Do not take any vitamins with unusually high levels of vitamin A. In fact, discuss any and all medications with your doctor before taking them. Even over-the-counter medications can pose a risk to your pregnancy. Aspirin derivatives are especially unsafe. Many doctors will provide lists of safe medications at your first OB visit," adds Dr. Brown.

The Story of Weight

Excessive weight gain during pregnancy or anytime for that matter is a major concern for most women. To avoid overeating, try putting your fork or spoon down between bites and really chew your food. Stop when you are full and don't feel the need to clean your plate. But be sure you are getting the nutrients you need for a healthy pregnancy.

"Weight gain is not only normal, but desired. The average weight gain in pregnancy is 25-35 lbs" suggests Dr. Brown. "Your doctor may recommend more or less weight gain depending on your pre-pregnancy weight."

Will Nausea Ever End?

"Early in pregnancy you may not be able to tolerate breakfast every morning. Some women have more trouble at night. Try smaller but more frequent meals. Bland foods such as bananas, rice, and applesauce are sometimes easier to tolerate. Nausea can be especially troublesome, and it's not always limited to the first trimester," continues Dr. Brown. "If a bland diet, smaller meals, and a little time don't suffice, talk to your doctor about a special prenatal vitamin that is fortified with Vitamin B6. It's safe, frequently effective, and well-studied in pregnancy. Other treatments are available and can be tailored to your needs."

If odors are triggering your nausea, it's best to eat cold foods, keep your kitchen well-ventilated or have someone else do the cooking if possible.

Take the Burn Out of Indigestion

Heartburn often occurs toward the end of pregnancy when the baby's size can cramp the proper functioning of the digestive system. The body does a better job digesting smaller, more frequent meals.

"Avoid acidic foods or lying down after a meal if heartburn is a problem. Sometimes medication is necessary in some patients for excessive heartburn," suggests Dr. Brown.

If all else fails, it is safe to take calcium-based antacids.

Avoid High Risk Foods

Pregnant mothers usually know they need to stay away from caffeine and alcohol but certain fish and soft cheeses also can be risky choices. Try to limit fish intake to no more than a half-pound a week.

"Recently, fish has been in the spotlight. This is due to unacceptable mercury levels in some fish. High levels of mercury may lead to neurological abnormalities in the developing fetus. In general, some of the bigger species of fish are known to harbor higher levels of mercury, due to their typically longer lifespan. Shark, tilefish, King Mackerel, and sword fish should not be consumed in any amounts," says Dr. Brown.

"Guidelines have been published regarding acceptable amounts of fish to be consumed. Light tuna can be consumed in higher amounts than albacore (white) tuna. The EPA's Water Science Web site is a good resource. Be sure to check local advisories before consuming fish from local waters. "

Bacterial contamination of food is another risk to pregnant mothers, not only because it can make you sick, but also some of the medications recommended for such conditions may be associated with birth defects. Also stay away from soft cheeses if they are unpasteurized, such as brie and camembert (popular holiday choices) which can harbor the bacteria Listeria.

"Some meats may not be safe in pregnancy," says Dr. Brown. "Luncheon meats and hot dogs should be heated until they are steaming hot. Please see the FDA Web site for additional information. Never consume dairy products or fruit juices unless they are labeled as pasteurized. All are susceptible to certain types of bacteria that are potentially dangerous in pregnancy."

Other risky choices are raw foods like sushi and dishes containing raw eggs such as homemade eggnog or ice cream, Caesar salad dressing, raw cookie dough and homemade pancake batter.

Other Practical Tips

"I would love to have a patient tell me she wants to start a family in six months so that I could counsel her not only about nutrition but also other important things," says Dr. Brown.

Besides starting a prenatal vitamin and avoiding alcohol, he also would advise not to use tobacco products and to avoid second-hand smoke. He would advise against unapproved medications, some vaccinations and to avoid changing cat litter.

"We could do tests for rubella to see if she needs a vaccination, which prevents the disease but which cannot be given after pregnancy begins," he adds. "I'd also advise her to get a flu shot. Many women are worried about flu shots, but the risks of complications from flu are much greater in pregnancy than when you are not pregnant."

"Most of all, I'd advise her always to wear a seatbelt. Many women do not use them because they are afraid an accident might hurt the baby. But trauma from motor vehicle accidents is still the number one killer of young women. Seatbelts protect her and her baby - just wear them correctly, below the belly and across the chest," he adds.

Pregnancy is a Happy Time

While pregnancy may bring on some unwanted pounds or feelings for some women, for many it is the incentive needed to adopt healthier lifestyle habits.

"Pregnancy is not a disease. It's a beautiful gift and a special time that deserves a team approach. Your team includes your partner, family, supporting friends, and your physician. Find an obstetrician early in your pregnancy and choose carefully. Your team should always be welcome at your prenatal visits. Nine months is a long time to feel uncomfortable or uneasy," advises Dr. Brown

Kevin H. Brown, MD, FACOG
Round Rock OBGYN, PA
1000 Hester's Crossing, Suite 400
Round Rock, TX 78681

Dr. Brown received a Bachelor of Science degree Magna Cum Laude from the University of Georgia, studied medicine at Medical College of Georgia, then pursued specialty training in obstetrics and gynecology at the University of South Florida in Tampa. He is board certified by the American Board of Obstetrics and Gynecology.

He is in private practice with his wife Dr. Ingrid Brown at Round Rock OBGYN, PA. Dr. Brown serves on the editorial advisory board for "The Prescriber's Letter" and "The Pharmacist's Letter" national publications for doctors and pharmacists. He was recognized this year as a reviewer in the top 10% for the official journal of the American College of Obstetricians and Gynecologists, "Obstetrics and Gynecology."

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