Diet and Weight Gain
During pregnancy, you need to eat only about 300 extra calories per day. If you eat a well-balanced diet, the most important additional nutrient you need is Folic acid. Folic acid is present in every prenatal vitamin and ideally you would take a prenatal vitamin months before getting pregnant and during the first few weeks of pregnancy.
Normal weight women gain 25-35 lbs during their pregnancies. Underweight women may need to gain more and overweight women less. For overweight women, dieting is safe and beneficial during pregnancy. Most weight gain comes in the second half of pregnancy and often women have gained no weight or even lost weight by 20 weeks; this is healthy. We check your weight at every visit, but don’t focus on how much you gain. We are usually not worried about you gaining too little weight but instead gaining too much. Excess weight gain increases the risks of pregnancy, including the risks of preeclampsia, diabetes, fetal macrosomia, and cesarean delivery.
Because of high-levels of mercury, pregnant women should avoid shark, swordfish, king mackerel and tilefish. Smaller fish are usually safe, such as light tuna, salmon, pollock, and catfish. Up to 12 ounces per week of these fish is considered safe.
Listeriosis is a rare type of food-poisoning that can affect pregnant women and cause stillbirths. To avoid this, you should wash all fruits and vegetables before eating them and avoid eating unpasteurized milk or soft cheeses, raw or undercooked meats such as meat, poultry, or shellfish. Ideally, hot dogs and deli meats should be heated thoroughly prior to eating though the absolute risk of acquiring listeria from deli meats is extraordinarily low.
Caffeine. Most women try to avoid caffeine during pregnancy, particularly during the first trimester. However, there is little scientific data that this is necessary. Most recommend limiting caffeine to less than 350 mg per day. Most soft drinks have about 40 mg per 12 ounces. Most coffee has around 75 mg per 8 ounces, but this amount varies widely. Most teas have around 40 mg per 8 ounces. And energy drinks like Red Bull have about 80 mg per can.
If you drink a lot of caffeine prior to pregnancy, cutting it out altogether can produce daily headaches.
What can’t I eat?
Good question. The truth is, you can eat just about anything you want. Visit our page here for a full explanation. But here's the quick answer. Don't eat:
- Big fish with high levels of mercury (shark, swordfish, king mackerel, and tile fish).
- Unpasteurized milk and soft cheeses
- Raw or undercooked meats
- Unreheated meats
Finally, make sure you wash your fruits and vegetables well before eating them. The absolute risk of the anything that happening from eating any of these foods is incredibly low. So you shouldn't worry too much; but pregnancy isn't the time to explore strange and new foods from uncertain sources.
How much weight should I gain?
Normal weight women gain 25-35 lbs during their pregnancies. Underweight women may need to gain more and overweight women less. For overweight women, dieting is safe and beneficial during pregnancy. Most weight gain comes in the second half of pregnancy and often women have gained no weight or even lost weight by 20 weeks; this is healthy. We check your weight at every visit, but don’t focus on how much you gain. We are usually not worried about you gaining too little weight but instead gaining too much. Excess weight gain increases the risks of pregnancy, including the risks of preeclampsia, diabetes, fetal macrosomia, and cesarean delivery.
Many overweight women will gain no weight for the entire pregnancy or even lose weight if they're actively dieting. This is not a bad thing. Maternal weight gain when it is excessive is associated with excessive fetal size; but gaining too little weight during pregnancy will not make your baby too small if you are overweight at the start of the pregnancy.
Can I drink caffeine?
Yes you can.
As with most things in life, moderation is the key. Scientific studies have not demonstrated any problems with caffeine consumption during pregnancy until a woman consumes over 700 mg per day. That's a lot of caffeine! To be safe, and to make sure that a woman never approaches that amount of caffeine consumption, we recommend that women limit themselves to 350 mg of caffeine per day.
Check out this list to learn how much caffeine is in common beverages. In general terms, the average cup of regular coffee and the average serving of a caffeinated soft drink. But beware: it is possible to overdo it with a large special order from Starbucks.
I’m throwing up! Help!
Nausea and vomiting during pregnancy is no one's idea of a good time. The good news is, nausea and vomiting is not associated with risk to the pregnancy; the bad news is, you aren't nauseated and throwing up.
What can you do?
- Eating several small meals per day and avoiding high fat foods may help.
- Emphasize bland foods and avoid smells that are noxious.
- Increasing protein and liquid content of your food maybe beneficial.
- Ginger ale, ginger teas, or ginger capsules may be helpful.
- Taking a vitamin B6 supplement 2 to 3 times per day alone or in combination with doxylamine at night may be beneficial.
- Your doctor may need to prescribe you an anti-nausea medicine. There are several drugs that are safe in pregnancy to choose from.
- Make sure that your acid reflux and constipation are treated as well; both can contribute to the problem.
- In bad cases, you may need to be hospitalized for IV fluids and other treatments.
Hopefully, you should feel better by the end of the first trimester. If you don't, or if the above remedies are not working, your doctor may need to investigate other causes of your nausea and vomiting apart from pregnancy. Typically, you shouldn't be concerned as long as you can maintain your bodyweight or even lose a few pounds during the first trimester and as long as you can stay hydrated.
Do I need to take anything besides my prenatal vitamin?
In most cases, the answer is no.
There is a whole industry that markets supplements in other products to pregnant women. Even among prenatal vitamins, from most women the only ingredient that is actually required is folate, and that folate is only necessary until the baby's neural tube is closed, which happens early in the first trimester. The truth is, prenatal vitamins are best taken ended 2 to 3 minutes before pregnancy and provide little to no benefit past the first half of the first trimester. In fact, if you are beyond six weeks and prenatal vitamins are making you nauseous for constipated, there's no reason for you to not stop them.
Aside from the folate in a prenatal vitamin, the other ingredients often found in these vitamins are not science based. Don't get caught up on buying the most expensive prenatal vitamin because the company says it will make your child smarter or reduce the risks of pregnancy; this simply is not true.
In some cases, due to restrictive diets or pre-existing anemia or other risk factors, your doctor might ask you to take an additional supplement or medication.
I have gestational diabetes. Now what?
If you failed your glucose screen and your glucose tolerance test, then you now have gestational diabetes.
Hopefully, you'll get a chance to talk to a dietitian. In the meantime, cut out all of the simple sugary items from your diet: colas, cookies, cakes, candies, and other sources of sugary carbs. Pay attention to portion size. If you're not already, and-in for or five 20 minutes walks or other cardiovascular exercise sessions per week.
You'll need to check your blood sugar several times per day, at least initially. You should check your blood sugar first thing in the morning, a fasting blood glucose, and then check it two hours after each large meal – breakfast, lunch, and dinner. You're fasting blood sugars should be below 95 and your blood sugars after meals should be below 120. If your blood sugars are running higher than this, you may need to take medicine to help lower your blood sugars.
Is also helpful in the beginning at least to track what you are eating. This can help your dietitian and your doctor decide if their are some things you should do differently in your diet. It can also help you understand why your blood sugar might spike – for example, after delicious pizza.
Can I eat fish?
Yes!
Because of high-levels of mercury, pregnant women should avoid shark, swordfish, king mackerel and tilefish. Smaller fish are usually safe, such as light tuna, salmon, pollock, and catfish. Up to 12 ounces per week of these fish is considered safe.
In fact, regular consumption of fish (and their omega fats) has been associated with lower rates of preterm labor and other complications of pregnancy.
