Caring for yourself during pregnancy

Congratulations!! You are pregnant! Whether you are just finding out or already in your final trimester it is likely you are over the moon excited and also, as expected, a little nervous. After all, you are growing this tiny human and it may be the first time, although not the last, you have to now think about what’s best for him or her.

Today’s internet, social media, and mom’s group are a wonderful resource for support but also offer information overload. You may find some topics discussed during pregnancy is your diet, what do you avoid? What do you need to eat more of? What can you have just a little bit of?

Still, there is some disagreement between all the governing bodies of health, a.k.a the American Academy of Pediatrics, American Pregnancy Association, World Health Organization, Academy of Nutrition and Dietetics, American College of Obstetricians and Gynecologists, and many many more, so it’s not easy to know what advice to follow, and what is precautionary overload. To help navigate the waters, let’s break down the standards and update the information on some of these grey area topics so that you can conquer the food world with some understanding.

Just one disclaimer before we start, this is meant to be a guideline. It should not substitute for doctor’s advice and when it comes to a question regarding your individual pregnancy always, always, consult your medical provider.

The low down on calories
You will gain weight, it’s a fact and it’s amazing. You will be housing this 6 to 10 pound baby, working up a milk supply, storing fat for delivery and breastfeeding, and increasing your blood supply by as much as 60% (1 liter can weigh about 2.2 pounds). With in a balanced diet, you will need to add roughly 300 calories per day during the 2nd and 3rd trimester, if pregnant with a single baby. Try to include whole grains, protein, and calcium or iron sources in these extra calories. Ideas include veggies and pita with hummus, low fat yogurt and granola, banana with peanut butter, cottage cheese and peaches, ½ cup dried fruits and nuts, whole grain cereal and milk, chips with salsa and guacamole. If you have never counted calories before now may not be the time to start, this is meant to be a reality check of what “eating for two” really means.

VITAMINS
Two words, prenatal vitamin. Take them. There is a lot of information regarding which vitamins and minerals you need. Most products on the shelf meet, or exceed, these recommended amounts. When comparing products keep in mind the portion or serving size. Make sure that one serving is one pill. Some brands suggest you need two vitamins per day, or more than this. What that means is the nutrients listed are only provided once you have taken these multiple pills. Some nutrients to give more attention to if you want to learn more or compare products include Folate, Iron, Calcium, Vitamin D, Choline, and Omega-3 Fatty Acids.

….Fatty what?
EPA and DHA (Eicosapentaenoic acid and docosahexaenoic acid), or more commonly Omega-3 fatty acids, are becoming almost standard in prenatal vitamins or at least in recommendations for supplements. These fatty acids are essential for fetal growth, as well as brain and eye development of baby but also there’s something in it for mom too! Some studies link EPA and DHA to healthy labor and delivery outcomes, mood stabilizing postpartum and then ongoing benefits through breastfeeding too. While possible to get these good fats in fish and plant sources, most women in the USA will best meet the demands with a supplement. With this supplementing, there is not too much grey area, just do it! Look for EPA/DHA to be supplemented with in your prenatal vitamin or take it separate in it’s own pill as a fish oil or algae oil.

So wait, I can have fish?
Fish is safe, and encouraged by many of those mentioned associations and health groups that oversee recommendations for pregnant women. Each have their recommendations of exactly how much but the general consensus is, eat it a couple times a week and eat the kind that’s low in mercury. So, on the menu look for salmon, tilapia, shrimp, canned light tuna (so not albacore and yes, most restaurants will use Albacore when making tuna salad), cod, and catfish. Now, what about sushi? Sushi has two concerns, bacteria, or food safety, as well as mercury levels. When you have that sushi craving think about rolls that are cooked and include fish like crab, shrimp, salmon, scallops, or eel.

Safety? Are some foods not safe?
Safety, as in food safety or safe cooking and storage practices. Now that you are pregnant you are now at greater risk for food borne illness. What that means is you may not be able to defend against bacteria on foods like you did before pregnancy. The hottest concern is Listeria. Listeria has been linked to miscarriage so rightfully should be taken seriously, but with the caveat that it is very rare. To decrease your risk, eat hard cheese (cheddar, Colby, mozzarella) and avoid cheese that does not state “pasteurized” in the ingredient list (soft cheese, such as blue, feta, brie, queso fresco, etc), avoid hot dogs and lunch meat unless it’s cooked to >160 degrees F (think meatball, hot Italian beef, or veggie if you are feeling a sub sandwich), avoid meat spreads, raw meat, and smoked seafood. If you are at a picnic or barbecue be aware of the salads and dips that have been out for a couple hours. Wash your fruits and vegetables and if you get it from a bin at the store that everyone digs through, you may want to cut off the skin or cook it before eating.

Are you exhausted yet? How about some caffeine?
Oh, if it were only so easy. Here comes one of those grey areas. Most of the governing bodies are in agreement that caffeine is safe within a moderate amount. General consensus is limit to 200 mg caffeine per day from all sources; this includes coffee, soda, chocolate, and even some headache medicine. What does 200mg mean and how can you still have caffeine? Green tea and black tea are about 50-60 mg per 8oz cup. A 12oz soda clocks in about 100 mg caffeine. A medium or grande drip coffee (16oz) has about 350-450 mg caffeine, but a similar sized Americano offers closer to 200-250 mg because espresso offers less caffeine by nature of it’s size. So, do the math and shout out a complicated order of “2/3rds decaf grande soy latte” and be proud of it!

Can I make my latte a skinny, sugar-free vanilla?
Typically skinny flavor suggests using a sugar free syrup. Sugar free in real terms means “we are adding a sugar substitute”. Here comes another hot topic, non-nutritive sweeteners. To say there is a lack of research on safety in pregnancy is an understatement. Essentially, most of the powers in pregnancy leave a very blah statement about certain non-nutritive sweeteners being generally safe. In fact it even has a fancy acronym of GRAS (generally recognized as safe) by the FDA. Those listed as being generally safe are Stevia, Aspartame (Equal or Nutrasweet), Sucralose, and (Splenda). Listed on the not safe list is saccharin (Sweet ‘N Low), and while hard to find, it still sometimes may be added to foods or beverages. When in doubt, add it to the list of questions for your provider if sugar substitutes are an essential part of your diet. The alternative to non-nutritive sweeteners is table sugar. Additional sweeteners include honey, dextrose, corn sugar, fructose, and sucrose. These are empty calories, and while safe during pregnancy still run the risk of excess calories and weight gain if not used in moderation.

Ready, set…eat!
The role of a dietitian is to give you the nutrition facts and get you started on a healthy pregnancy. However, there is more to the food you eat than calories and nutrients. Food is love, food is the ground work of making memories, and food is comfort. Enjoy your meals, enjoy making them and enjoy eating them. Surround yourself with those you love at the table and talk about the dreams you have for your baby. By reading this and advocating for yourself and your baby you are on your way to a healthy and beautiful pregnancy.