Eating for Two? Nutrition in Pregnancy

August 6, 2012 Teresa Patani, MD

You may have many questions when you find out that you are pregnant, but some of the most common concerns revolve around nutrition and food safety. These are some basic guidelines from the American College of Obstetricians and Gynecologists to get you started. As always, your situation may be different and so always discuss specifics with your provider.

How much weight should I gain?

This depends on your pre-pregnancy BMI (body mass index - a calculation from your height and weight). In general, however, if your pre-pregnancy weight is normal you should gain between 25 to 35 pounds. Most women stay within this goal with an increase of only 300 extra calories a day (equal to about 2 tablespoons of peanut butter and one slice of whole wheat bread). If you are underweight, however, you may need to gain more weight, and if you are overweight, less. Your doctor can help you to come up with a specific weight goal.

What foods can't I eat?

Alcohol, of course, is not recommended in pregnancy, but there are other restrictions. Other foods can put you at risk for listeriosis, a bacterial infection that causes miscarriage and stillbirth. Unpasteurized milk and cheese can put you at risk, as can raw or undercooked shellfish, meat, or poultry. Deli meats and hotdogs are okay if they are heated until they are steaming hot.

What about fish?

That depends on the fish! Certain large fish may contain too much mercury to be safely eaten in pregnancy. High levels of mercury exposure in pregnancy may lead to nervous system damage in the unborn child. If you are pregnant you should avoid eating Shark, Tilefish, Swordfish, and King Mackerel and limit your intake of albacore tuna to 6 ounces a week.

You may eat fish and shellfish that are lower in mercury, but no more than 12 ounces a week. If you want to eat fish caught by family or friends from local waterways check for local advisories first, and do not eat more than 6 ounces.

Do I need to take extra vitamins or supplements?

It is important to take enough folic acid and iron in pregnancy. Usually prenatal vitamins have enough of both of these nutrients. Folic acid can prevent neural tube defects and is most effective if it is taken before pregnancy through the first trimester. For most women 400 mcg of folic acid is enough, though some women are at a higher risk. If you have a history of a child with a neural tube defect or take certain medications you may need 4mg a day instead.

Iron helps to support the growing baby an extra blood supply. During pregnancy you need 27 mg of iron daily, though if you develop anemia you may need more.

Can supplements be dangerous?

Many supplements and herbs are not well studied in pregnancy and therefore should be avoided. To be safe, review any medications (prescription or not) you are taking with your doctor. Certain supplements are known to be dangerous in excess. High amounts of vitamin A (over 10,000 IU a day) can cause birth defects.

What else should I know?

Many different things can affect your nutrition and nutritional needs in pregnancy. Pre-existing medical problems, prior pregnancy history, and carrying multiples are only a few of the factors that can change your needs, so it is important to maintain a dialogue with your provider and discuss any concerns you may have.

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