Monday, December 5, 2011

Ask Us Anything: What Should I Eat During My Pregnancy?

"I am pregnant with my first child and am wondering what kinds of foods I should be eating. Are there certain foods that I should eat more of or stay away from? Also, how much more should I be eating than usual?"

Registered Dietitian Deborah Richter Responds:

Having a healthy baby and maintaining good health during pregnancy are the goals of all expectant mothers, but knowing what to eat and how much to eat is often a question once the positive pregnancy test is confirmed.

Foods to Eat

Start with consuming a wide variety of food from all the food groups. Select whole grains and cereals fortified with iron. Take the prenatal vitamin as prescribed.

Have at least 1 serving per day of each of the following:

A fruit or vegetable high in vitamin C

Good choices include:
  • Oranges
  • Orange juice
  • 100% fruit juice that is fortified
  • Most melons
  • Green leafy vegetables
  • Red of green peppers
Fruits, vegetable, or grains that are high in folic acid/folate

Good choices include:
  • Dark green leafy vegetables (i.e. spinach and turnip greens, asparagus, broccoli)
  • Dried beans, peas and lentils
  • Citrus fruits and juices (i.e. melon)
  • Most berries
Fruits and vegetables high in vitamin A

Good choices include:
  • Dark green leafy vegetables
  • Orange vegetables and fruits
  • Tomatoes and tomato products
Fiber-containing foods to help prevent constipation (remember to drink plenty of fluids too)

Good choices include:
  • Whole grain cereals and bread products
  • Fruits and vegetables
  • Cooked dried beans and peas

Foods to Avoid

Beverages
  • Alcohol
  • Excessive caffeine
  • Some types of herbal tea
Dairy
  • Raw or unpasteurized milk
  • Cheese and dairy products made with raw or unpasteurized milk
  • Raw or uncooked eggs
Meat and Seafood
  • Raw or uncooked meats, fish, or poultry
  • Shark, swordfish, King mackerel, or tilefish (due to higher mercury levels)
  • Limit all other fish (including tuna) to 12 oz. or less per week
  • Hot dogs, luncheon meats, bologna or other deli meats unless they are heated until steaming hot
Other items to avoid:
  • Tobacco and second hand smoke
  • Herbal remedies or supplements
  • Vitamin/mineral supplements other than those recommended or prescribed by your doctor, nurse practitioner of midwife

Weight Goals

The goal for adequate weight gain is to achieve an optimal birth weight for the baby and a healthy, well-nourished mother.

Expected pregnancy weight gain is determined by the pre-pregnancy weight status.
  • If your BMI (body mass index) is less than 18.5, the pregnancy weight gain goal is 28 pounds.
  • If your BMI is within 18.5 to 25, the expected weight gain guideline is 25 pounds.
  • If your BMI is over 25, the desired weight gain is approximately 15 pounds.
Use a BMI Calculator and enter your height and weight to determine your current BMI.

Remember that each woman should follow the weight gain goals determined by their doctor, nurse practitioner or midwife.

Morning Sickness

To avoid morning sickness, it is recommended to avoid strong odors in foods, perfumes, laundry detergent, shampoos, soap, chemicals and pets.


Get adequate fluids, often taking smaller sips of cool liquids, eating small more frequent meals, and often dry foods like crackers or toast are better tolerated than soft breads. Some woman find that consuming a small amount of ginger may help to decrease the nausea and vomiting.

Remember to plan ahead and prepare to breastfeed this new baby. It is beneficial for both of you.

— Deborah Richter, RD

Deborah Richter is a registered dietitian at Sisters of Charity Hospital, St. Joseph Campus in Cheektowaga. She teaches diabetes education classes and provides outpatient nutrition counseling. She has helped her clients to lose weight, reduce their blood pressure and feel better about themselves through healthy eating choices.

If you have a question about your health, click here to ask our experts.

6 comments:

  1. Synthetic folic acid from vitamins and supplements (including fortified cereals, flour, and rice) have recently been linked to breast and other cancers, and some prominent physicians suggest that even pregnant women now avoid them. Are there any specific dietary suggestions for women who choose to get their folate (and other vitamins) from only their diet?

    ReplyDelete
  2. Folic acid is the synthetic form of folate. Folic acid is found in supplements and added to fortified foods. Folate is the water-soluble B vitamin that occurs naturally in food. Leafy green vegetables (like spinach and turnip greens, asparagus, broccoli), fruits (like citrus fruits and juices, melon), dried beans, peas and lentils are natural sources of folate.

    In 1992, the US Public Health Service (USPHS) recommended that all women capable of becoming pregnant consume 400 micrograms of folic acid daily. This recommendation was followed by the January 1998 mandatory fortification of cereal grain products with folic acid. This step has been shown to reduce the risk of serious neural tube defect, such as spina bifida by up to 70 percent.

    The American Cancer Society's website (www.cancer.org) says that how folic acid might affect cancer risk is not exactly clear.

    The concern about folic acid supplementation and possible increase risk for breast cancer seems to be associated with the American Journal of Clinical Nutrition's decade-long study that was published on March 24, 2010 (http://www.ajcn.org/content/early/2010/03/24/ajcn.2009.28837.abstract). They studied more than 35,000 Swedish women. The women, ages 49 to 83 were cancer-free at the onset of the study. Over an average of 10 years, 974 women were diagnosed with breast cancer. Researchers found that women who were reported to be taking a multivitamin supplement at the start of the study were 19 percent more likely than non-users of multivitamins to develop breast cancer.

    This study points only to an association between multivitamin use and breast cancer. It does not prove that supplements have a direct link with breast cancer. Some animal research has linked folic acid to breast cancer, yet additional human studies have come to various conclusions. One study found a higher risk, yet others have found either no effect of decreased risk of breast cancer.

    Most of this research on folic acid and breast cancer is for older women, most beyond child bearing age, and yet there is known clear indication that higher levels of folate (which is difficult to get with food choices only) has significantly reduced major birth defects. Until further investigation shows differently, pregnant women and those planning to become pregnant should be consuming 400 to 800 micrograms of folic acid every day. Talk with your doctor about how much folic acid is needed for you.

    ReplyDelete
  3. While studies have shown that folic acid can reduce major birth defects, its link to cancer is unclear.

    In 1992, the US Public Health Service (USPHS) recommended that all women capable of becoming pregnant consume 400 micrograms of folic acid daily. This recommendation was followed by the January 1998 mandatory fortification of cereal grain products with folic acid. This step has been shown to reduce the risk of serious neural tube defect, such as spina bifida, by up to 70 percent.

    The concern about folic acid supplementation and possible increased risk for breast cancer seems to be associated with the American Journal of Clinical Nutrition’s decade-long study that was published on March 24, 2010. They studied more than 35,000 Swedish women, ages 49 to 83, who were cancer-free at the onset of the study. Over an average of 10 years, 974 women were diagnosed with breast cancer. Researchers found that women who were reported to be taking a multivitamin supplement at the start of the study were 19 percent more likely than non-users of multivitamins to develop breast cancer.

    This study points only to an association between multivitamin use and breast cancer, it does not prove that supplements have a direct link with breast cancer. Some animal research has linked folic acid to breast cancer, yet additional human studies have come to various conclusions. One study found a higher risk, yet others have found either no effect of decreased risk of breast cancer.

    Most of this research on folic acid and breast cancer is for older women, most beyond child bearing age, and yet there is known clear indication that higher levels of folate (which is difficult to get with food choices only) has significantly reduced major birth defects. Until further investigation shows differently, pregnant women and those planning to become pregnant should be consuming 400 to 800 micrograms of folic acid every day. Talk with your doctor about how much folic acid is needed for you.

    ReplyDelete
  4. Perhaps you are unaware of all the other research out there. At this point it would be irresponsible to tell the public that the link to cancer is "unclear." The concern stems not just from that study, but many many many others. For example:

    A study 2004 determined that, "Women taking high doses of folate throughout pregnancy may be more likely to die from breast cancer in later life than women taking no folate."[1]

    A study of pre- and post- grain-fortification colon cancer rates in Chile found "a folate fortification program could be associated with an additional risk of colon cancer."[2]

    Norwegians studying folic acid and b12 for heart disease patients were surprised to find that "Treatment with folic acid plus vitamin B12 was associated with increased cancer outcomes and all-cause mortality in patients with ischemic heart disease in Norway, where there is no folic acid fortification of foods."[3]

    A 2009 study published in the Journal of the National Cancer Institute found that prostate cancer risk increased 163% in men taking folic acid supplements.[4]

    The list goes on and on. More and more physicians are now suggesting that pregnant women eat a diet high in leafy greens, fruits and vegetables and avoid folic acid supplementation altogether. There is even one physician marketing a prenatal without folic acid.

    [1] Charles D et al. Taking folate in pregnancy and risk of maternal breast cancer. BMJ 2004;329:1375
    [2] Eur J Gastroenterol Hepatol. 2009 Apr;21(4):436-9.
    [3] Ebbing M et al. Cancer Incidence and Mortality After Treatment With Folic Acid and Vitamin B12. JAMA. 2009;302(19):2119-2126.
    [4] Figueiredo JC et al. Folic acid and risk of prostate cancer: results from a randomized clinical trial

    ReplyDelete
  5. The American Cancer Society agrees that the link is unclear:

    "Evidence of folic acid's ability to reduce certain birth defects in infants when taken by the mother before and during pregnancy is fairly strong, but its effects on other conditions are still under study.

    How folic acid might affect cancer risk is not exactly clear. Some studies that looked at large groups of people have found a link between lower intake of folic acid and higher risk of certain types of cancer. But these studies were done at different times and looked at different groups of people around the world, which can make it harder to compare findings and draw conclusions.

    Until more is known about this, the American Cancer Society (ACS) recommends eating a variety of healthful foods--with most of them coming from plant sources--rather than relying on supplements. Supplements may help some people, such as pregnant women, women of childbearing age, and people with restricted food intakes. If a supplement is taken, the best choice for most people is a balanced multivitamin/mineral supplement that contains no more than 100% of the "Daily Value" of most nutrients."

    ReplyDelete
  6. Here is the URL to the American Cancer Society information: http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/folic-acid

    ReplyDelete

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