USF-COM Department of Family Medicine

Patient Education Information on... Index of Patient Education Topics

Introduction

Congratulations on your pregnancy!  If there was ever a time in your life when eating healthy was essential, it’s now.   Not only is good nutrition important for your health, it is also essential for the health of your unborn baby.  Don’t think of eating during pregnancy as though you are eating for two, but rather that you need to be eating twice as healthy.

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Weight Gain

Total weight gain throughout pregnancy varies and is dependent upon the mother’s prepregnant weight, daily energy expenditure, and appetite, but is usually about 25 to 35 pounds.  Women who are underweight before becoming pregnant should gain 28 to 40 pounds, while overweight women should gain 15 to 25 pounds. Young adolescents should gain 28 to 40 pounds and women carrying twins should gain 35-45 regardless of their prepregnancy weight.

Growth of the fetus is associated with maternal weight gain; therefore pregnancy is not the time to diet (unless directed by your physician). Women with healthy pre-pregnancy weights should gain only 2 to 4 pounds during the first trimester, keeping in mind that slight weight losses during this trimester are normal.  Weight gain should average one pound per week during second and third trimesters, with overweight women gaining less.

Weight Gain Distribution During Pregnancy
Baby – 7 to 7 ½ pounds
Breast tissue – 2 pounds
Placenta – 1 to 1 ½ pounds
Increased blood volume = 3 to 4 pounds
Uterus – 2 pounds
Excess water and fat – 6 to 6 ½ pounds
Amniotic fluid – 2 pounds

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What to Eat

Food requirements during pregnancy are not drastically different from a normal well-balanced diet. Nutrient needs are higher, but the general principles of sound nutrition--variety, balance and moderation--still apply. During pregnancy, eating should be as much a pleasure as it is throughout life. Expectant mothers should continue to enjoy favorite foods in moderation. Attention to portion size and frequency of consumption is the key to choosing occasional treats while keeping total caloric intake under control.

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Calories

To support the rapid growth of the fetus, pregnancy demands an additional 300 calories a day over prepregnancy needs. This is approximately the same number of calories as supplied by 2-1/2 cups of low-fat milk, one cup of ice cream, a bagel with cream cheese or a tuna fish sandwich.  This additional caloric requirement may seem small, but it will supply the extra energy essential to support the growth of the fetus.  Some expectant mothers may be tempted to literally "eat for two," or double the amount of food they normally eat; however, this practice is likely to result in excessive weight gain.

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Food Choices

There are no "perfect" foods that supply all the necessary nutrients.  Only a variety of foods with a balance of choices over the course of the day will provide the recommended amount of calories, protein, vitamins and minerals that are required during pregnancy.  The guidelines for daily food choices, adapted from U.S. Department of Agriculture recommendations, outline the kinds of foods and recommended amounts to eat daily. Individual requirements vary, depending on caloric needs. Use the guidelines to determine the basics of the diet.  Additional servings and larger portion sizes may be necessary in cases of slow weight gain, while smaller portions of higher calorie foods may be needed when the mother is gaining weight too rapidly.
 

Guidelines for Daily Food Choices for Pregnant Women

Suggested Daily Servings of Various Foods and Serving Sizes
Breads, Cereals and other Whole grain and Enriched Products Fruits Vegetables
6-11 servings  2-4 servings
(Include at least one citrus fruit or juice.)
3-5 servings
(Include at least two servings of dark green leafy, yellow or orange vegetables.)
  • 1 slice bread
  • ½ hamburger bun or english muffin
  • 3-4 small or 2 large crackers
  • ½ cup cooked cereal, pasta or rice
  • 1 ounce ready-to-eat cereal.
  • 3/4 cup juice
  • 1 medium apple, banana or other fruit
  • ½ cup fresh, cooked or canned fruit.
  • ½ cup cooked or chopped raw vegetables
  • 1 cup leafy raw vegetables

 
Meat, Poultry, Fish and Alternates Milk, Cheese and Yogurt  Fats, Sweets and Alcohol 
2-3 servings 4 servings
  • 6-7 ounces cooked lean meat/poultry/fish/other protein sources daily
  • 1 oz. = 1 egg
  • ½ cup cooked beans
  • 2 tablespoons peanut butter.
  • 1 cup milk
  • 1 cup buttermilk
  • 8 ounces yogurt
  • 1½ ounces natural cheese
  • 2 ounces processed cheese.
Limit fats and sweets and
avoid alcoholic beverages.
(Adapted from United States Department of Agriculture Home & Garden Bulletin No. 232-8.)

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Protein

Both the expectant mother and developing fetus need increased amounts of protein.  It is recommended that pregnant women consume 60 grams of protein a day, or only 10 grams more than nonpregnant women do.  Ten grams of protein is roughly equivalent to the amount in 1½ ounces of meat or 1 ¼ cups of milk. Since most Americans regularly consume more protein than they require, most women will not need to consciously increase their protein consumption during pregnancy.  Because of this, there usually is no need to use high-protein beverages, supplements or powders.

Lean meats, poultry and fish are good sources of protein that also supply other necessary nutrients, such as iron, B vitamins and trace minerals. Dried beans, lentils, nuts, eggs and cheese are other high-protein foods.

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Calcium

The calcium requirement during pregnancy is 1200 mg/day, a 50 percent increase over the requirement for nonpregnant women.  Women who are not pregnant generally consume only about 75 percent of the recommended amount of calcium; so most pregnant women need to add calcium-rich foods to the diet.  These include milk, yogurt, frozen yogurt, ice cream, ice milk and cheeses. Non-fat and low-fat dairy products supply equal amounts of calcium with fewer calories than higher-fat counterparts.

Green leafy vegetables, tofu and canned salmon (bones included) are other good sources of calcium.

Calcium-fortified foods, such as some orange juices and breakfast cereals, also provide significant amounts of calcium, especially for women who do not eat dairy products.

Pregnant women should consume at least four servings of calcium-rich foods a day, or the equivalent of one quart of milk.  Adequate calcium intake is especially critical for pregnant women under 25 years of age whose bones are continuing to increase in density

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Iron

The iron requirement doubles during pregnancy, from 15 to 30 mg/day. Additional iron is needed for mom due to an increase in maternal blood volume as well as for the fetus who stores enough iron to last through the first few months of life.

It is very important for you to eat foods that are rich in iron.  Examples include liver and red meat. Other meats, fish and poultry are also good sources of iron. Enriched and whole grain breads and cereals, green leafy vegetables, legumes, eggs and dried fruits also provide iron.

Unfortunately, the iron in fruits, vegetables, cereals and eggs is not absorbed as efficiently as iron from meat, fish and poultry. Iron absorption from these nonflesh foods is enhanced when consumed with foods high in vitamin C, such as orange juice, or served with meat, fish or poultry.

A well-balanced diet typically provides a maximum of 12-14 mg of iron. As a result, maternal iron stores are often tapped to meet the demands of pregnancy. This increases your risk of developing anemia since many women enter pregnancy with low iron stores.  Therefore, it is recommended that you take supplements of ferrous at a level of 30 mg/day during the second and third trimesters.  Most prenatal supplements supply this dosage.  Iron supplements are absorbed best when taken between meals, with liquids other than milk, coffee or tea. Taking them at bedtime often reduces problems of gastric irritation.

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Folic acid

Taking folic acid before and during early pregnancy can reduce the risk of spina bifida and other neural tube defects (NTDs) in infants.  This effect has been observed both in women with a previously NTD-affected pregnancy, who are considered at high risk for having a subsequent affected pregnancy, as well as other females.

Because of its important role in cell development, pregnant women need more folic acid (a water-soluble vitamin) than non-pregnant women do.  The U.S. Public Health Service recommends that all U.S. women of childbearing age who are capable of becoming pregnant should consume 400 micrograms (mcg) of folic acid daily to reduce their risk of having an NTD- affected pregnancy.

To obtain recommended intakes of folic acid through the diet requires careful selection of foods consistent with the U.S. Dietary Guidelines and the Food Guide Pyramid.  Good sources of folate include leafy dark-green vegetables, legumes, citrus fruits and juices, peanuts, whole grains and some breakfast cereals.

Because most women do not consume adequate amounts of folate in their diets and may not know they are pregnant when the need for folate is the most critical (the first eight weeks of pregnancy), it has been recommended all women - whether planning to become pregnant or not - take a multivitamin containing folate daily.

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Vitamin Supplements

Though it's possible to meet the requirements for most nutrients through a balanced diet, most experts recommend pregnant women take daily vitamin supplements, including iron and folic acid, as a safeguard. Supplementation should begin, at the latest, by the start of the second trimester at the following levels:
  Strict vegetarians should receive additional daily amounts of 10 mcg of vitamin D and 2 mcg of vitamin B12.

Because excessive levels of vitamin A can be toxic to the fetus and adequate levels are available through a balanced diet, vitamin A supplementation is not recommended during pregnancy.

There is no evidence that vitamin B6 supplementation is an effective treatment for morning sickness.

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SUBSTANCES TO AVOID

Alcohol, drugs, and smoking all are capable of causing harm to your developing baby and should be avoided during pregnancy.  Excessive consumption of alcohol can lead to fetal alcohol syndrome (FAS), which is characterized by abnormalities of the face, heart and central nervous system, as well as small head size and mental and growth retardation.  Even moderate drinking can contribute to spontaneous abortion, low birth weight babies, and more subtle features of FAS.

Many drugs – ranging from crack to seemingly harmless aspirin – can be dangerous for your unborn child.  Crack, cocaine and other "recreational/ illegal" drugs can kill an unborn baby or cause any number of major birth defects and/or childhood problems.  Many prescription and over the counter drugs cross the placenta and are capable of harming a fetus.  You should check with your health care provider before using any medications.

Cigarette smoking should be avoided completely.  Infants born to mothers who smoke during pregnancy have proven to be smaller than infants born to mothers who do not smoke are.  Babies of mothers who smoke also experience a higher rate of stillbirth and neonatal death.

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COMMON QUESTIONS

Do food cravings indicate nutritional deficiency?
No. Food cravings and aversions to certain foods are common during pregnancy. There is no evidence that food cravings are the result of nutritional deficiencies, and their cause remains a mystery. There is no harm in satisfying food cravings within reason, especially when they make a nutritional contribution to the diet.
Some pregnant women have the urge to eat nonfood substances, like laundry starch or clay. Known as pica, the consumption of nonfood items is not safe. The etiology of pica has been speculated to be psychological, cultural or even physiological. In some cases, pica may be practiced in an effort to relieve nausea. It has been suggested that pica is a sign of anemia, but it appears that anemia may be a result rather than a cause of pica.  Women at high risk of practicing pica are likely to live in rural areas and have a childhood or family history of pica. The practice should be discouraged. In some cases it involves consumption of large amounts of nonfood items that displace foods and interfere with adequate nutrient intake.

Is moderate caffeine consumption safe?
Major studies over the last decade have found no association between birth defects and consumption. Even offspring of the heaviest coffee drinkers were not found to be at higher risk of birth defects. Evidence from other human studies also supports the conclusion that moderate consumption of caffeine by pregnant women does not predispose the mother to spontaneous abortion or preterm delivery. While many studies show no relationship between birth weight and caffeine consumption, some studies suggest that drinking more than two or three cups of coffee daily (approximately eight cups of tea or nine cans of caffeinated soft drinks) increases the chances of low-birth weight.
The Food and Drug Administration has stated that, "There is insufficient evidence to conclude that caffeine adversely affects the reproduction in humans." As with all foods, pregnant women should apply the principle of moderation to caffeine consumption and discuss it with their personal physician. A reasonable guideline for daily intake of caffeine is around 300 mg.

Should salt intake be restricted during pregnancy?
No. In fact, salt requirements increase during pregnancy. But the sodium provided by the average diet is likely to be adequate for expectant mothers, but make sure that you are using iodized salt. Use of additional salt is rarely warranted. At one time, salt was routinely restricted during pregnancy in an effort to reduce the incidence of toxemia (a condition characterized by a combination of symptoms including hypertension, fluid retention and protein in the urine). But there is no evidence that sodium restriction prevents or alleviates toxemia.  Excessive sodium intake does contribute to high blood pressure in some people. Women who have been advised to limit sodium before becoming pregnant should continue this practice until they discuss it with their doctors.

Can morning sickness and other forms of GI distress be relieved?
Although some expectant mothers may never experience it, morning sickness is common and does not necessarily occur only in the morning. Eating low-fat, high-carbohydrate foods like dry toast, plain crackers or cereal may relieve feelings of nausea.  Some women have such severe cases of nausea and vomiting that they cannot stand even the thought of food. Soft drinks, popsicles or hard candy may be agreeable and will supply fluid and a few calories. Small, frequent meals tend to be tolerated better than large ones during periods of nausea. Fluids often are better tolerated between meals rather than with them.
Constipation also can be a problem and may partially result from decreased intestinal motility, characteristic of the second and third trimesters. Foods high in fiber, such as fresh fruits and vegetables and whole grain breads and cereals, can help alleviate constipation. Liberal consumption of fluids and a regular pattern of moderate exercise also can be helpful.

The basic principles of good nutrition - balance, variety and moderation - should be encouraged during pregnancy and as lifetime habits.

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