A Complete Guide to Pregnancy Nutrition
From the minute you find out you’re pregnant to the day of your delivery, you’re inundated with information and varying opinions on everything from home remedies for morning sickness to how to choose the best stroller. As an expecting mother, I know you want to make the best choices for you and your growing baby, so the goal of this blog post is to make navigating pregnancy nutrition as easy as I can for you! Here’s your pregnancy nutrition 101 course with everything you need to know about nourishing yourself and your baby during the next nine months!
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Pregnancy and Nutrition
First, can we all agree…the female body is amazing! It has the capability to create a human all on its own. But in order for the body to perform this incredible feat, it needs to be supplied with the proper tools — which is where nutrition comes in. Many birth defects or significant pediatric conditions are caused by inadequate nutrition before, during and after pregnancy. That statement is not meant to scare you; instead it is meant to help you appreciate how critical it is to eat a healthy and balanced diet during this precious time.
While you are building this new life inside your womb, it should go without saying that you need quality sources of all the raw materials necessary to support growth and development. The focus should be on macronutrients (proteins, fats, carbs) and micronutrients (vitamins and minerals) instead of calories. While calories matter to some degree, it’s important to understand that it is the nutrient density of those calories that matters the most when it comes to prenatal nutrition.
Since I brought up calories, let’s get a few things cleared up about that whole ‘eating for two’ thing….
Sorry if this bursts your bubble, but you are never “eating for two” in the sense that you need to be doubling the amount of food you’d normally consume. In fact, in the first trimester of pregnancy, your body does not require any additional calories. Due to morning sickness, you may find your appetite is lower than normal and that you’re actually eating less than you were pre-pregnancy. Don’t fret – your baby will still be getting what she needs to grow!
In the second and third trimesters, you will need to increase calorie consumption slightly. Generally speaking, an increase of about 340 calories per day during the second trimester and about 450 calories per day during the third trimester is recommended (Brown, 2016). Pre-pregnancy weight, physical activity levels and individual needs must also be considered before making specific recommendations, so please consult with your healthcare provider on what is right for you.
Weight Gain During Pregnancy
We all know that pregnancy undoubtedly signifies an increase in weight, but where exactly is the weight being gained, and how much is normal? In addition to the weight of the actual baby (~6-10 lbs at full term), the following accounts for the remaining weight gained during pregnancy:
Placenta
Amniotic fluid
Additional maternal fat stores
Increased blood volume
Uterus and breast tissue growth
Below is the recommended weight gain based on pre-pregnancy weight status (Brown, 2016):
Underweight (BMI <18.5): 28 – 40 lbs
Normal weight (BMI 18.5 – 24.9): 25-35 lbs
Overweight (BMI 25 – 29.9): 15 – 25 lbs
Obese (BMI >30): 11-20 lbs
Twin pregnancy: 25 – 54 lbs
Again, we’re all unique individuals, so please view the above weight gain recommendations as general guidelines and discuss your specific case with your healthcare provider.
Macronutrients During Pregnancy
As stated previously, I recommend focusing less on simply increasing food intake and more on ensuring your meals are nutritionally balanced and nutrient-dense. In order to achieve the latter, you want to include all three of the macronutrients at each of your meals. The three macronutrients are proteins, carbohydrates and fats. Below is a high-level overview of each, its role/function, as well as high-quality sources you can choose to use in your meals.
Protein
Adequate protein intake is vital for a healthy pregnancy. It’s particularly important for new tissue synthesis in both you and the baby (remember you’re 3D-printing a whole new human and growing a lot yourself!). Proper amounts of protein will aid the production of the baby’s brain in addition to your breast and uterine tissue. Some research shows lower risk of preeclampsia and other complications with adequate protein intake, and some women report less morning sickness when they consume proper amounts of protein at each meal.
As calorie intake increases with the start of the second trimester, protein intake should increase as well. An increase from 0.8g/kg/day to 1.1g/kg/day (based on pre-pregnancy weight) is recommended (Brown, 2016). In other words, if you up your daily intake of protein by about 15-25g a day, you should be good to go.
Best sources of protein:
Eggs and poultry from pastured chickens
Wild caught seafood (particularly salmon and cooked shellfish)
Grass-fed, organic beef, bison and lamb
Bone broth made from organic grass-fed/finished animal bones (brands: Kettle & Fire and Bonafide Provisions are my picks)
Beans and legumes
Organic tofu and tempeh
Nuts and seeds
Organic, grass-fed cottage cheese
Organic pea protein powder
Spirulina
A mix of animal-based and plant-based protein is recommended. With animal protein especially, quality is of vital importance. If your budget allows, choose organic, grass-fed/pastured and local animal proteins whenever possible to avoid excess toxin exposure. While animal muscle meats are a great source of protein, they can be heavy and difficult to digest when digestion is compromised during pregnancy. Try smaller portions of meat (2-4 ounces), and consider using bone broth and/or collagen peptides for easy-to-digest animal protein.
Carbohydrates
Carbohydrates may have gotten a bad rap over the years, but they are an important source of fuel for the healthy mother and her growing baby because they are broken down into sugars that easily cross the placenta, providing baby with his/her primary source of energy.
If you’re confused about carbs, let’s keep things simple here. Emphasize mostly complex, unrefined carbohydrates which will digest and absorb more slowly, providing a steadier release of glucose into your bloodstream, rather than the quick spike and subsequent crash that is common with simple, processed carbs.
Best sources of carbohydrates:
Root vegetables (sweet potatoes, parsnips, carrots, beets, turnips, etc.)
Winter squash (acorn, butternut, delicata, spaghetti, etc.)
Seasonal and local fruit
Rice
Quinoa
Buckwheat
Oats
Millet
Jilz crackers and Simple Mills crackers
In addition to eating mostly complex carbs, you also want to ensure you’re choosing carbs with ample fiber. Fiber is a type of carbohydrate that our bodies cannot digest. Instead of being absorbed like a normal nutrient, fiber’s job is to sweep the toxins out of our digestive tracts and provide necessary bulk to stimulate the healthy movement of our bowels. Fiber also helps control blood sugar levels and keeps us feeling full and satiated between meals. Heartburn, constipation and indigestion are common occurrences during pregnancy, and the remedy to those uncomfortable symptoms may be as simple as making sure you are getting enough fiber in your diet.
Best sources of fiber:
Beans and legumes
Leafy greens (collards, spinach, kale, chard, etc.)
Cruciferous veggies (broccoli, cauliflower, brussels sprouts, etc.)
Fruits (avocado, pear, apple, raspberries, etc.)
Whole grains (oats, quinoa, buckwheat, etc.)
Seeds (chia seeds, ground flax seeds, sesame seeds, sunflower seeds, pumpkin seeds, etc.)
Fat
Healthy fats are very important for your health and vital to the baby’s organ and brain development. A notable mention, particularly in the context of prenatal nutrition, goes to the omega-3 fatty acids, EPA and DHA. These fats are necessary to develop and sustain the health of your baby’s brain, eyes, heart, immune system, and more. Most pregnant women are told by their doctors to supplement with DHA, which is the major structural fat in the brain and eyes. Getting enough DHA is crucial, especially during your third trimester when baby’s brain is developing the fastest. You can get DHA from consuming wild-caught cold water fatty fish, like salmon and sardines.
Best sources of healthy fats:
Avocado
Olives
Nuts and seeds
Coconut products (flakes, milk, yogurt, etc.)
Healthy oils (coconut oil, olive oil, ghee)
Organic, pastured-raised eggs
Wild caught cold water fatty fish (salmon, sardines, trout and cod)
Organic, grass-fed, full fat dairy products, especially those that are fermented, such as yogurt and kefir
Water
While not technically a macronutrient, I couldn’t leave water out of the discussion since your pregnant body requires more fluids! A woman’s blood volume increases about 50% during pregnancy and her body has to supply the fluid to the amniotic sac that the growing baby is in. Water is essential for maintaining good circulation of nutrients and removal of waste. Staying properly hydrated can help prevent some common pregnancy woes, such as morning sickness, constipation, hemorrhoids, muscle cramps, headaches, bladder infections, etc. Aim to drink half your body weight in ounces daily at a bare minimum (i.e. if you are 130 lbs, drink 65 ounces of water daily). You’d likely benefit from even more, or closer to 100 ounces/day (Montgomery, 2002). You can tell if you’re adequately hydrated by looking at your urine. Pale yellow is what you want to shoot for.
Micronutrients During Pregnancy
I mentioned previously that nutrient density is key when it comes to supporting a healthy mama and baby. This is where micronutrients come in. Micronutrients are vitamins and minerals. In the case of prenatal nutrition, there are a few micronutrients that deserve a bit of extra attention. Calcium, choline, iron, folate, vitamin B12, vitamin D, vitamin A and glycine are particularly important for pregnant women to ensure adequate intake.
Calcium
Calcium is an essential mineral during pregnancy. It is important for healthy teeth and bones, muscle development, heart rhythm and blood flow. Recommended intake for pregnant women is 1,000 -1,300 mg/day, depending on age. As much as 350 mg of calcium is transferred to the baby each day in the third trimester. If you don’t have enough calcium in your diet, your body will default to pulling the needed calcium from your bones, so it is important to ensure your diet is rich in calcium so it doesn’t have to do this. You can find calcium in dairy products, salmon, sardines, dark leafy greens and beans.
Choline
Choline is critical during fetal development, particularly for the development of the brain, where it can influence neural tube closure, as well as memory and learning functions. The recommended dietary intake of choline is 550 mg/day for pregnant women, and choline deficiency is extremely common. I recommend taking a prenatal supplement that contains choline, as well as adding more choline to your diet by incorporating foods such as beef liver, salmon, cod, egg yolks and chickpeas. If your prenatal does not contain choline or you’re not getting enough from your diet, you can supplement with Needed’s Prenatal Choline.
Iron
Iron is a key component of red blood cells, which are important for the creation of blood. As blood volume increases by 50% during pregnancy, this results in an increased need for iron as well. If your diet is low in iron, you are at higher risk for iron-deficiency anemia. The RDA for iron in pregnancy is 27mg. Dietary iron comes in two forms: non-heme and heme iron. Non-heme iron (aka ferric iron) comes from plant-based sources, such as white beans, chocolate, blackstrap molasses, lentils, spinach and prunes. Plant-based iron is a bit harder for the body to absorb and utilize, but consuming it with vitamin C improves absorption. Heme iron (aka ferrous iron) comes from animal-based sources, such as oysters, beef liver, sardines and beef. This form of iron is more bioavailable (better absorbed) than non-heme iron. I recommend including both non-heme and heme sources of iron in your daily diet. If you are using supplemental iron, avoid sulfate forms which are poorly absorbed and can cause digestive upset / constipation. Instead, opt for Ferrochel chelate iron, found in Needed’s Prenatal Iron, which is the most bioavailable form.
Folate
I’m sure this is not the first time you’ve heard that folate (aka vitamin B9) is an especially important nutrient before and during pregnancy. This micronutrient is essential for healthy brain development, DNA/RNA production, proper genetic development, and methylation, thus helping to prevent neural tube defects and other fetal abnormalities. So why am I saying folate instead of folic acid? Folate is the naturally occurring form found in food, while folic acid is the synthetic form found in fortified foods and supplements. Due to a common polymorphism of the MTHFR gene, many women struggle to properly metabolize folic acid into useable folate. The folic acid can “sit” in the body’s folate receptors and not activate them properly, thus actually causing a folate deficiency in some people (Lynch, B., 2020). For this reason, I recommend all women who are pregnant or wanting to fall pregnant make sure they are getting the right form of folate, called methylfolate, in their diet and prenatal supplements. Good sources of dietary folate include beef liver, lentils, chickpeas, asparagus, and dark leafy greens. Recommended daily intake is 600-800 mcg/day during pregnancy.
Vitamin B12
Vitamin B12 during pregnancy is essential for the synthesis and methylation of DNA. This vitamin plays an important role in the energy production of the cell and is necessary for the development of the central nervous system. As the baby grows in utero, DNA, cells, cell membranes and nerves are forming. These processes require not only a constant supply of energy, but also rapid and continuous methylation. Vitamin B12, in its active coenzyme forms, is essential for the proper function of your body’s methylation processes. Foods rich in vitamin B12 are animal-derived, such as clams, mussels and beef liver, so if you are following a vegan/vegetarian diet, you will need to supplement. I recommend finding a prenatal with vitamin B12 in the form of methylcobalamin and/or adenosylcobalamin.
Vitamin D
Vitamin D is needed for a healthy immune system, cell division and bone growth. It is also required for your body’s absorption of calcium and phosphorous, making it necessary for healthy teeth and bone development. Deficiencies in vitamin D during pregnancy are common and linked to increased risk of preterm labor, preeclampsia, gestational diabetes and bacterial vaginosis. I recommend asking your OB or midwife to test your vitamin D level early in pregnancy (like at your 8- or 12-week visit). Optimal levels are between 50-80 ng/mL. If you are low, consider supplementing with vitamin D3. The dose is dependent on the degree of deficiency, but most women need between 2,000 – 5,000 IU/day.
Vitamin A
Vitamin A is an essential nutrient for normal brain development, healthy skin and eyes, immune system function, and healthy mucus membranes. Vitamin A needs are slightly increased during pregnancy to about 750-770 mcg/day (= ~2,500 IU/day) of preformed vitamin A. There are two forms of vitamin A: preformed vitamin A and provitamin A carotenoids. Preformed vitamin A is found in foods from animal sources, such as beef liver, cod liver oil, fish, eggs, and dairy products. It can also be found in prenatal supplements as retinyl palmitate. Preformed vitamin A is readily converted into retinol, which is the form that can be used by the body. Provitamin A carotenoids, such as beta-carotene, are naturally occurring in plant-based foods, such as carrots, sweet potato and pumpkin, but may not be as easily converted into retinol. This is especially true for those who have a genetic polymorphism that does not allow their bodies to convert beta-carotene into retinol, thus causing a possible vitamin A deficiency. For this reason, I recommend a prenatal supplement that contains both forms of vitamin A (retinyl palmitate and beta-carotene) to benefit those with genetic polymorphisms (that they may not even know about!), but still contain safe amounts of vitamin A for all mamas.
Glycine
I’m going outside the micronutrient box with glycine as it is not a vitamin or mineral but instead an amino acid. This amino acid becomes conditionally essential during pregnancy, meaning your body can’t make all it needs from other amino acids so therefore you must get it through your diet. Glycine is required to support the growth of the baby’s skeleton, teeth, internal organs, hair, skin and nails. It’s also involved in the formation of baby’s DNA and in brain development due to its role in methylation. For mom, it’s necessary to support your own stretching skin, growing uterus, placenta and to help your circulatory system adapt to the demands of pregnancy (Nichols, L., 2020). Glycine is found in greatest concentrations in animal foods, mostly in the bone, skin and connective tissues of animals. Thus, glycine is abundant in bone broth, slow cooked meat and poultry with the skin on. You can also get a good dose of glycine via collagen and gelatin powders such as those from the brand Vital Proteins.
Supplements
Below is a list of supplements that are generally recommended during pregnancy. Supplement needs vary for each individual mama so please have your OB or midwife approve all supplements before you start taking them.
Prenatal
A prenatal vitamin should not be thought of as a replacement for a real food diet, but more of an “insurance policy” to help meet your nutrient needs before, during and after pregnancy. I recommend starting a high-quality prenatal supplement ~3-6 months before trying to conceive, taking through pregnancy, and for the duration of breastfeeding, or at least 6 months postpartum if not breastfeeding. Quality, as well as dose and bioavailability of the micronutrients included in the prenatal formula, is absolutely KEY. I recommend Needed’s Prenatal Multi capsules or powder. Avoid prenatal supplements with food dye or coloring (check “other ingredients”), hydrogenated fats, folic acid, iodine without selenium included, MSG, and polyethylene glycol.
Fish Oil
Fish oil supplements provide you with a daily dose of omega-3 fatty acids, EPA and DHA. I recommend finding a supplement that has a 2:1 ratio of EPA to DHA, and includes at least 400mg DHA per serving. Again, quality is crucial when choosing an omega supplement because the fish oil is derived from from fatty fish which can be high in mercury. Look for ones that have been tested for purity by a 3rd party and are molecular distilled, which is a process that removes contaminants such as heavy metals, pesticides and PCBs. I recommend 2 capsules daily of Xymogen’s Omega MonoPure 1300 EC for its improved absorption.
Vitamin D3
Having adequate vitamin D levels in pregnancy can reduce your risk of developing gestational diabetes, preeclampsia and giving birth prematurely. Vitamin D is synthesized in our skin when exposed to UV light from the sun. It is also found in small amounts in several foods, such as fatty fish, eggs, mushrooms, grass-fed meat and organ meats, however it’s virtually impossible to keep vitamin D levels in the optimal range (50 – 80 ng/mL) with sunlight and food alone. Speak with your OB or midwife about checking your 25-hydroxy vitamin D level to see where you’re at before you start supplementing. Look for supplements that provide D3 (cholecalciferol) and take with your largest meal of the day. I recommend Needed’s Prenatal Vitamin D. Generally, 2,000 – 5,000 IU of vitamin D3 is a typical maintenance dose, but you may need more if your levels are low. Don’t take more than 5,000 IU per day without a clinician’s supervision and regular blood testing.
Probiotics
Probiotics are the beneficial microorganisms that live in your gut and play a significant role in your overall health. These good gut bugs aid in digestion, manufacture key nutrients (like B vitamins and vitamin K), limit the growth of pathogenic bacteria and yeast, promote regular BMs, boost your immune system and regulate your mood. Bacterial colonization of your baby’s gut begins in the womb so keeping your own gut in tip top shape is laying down the foundation for your child to have a healthy and resilient microbiome. Research shows that mothers receiving a probiotic in the third trimester have babies with lower rates of atopic conditions, such as eczema and allergies (Rautava, Samuli, Kalliomaki, & Isolauri, 2002). This early inoculation of good microbes being passed from you to baby is important for your child’s long-term health! I recommend Needed’s Prenatal Pre/Probiotic.
Food Items to limit/avoid
High Mercury Fish
There is no need to be afraid of eating fish during pregnancy. While there are certain fish that are high in mercury and thus should be avoided (namely, shark, swordfish, king mackerel and tilefish), most other types of fish are perfectly safe to eat while pregnant. In fact, cold-water fatty fish are especially beneficial to eat while pregnant thanks to high levels of the omega-3 fatty acids, EPA and DHA, as well as vitamin D, and trace minerals. If you like fish, freely consume 8 – 12 ounces (or 2-4 servings) of wild-caught low mercury fish per week. You can use the acronym SMASH to remember the ones to emphasize: sardines, mackerel, anchovies, salmon and herring. Shellfish, such as scallops, shrimp, clams and oysters, are all fair game as well, just make sure you consume them cooked, not raw.
Alcohol
While the placenta acts as the “gatekeeper” between the mother and the baby, it unfortunately doesn’t have the ability to stop alcohol from passing through. When you drink alcohol, the baby will receive it as well. Alcohol consumption during pregnancy has been linked to Fetal Alcohol Syndrome, low birth weights and many other abnormalities. Because of this, the avoidance of alcohol is generally recommended throughout pregnancy. That said, several studies have found conflicting results, concluding that low amounts of alcohol are not harmful. There is research showing that 1-2 drinks/week in the first trimester, and 1 drink/day in the second and third trimesters, is safe. I recommend discussing alcohol consumption with your OB or midwife to determine what is the best choice for you and your baby.
Caffeine
The safety of caffeine in pregnancy is controversial and studies show mixed results. What we do know is that, just like alcohol, caffeine crosses the placenta so baby’s caffeine levels are similar to mom’s. If mom has a high level of caffeine in her bloodstream, it may reduce placental blood flow, which could limit nutrient transfer to the baby. Current recommendations suggest that up to 200 mg/d (or about 16 oz / 2 cups of regular coffee) is safe in pregnancy. While the baby is able to metabolize caffeine, it isn’t metabolized well until after three months of gestation so you may consider waiting to resume your morning cup o’ Joe until after the first trimester.
Reducing Risk of Food Borne Illness
During pregnancy, the mother’s immune system makes some adaptations to allow the baby to grow, and as a result, your body becomes slightly more susceptible to foodborne illness. Listeria monocytogenes, Salmonella, and Toxoplasma gondii are the biggest offenders. To reduce your risk of foodborne illness, general recommendations suggest avoiding:
Raw/rare meat
Raw fish
Raw shellfish
Raw milk cheese
Raw eggs
Raw sprouts
Deli meat (cold cuts)
Cold smoked fish
Meat spreads or pate
Unwashed produce
That said, there are many women who feel comfortable consuming raw milk cheeses or sushi. I personally believe these foods are safe as long as they are purchased from reputable establishments, stored and handled properly, and consumed in a timely manner.
To conclude this lengthy post on prenatal nutrition, remember that your body has the blueprints for a healthy baby. It is going to follow those blueprints. You can support your body and this “construction process” with your diet and lifestyle choices, but ultimately, your body is going to do everything it can to grow a healthy baby. So, if you’ve been feeling worried about your dietary choices, I encourage you to take a deep breath, do the best you can and enjoy this miraculous journey into motherhood! Always feel free to reach out for personalized support with your prenatal nutrition and supplementation needs. You can schedule a session with me here.
References:
Brown, J.E. (2016). Nutrition through the life cycle. (6th ed.). Boston: Cengage
Lynch, Ben (2020). Folic Acid Side Effects. Retrieved from: https://www.drbenlynch.com/folic-acid-side-effects/
Montgomery K. S. (2002). An update on water needs during pregnancy and beyond. The Journal of Perinatal Education, 11(3), 40–42. doi:10.1624/105812402X88830
Nichols, L. (2018). Real Food for Pregnancy: The Science and Wisdom of Optimal Prenatal Nutrition.
Nichols, L. (2020). Vegetarian Diet in Pregnancy. Retrieved from: https://lilynicholsrdn.com/vegetarian-diet-in-pregnancy/
Rautava, Samuli, Kalliomaki, & Isolauri (2002). Probiotics during pregnancy and breast-feeding might confer immunomodulatory protection against atopic disease in the infant. Journal of Allergy and Clinical Immunology, 109(1), 119 - 121