What To Eat When You're Expecting

WHAT TO EAT WHEN YOU’RE EXPECTING
JULIE REDFERN, LD, RDN, TALKS NAUSEA, NUTRITION AND SUPPLEMENTS,
GIVING YOU HER THOUGHTS ON FOOD FOR YOUR 40 WEEKS

IN THE BEGINNING: NAUSEA VERSUS NURTURE
Congratulations! You’re about to become a mom.
You and your family are adjusting to the idea of a new
addition. You’re experiencing a wide array of emotions
and physical changes. You’re happy, nervous and excited
about the prospects of having a baby. You’re also either
tired, nauseated and vomiting or starving and craving certain
foods—or all of the above. Many of these new physical changes affect the entire family. You may be too tired to do your usual activities and chores or so nauseated that you can’t go near your kitchen. The first thing you should know about these physical changes is that most subside between the 13th and 17th weeks. Below are some helpful tips, sure to make each trimester easier rather than queasier.

1	Eat small, frequent meals—every three hours.
2	Choose cold foods since they incite less nausea and vomiting than the strong odors of hot foods tend to.
3	Eat what appeals to you, be it salty, sweet or spicy.
4	Drink adequate fluids like water, milk, 100 percent juice or soups.
5	Enlist family members in food preparation and shopping.

THE GOOD EATS
Eating when pregnant should be a positive experience, and you should aim to have an optimal diet. The good news is you have many choices about how to eat healthfully for you and your baby. Target foods containing nutrients such as protein, calcium, folic acid, omega-3 fats and vitamin D.

Protein
Protein is needed for the baby’s growth, as well as for the developing placenta. Your baby’s cells are comprised of protein. Protein is made up of amino acids, some of which your body cannot make. Therefore, you need to eat it daily. Complete sources of protein include meat, poultry, fish, eggs, milk, cheese, yogurt and soy. During pregnancy, you need 25 extra grams of protein per day or an average daily intake of 70 grams per day. As a reference point, there are eight grams of protein in the following:

• 1 ounce of meat, fish, poultry, cheese, tofu or most nuts
• 2 tablespoons of nut butters like peanut or almond, 1/2 cup of beans or 1/3 cup of hummus
• 8 ounces of milk or yogurt
• 1 egg

Many women experience aversions to meat, poultry and fish early in pregnancy. Having a daily intake of alternative meat sources will enable you to get enough protein.

Calcium
Calcium is needed in pregnancy to support the baby’s skeletal and teeth development. If not enough is available, your growing baby pulls calcium from your bones. Teeth and bones begin to develop from the second month and double their growth by the sixth month, with large increases by the third trimester. You don’t have to be a dairy lover to achieve the recommended amount of 1,200 milligrams per day. Choose from the following:

• 1 cup of yogurt, 350 to 400 mg
• 1 ounce of cheese, 200 mg
• 1 cup of milk, 300 mg
• 1 cup of cottage cheese, 150 mg
• 1 cup of calcium orange juice, 300 mg
• 1 ounce of almonds, 75 mg
• 1/2 cup of firm tofu, 250 mg
• 1/2 cup of broccoli, 50 mg

If you have trouble tolerating dairy products due to lactose intolerance or allergies, or you just don’t like them, you have a wide choice today from many designer milks available. Milk can be lactose-free, full-fat, low-fat, soy, etc. For the most part, the amount of calcium and protein in these products is excellent. However, soy-based milks and yogurts need to be enriched with extra calcium.

Folic acid
Folic acid is a B vitamin that’s essential for a growing baby. Vitamin B deficiencies have been associated with problems of the central nervous system, such as neural tube defects like spina bifida. Since these problems can occur in the first few weeks of pregnancy, it’s now advised to increase folic acid when planning a pregnancy. Research shows that this vitamin is also helpful throughout the pregnancy to prevent premature birth. Food sources of vitamin B include enriched cereals and breads, black and navy beans, black-eyed peas, lentils, asparagus, avocados, orange juice and sunflower seeds. Since your body doesn’t store this critical vitamin, it’s advised to take a folic acid supplement of 600 micrograms to 1 milligram per day. Women who have previously had a child with neural tube defects may be on a therapeutic dose of folic acid. Try to increase this vitamin by adding beans to salads, soup or pasta dishes. Drink fruit smoothies made with orange juice. Combine enriched cereals with yogurt.
What To Eat

THE LATEST NEWS
Recently, an effort is being made to ensure pregnant women are getting adequate amounts of the following two important nutrients.

Omega-3 fats
Omega-3 fats are a type of polyunsaturated fat that we can’t produce in our bodies, so we need to get them through our diet or supplements. The three major types of omega-3 fats are DHA (docosahexaenoic acid), EPA (eicosapentaenoic acid) and ALA (alpha-linolenic acid). DHA and EPA are superior to ALA because our body more readily uses them.

In pregnancy, these fats are important for the development of the baby’s eyes and brain, and they may prevent premature birth and protect against postpartum depression, as well as protect against high blood pressure.

I recommend 650 milligrams of EPA and DHA (including a minimum of 300 milligrams of DHA) daily through our diets and supplements. Your best diet sources of these fatty acids include salmon, herring, anchovies, sardines and omega-3 enriched eggs. To get the recommended minimum through food, you need to eat nine ounces per week of salmon or herring or 15 ounces per week of sardines. (These fish have the most omega-3s.)

If you do not think you will eat enough of these foods to get the recommended amount of omega-3s, then take a supplement. When choosing a supplement, consider the following:

• Be sure to check labels for EPA/DHA content per pill.
• Freeze pills or choose odorless ones to avoid any aftertaste.
• If swallowing big pills is a problem, try the paste varieties.

Vitamin D
We are learning that this vitamin plays a role in many parts of the body. It can be made in the body—through the sunlight or eaten through food or supplements. Recent research shows that most Americans are deficient in vitamin D. Pregnant and lactating women are at greater risk because the fetus takes vitamin D from the mother. Infants born deficient are at risk for calcium deficiencies, rickets (soft bones), dental malformations, being smaller in size and at greater risk for diabetes, certain cancers, high blood pressure and bone issues later in life.

Women who may be at greater risk include women who are overweight, have very limited sun exposure, use sunscreen with an SPF of 8+, are dark-skinned, or live in Northern latitudes (i.e., northern USA). If you belong to one of these high-risk groups, you may consider having your 25(OH)D blood level checked by your doctor to determine if you need additional supplementation to reach adequate levels.

It’s recommended that pregnant women consume 2,000 international units of vitamin D per day from a combination of food, prenatal vitamins and vitamin D supplements, such as the following:

• Food sources, such as herring, sardines, salmon and products fortified with vitamin D, such as milk, OJ and yogurt
• Prenatal vitamins—most contain 400 international units of vitamin D
• Vitamin D supplements—be sure to choose supplements that contain D3 (cholecalciferol), which is best absorbed and sustained in the blood

THOUGHTS ON FOOD
In closing, pregnancy is an opportunity for the entire family to look at their eating habits and make some positive changes. Choosing to eat more fruits and vegetables, eating healthier snacks, or buying fewer fast food items can support the pregnant woman and improve the family’s health as well. Take small steps to improve your diet and incorporate the recommended nutrients. Try not to be worried or stressed about eating well, especially when nausea and fatigue take over. If you have special nutritional needs—for example, if you are carrying multiples or following a vegetarian diet—you may want to seek advice from a registered dietitian who specializes in obstetrical nutrition.

Julie Redfern, RD, LDN, attended the University of Vermont and completed her dietetic internship at the University of Cincinnati Medical Center. She has had more than 25 years of experience in the ambulatory counseling setting. Julie specializes in individual and group settings, and has worked with all ages of the life cycle, specializing in weight control for adults and teens. Her present position at Brigham and Women's Hospital, since 1998, is with OB/GYN services, counseling both teens and adults on a variety of perinatal issues. She also works with patients who are not pregnant for management of chronic diseases, weight loss and eating disorders.