During my OB/GYN residency training, a friend once asked me how much I was learning about nutrition in pregnancy. I remember laughing at this, replying that my main concern was to keep my patients off crack. That was a sadly accurate, if snarky, response. In residency I took care of the sickest of the sick and many of our patients were non-compliant. I remember getting excited when a patient’s only bad habit was smoking. Honestly there wasn’t much of a chance to focus on daily healthy habits, as we spent most of our time learning to care for acute emergencies.
Fast forward to life in private practice suburbia where I immediately experienced a culture shock. Not only were my patient’s not on crack, many were obsessed with their health. Patients would call me at 3 am concerned that the lunch meat they ate 2 days ago might be killing their baby and over analyzing every lotion that came in contact with their body. I went from taking care of women who showed no regard for their own health to women who fretted over every bit of food that went into their body. I had spent my residency learning to keep people from dying, now it was time to learn how to help them live healthier and better.
One of the main reasons I became a doctor was my interest in preventative medicine, so I’ve enjoyed learning more about nutrition in pregnancy and integrating that into my practice. The goal is the happy medium: eating healthy in pregnancy without being obsessive. There’s plenty of resources for nutrition in pregnancy, including a recent book I was asked to collaborate on, but of all the advice out there I think these are the most essential habits to incorporate into pregnancy.
1. Take Your Folic Acid
Far too often when I see a patient for their establish pregnancy visit, they will say that they didn’t want to take any vitamins until they saw me so that I could advise them on which brand to take. Others respond that their vitamins were making them more nauseated, so they just quit taking them altogether. Both of these responses make me do an internal face palm. Folic acid is the most important nutrient needed for early organ development. You actually need folic acid BEFORE you even realize you are pregnant. All women of childbearing age are recommended to take 400 mcg of folic acid daily. If you are trying to conceive, up that to 1 mg a day. If your prenatals are making you sick, try a gummy variety or simply take folic acid alone. For the first 12 weeks of pregnancy folic acid is essential.
2. Treat Yourself Like a Diabetic
As the placenta grows, it secretes many hormones. One of the effects of these hormones is insulin resistance {your body needs higher levels of insulin to metabolize sugar}. In some people, the hormonal changes will actually put them into a temporary diabetes of pregnancy {gestational diabetes}, but even women who don’t develop diabetes can be effected by these hormonal changes.
The insulin resistance begins after the first trimester. If you eat a high carbohydrate snack alone or go several hours without eating, you can be very prone to low blood sugar episodes. These episodes cause you to feel weak, dizzy or clammy. Some women will even faint. The best advice is to eat frequent small meals throughout the day, keep simple carbs {white bread, cookies, candy, etc.} to minimum and always eat your carbs with a protein. While snacking on soda crackers is great for soothing your nausea in first trimester, in the second trimester add some cheese to your crackers or you may feel faint.
3. Drink Water
You should drink enough water so that your pee is clear to very light yellow. A good goal is 75 ounces a day. Dehydration can cause leg cramps, bladder infections, constipation and preterm contractions. Tea, soda, and juice do not count, you must drink water! What if you don’t like water? You can try flavoring it with lemon, cucumbers or strawberries to see if this helps. If that still doesn’t help, then just drink it anyway. How bad can it be? Water is tasteless and odorless.
4. Eat Your Fruits and Veggies
Aim for 5-8 servings of fruits and veggies a day. This number may seem overwhelming to some, but with a little planning it can be easily accomplished. Often you are already eating more than you realize. A large apple counts as 2 servings of fruit, and 1 cup of spinach is 1 serving {I usually use 2 cups for my salads}. In general, the darker the color of the vegetable, the healthier.
5. Juice is Not a Fruit
While prepacked juice does have some vitamins in it, it is mainly sugar and empty calories. It lacks fiber and does not give you the nutritional impact of eating real fruit. It does not count toward your daily fruit servings.
Additionally, the following do not count as a serving of fruit or vegetable:
- fruit snacks
- veggies chips
- French fries
- pop tart filling
- ketchup
6. Ice Cream is a ‘Sometimes’ Food
Cravings and food aversions are big part of pregnancy. If you crave healthy stuff, that’s awesome, but most of us do not. If you really need that chocolate milk shake, enjoy! Just not every afternoon. Give in to your cravings twice a week not twice a day.
7. Yes, Milk is Good for You…in Moderation!
I recently had a patient who was gaining over 10 pounds each month in her pregnancy. As I gently broached the subject, she was adamant that she was eating healthy and exercising daily. As she reviewed her daily food intake, I had to agree that it did not seem excessive. When I asked how much water she drank, she replied that she didn’t like water so she drank only milk. She was drinking a half a gallon of whole milk each day. Yes, milk IS good for you. It’s a great source of calcium and protein, but calories are calories and a half gallon of whole milk is an extra 1200 calories a day.
8. Be Aware of Your Food’s Nutritional Content
I recently learned that my favorite “healthy” snack from Starbucks, the banana bread, contained a staggering 400 calories and has nearly no nutritional value. For years, I’ve been choosing the banana bread over the brownies, thinking since it has a fruit in its title that it must be wholesome. We don’t want you losing weight during pregnancy or being obsessed with calories, but you do need to be aware of approximately how much you need to be eating and how much you are actually eating. While researching this article I came across an extremely helpful site to calculate your caloric and nutritional needs for pregnancy and breast feeding.
Once a week, track your food intake either using an APP like My Fitness Pal and the old fashion way with a pen and paper. Make sure you are staying on track with your nutritional intake.
9. Be Mindful of Your Nutritional Intake, Not the Scale
Weight gain in pregnancy is a tricky thing. It is not linear. Just as your baby will experience growth spurts during the first year of his life, he will also have them in the womb. The baby doesn’t reach a pound in weight until 20 weeks gestation. Often women will not have gained any weight at their 20 week appointment and that’s fine. Between 20 and 25 weeks, huge changes occur. The baby is growing rapidly and the pregnant body is adding significant water weight to expand its circulatory system. Often at the 25 week visit, women will have gained 8-10 pounds the month before, but usually they will only gain 1-2 pounds the next month. During the last month of pregnancy, most of the weight gain is due to swelling.
Early in pregnancy, your doctor will discuss what your overall weight gain range should be based on your pre-pregnancy weight and medical history.
10. Eat Real Food
In the end, this is what it all comes down to: eat real food. Avoid frozen dinners and processed food, for they shall give thee cankles! Processed food is packed with sodium that makes your already swollen legs even puffier. Try to do most of your shopping on the perimeter of the grocery store: meat, fruit, veggies and dairy.
Like all healthy habits, it’s what you do the majority of the time that makes a difference. Of course we all eat cookies from time to time, but eating junk should be the exception and not the rule. Pregnancy should be as enjoyable as possible. Nutrition like other aspects of pregnancy should not be an area where you strive for perfection but rather seek to find what works for you and your body.
And above all else, please don’t use crack.
For more tips on maintaining a healthy diet and an overall healthy pregnancy, check out The Pregnancy Companion book.
What was your favorite healthy pregnancy snack? Have any great recipes that you enjoyed that you can link us to in the comments?
For more tips and peace-filled advice like this, check out The Pregnancy and Baby Companion books
I really crave milk. Is it true that to much milk prevents your body from retaining iron? Because my doctor just told me I have really low iron level s.