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Healthy Pregnancy Introduction

Eat this. Don't eat that. Do this. Don't do that. Pregnant women are bombarded with dos and don'ts. Here's help to keep it all straight.

Eating For Two

Eating healthy foods is more important now than ever! You need more protein, iron, calcium, and folic acid than you did before pregnancy. You also need more calories. But "eating for two" doesn't mean eating twice as much. Rather, it means that the foods you eat are the main source of nutrients for your baby. Sensible, balanced meals combined with regular physical fitness is still the best recipe for good health during your pregnancy.

Weight Gain

The amount of weight you should gain during pregnancy depends on your body mass index (BMI) before you became pregnant. The Institute of Medicine provides these guidelines:

• If you were at a normal weight before pregnancy, you should gain about 25 to 30 pounds.
• If you were underweight before pregnancy, you should gain between 28 and 40 pounds.
• If you were overweight before pregnancy, you should gain between 15 and 25 pounds.
• If you were obese before pregnancy, you should gain between 11 and 20 pounds.

Check with your doctor to find out how much weight gain during pregnancy is healthy for you.

You should gain weight gradually during your pregnancy, with most of the weight gained in the last trimester. Generally, doctors suggest women gain weight at the following rate:

• 2 to 4 pounds total during the first trimester
• 3 to 4 pounds per month for the second and third trimesters

Recent research shows that women who gain more than the recommended amount during pregnancy and who fail to lose this weight within six months after giving birth are at much higher risk of being obese nearly 10 years later. Findings from another large study suggest that gaining more weight than the recommended amount during pregnancy may raise your child's odds of being overweight in the future. If you find that you are gaining weight too quickly, try to cut back on foods with added sugars and solid fats. If you are not gaining enough weight, you can eat a little more from each food group.

Calorie Needs

Your calorie needs will depend on your weight gain goals. Most women need 300 calories a day more during at least the last 6 months of pregnancy than they do pre-pregnancy. Keep in mind that not all calories are equal. Your baby needs healthy foods that are packed with nutrients — not "empty calories" such as those found in soft drinks, candies, and desserts.

Although you want to be careful not to eat more than you need for a healthy pregnancy, make sure not to restrict your diet during pregnancy either. If you don't get the calories you need, your baby might not get the right amounts of protein, vitamins, and minerals. Low-calorie diets can break down a pregnant woman's stored fat. This can cause your body to make substances called ketones. Ketones can be found in the mother's blood and urine and are a sign of starvation. Constant production of ketones can result in a child with mental deficiencies.

Foods Good for Mom and Baby

A pregnant woman needs more of many important vitamins, minerals, and nutrients than she did before pregnancy. Making healthy food choices every day will help you give your baby what he or she needs to develop. The MyPyramid for Pregnant and Breastfeeding Women can show you what to eat as well as how much you need to eat from each food group based on your pre-pregnancy BMI and activity level. Use your personal MyPyramid plan to guide your daily food choices. Here are some foods to choose often:

• Grains-fortified, cooked or ready-to-eat cereals; wheat germ
• Vegetables-carrots, sweet potatoes, pumpkin, spinach, cooked greens, winter squash, tomatoes, red pepper
• Fruits-cantaloupe, honeydew melon, mangoes, prunes or prune juice, bananas, apricots, oranges or orange juice, grapefruit, avocado
• Dairy-nonfat or low-fat yogurt; nonfat milk (skim milk); low-fat milk (1% milk)
• Meat and beans-cooked dried beans and peas; nuts and seeds; lean beef, lamb, and pork; shrimp, clams, oysters, and crab; cod, salmon, polluck, and catfish

Talk to your doctor if you have special diet needs for these reasons:

• Diabetes - Make sure you review your meal plan and insulin needs with your doctor. High blood glucose levels can be harmful to your baby.
• Lactose intolerance - Find out about low-lactose or reduced-lactose products and calcium supplements to ensure you are getting the calcium you need.
• Vegetarian - Ensure that you are eating enough protein, iron, vitamin B12, and vitamin D.
• PKU - Keep good control of phenylalanine levels in your diet.

Food Safety

Most foods are safe for pregnant women and their babies. But you will need to use caution or avoid eating certain foods. Follow these guidelines:

Clean, handle, cook, and chill food properly to prevent food-borne illness, including listeria and toxoplasmosis.

• Wash hands with soap after touching soil or raw meat.
• Keep raw meats, poultry, and seafood from touching other foods or surfaces.
• Cook meat completely.
• Wash produce before eating.
• Wash cooking utensils with hot, soapy water.

Do not eat:

• Refrigerated smoked seafood like whitefish, salmon, and mackerel
• Hot dogs or deli meats unless steaming hot
• Refrigerated meat spreads
• Unpasteurized milk or juices
• Shark, swordfish, king mackerel, or tile fish (also called golden or white snapper); these fish have high levels of mercury.
• More than 6 ounces per week of white (albacore) tuna
• Herbs and plants used as medicines without your doctor's okay. The safety of herbal and plant therapies isn't always known. Some herbs and plants might be harmful during pregnancy, such as bitter melon (karela), noni juice, and unripe papaya.
• Raw sprouts of any kind (including alfalfa, clover, radish, and mung bean)

Fish Facts

Fish and shellfish are a great source of protein and heart-healthy omega-3 fatty acids. But pregnant women shout not eat certain kinds of fish because they contain high levels of a type of mercury that is harmful to developing babies.

• Do NOT eat any shark, swordfish, king mackerel, or tile fish (also called golden or white snapper) because these fish have high levels of mercury.
• Do not eat more than six ounces of "white" or "albacore" tuna or tuna steak each week.

You can safely eat up to 12 ounces per week (about 2 meals) of a variety of cooked fish.

Vitamins and Minerals

In addition to making healthy food choices, ask your doctor about taking a prenatal vitamin and mineral supplement every day to be sure you are getting enough of the nutrients your baby needs. You also can check the label on the foods you buy to see how much of a certain nutrient the product contains. Women who are pregnant need more of these nutrients than women who are not pregnant:

Nutrient	How Much Pregnant Women Need Each Day
Folic acid	400 to 800 micrograms (mcg) (.04 to .08 mg) in the early stages of pregnancy, which is why all women who are capable of pregnancy should take a daily multivitamin that contains 400 to 800 mcg of folic acid. Pregnant women should continue taking folic acid throughout pregnancy.
Iron	27 milligrams (mg)
Calcium	1,000 milligrams (mg); 1,300 mg if 18 or younger
Vitamin A	770 micrograms (mcg); 750 mcg if 18 or younger
Vitamin B12	2.6 micrograms (mcg)

Women who are pregnant also need to be sure to get enough vitamin D. The current recommendation for all adults under 50 (including pregnant women) is 5 micrograms (mcg) of vitamin D each day. But many health experts don't think this is enough. Ask your doctor how much vitamin D you need each day. Because vitamin D is important to your unborn baby's development, your doctor might want to measure your vitamin D levels to be sure you are getting enough.

Keep in mind that taking too much of a supplement can be harmful. For example, too much of the nutrient vitamin A can cause birth defects. For this reason, only take vitamins and mineral supplements that your doctor recommends.

Don't Forget Fluids

All of your body's systems need water. When you are pregnant, your body needs even more water to stay hydrated and support the life inside you. Water also helps prevent constipation, hemorrhoids, excessive swelling, and urinary tract or bladder infections. Not getting enough water can lead to premature or early labor.

Your body gets the water it needs through the fluids you drink and the foods you eat. How much fluid you need to drink each day depends on many factors, such as your activity level, the weather, and your size. Your body needs more fluids when it is hot and when you are physically active. It also needs more water if you have a fever or if you are vomiting or have diarrhea.

The Institute of Medicine recommends that pregnant women drink about 10 cups of fluids daily. Water, juices, coffee, tea, and soft drinks all count toward your fluid needs. But keep in mind that some beverages are high in sugar and "empty" calories. A good way to tell if your fluid intake is okay is if your urine is pale yellow or colorless and you rarely feel thirsty. Thirst is a sign that your body is on its way to dehydration. Don't wait until you feel thirsty to drink.

Alcohol

There is no known safe amount of alcohol a woman can drink while pregnant. When you are pregnant and you drink beer, wine, hard liquor, or other alcoholic beverages, alcohol gets into your blood. The alcohol in your blood gets into your baby's body through the umbilical cord. Alcohol can slow down the baby's growth, affect the baby's brain, and cause birth defects.

Find out more about the dangers of drinking alcohol during pregnancy in our section on Substance Abuse.

Caffeine

Small amounts of caffeine (about one 12-ounce cup of coffee a day) appear to be safe during pregnancy. Some studies have shown a link between higher amounts of caffeine and miscarriage and preterm birth. But there is no solid proof that caffeine causes these problems. The effects of too much caffeine are unclear. Ask your doctor whether drinking a limited amount of caffeine is okay for you.

Cravings

Many women have strong desires for specific foods during pregnancy. The desire for "pickles and ice cream" and other cravings might be caused by changes in nutritional needs during pregnancy. The fetus needs nourishment. And a woman's body absorbs and processes nutrients differently while pregnant. These changes help ensure normal development of the baby and fill the demands of breastfeeding once the baby is born.

Some women crave nonfood items such as clay, ice, laundry starch, or cornstarch. A desire to eat nonfood items is called pica (PYE-KUH). Eating nonfood items can be harmful to your pregnancy. Talk to your doctor if you have these urges.