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Eating (Well) for Two

Eating (Well) For Two

WebMD Feature

Elizabeth Ward is the guru on nutrition during pregnancy. She wrote the book on it, literally. So what did the author of the American Dietetic Association's "Pregnancy Nutrition: Good Health for You and Your Baby" eat during her pregnancies? Doughnuts -- and lots of 'em.

"I had to have a doughnut just about every day about midmorning during my first trimester. It was the fat -- I love fat when I get pregnant," Ward concedes. "Especially with my third pregnancy. I was so sick for about the first four months that I ate whatever struck me. I had to get through the day, and I didn't stop to worry that I wasn't eating an orange or eating my carrots."

Don't misunderstand. It's not that Ward pushes a steady diet of crullers and cinnamon twists for pregnancy. A balanced diet, plenty of calcium and iron, and fluids are still essential for moms-to-be and the healthy growth of their babies, she says. Pregnant women who eat right and gain the recommended weight have fewer pregnancy complications, easier deliveries and lose the extra pounds faster. Malnourished babies are at greater risk for health problems and developmental difficulties, and large babies are harder to deliver.

But don't sweat it those first few months if you can't stomach everything you're supposed to eat, either. The nutritional needs of a tiny fetus are minimal then, and especially if you're taking a multivitamin, you'll be compensating for some of your dietary deficiencies. "If someone's well-nourished to begin with, they can really coast that first trimester," says Katherine Puls, a certified nurse-midwife in Evanston, Ill. "It's more a matter of not getting dehydrated and eating what appeals to you." Here are some nutrition tips to follow during pregnancy, as soon as you can.

Eat Twice as Well, Not Twice as Much

You may be eating for two now, but don't get psyched for that double-chocolate sundae -- an extra glass of milk is better. Nutritional needs during pregnancy only go up about 300 extra calories, which should generally be spread out over all the basic food groups. The only "extras" are another serving of milk or dairy for the necessary calcium (mostly to build strong bones) and about 10 more grams of protein (for cell formation) than your basic USDA food pyramid recommendations for women who are not pregnant.

For women who are already used to eating a balanced diet with plenty of breads and grain, fresh fruits and vegetables, dairy products, and some meat or protein, the change won't be dramatic. Fats should remain at about 30% or less of total calories, although fat restriction shouldn't be a major concern during pregnancy. Vegetarians should be able to get the nutrients they need from careful food choices, although those who don't eat animal products may need an iron supplement.

But since so many of us don't always get the recommended servings when we're not pregnant, eating right during pregnancy may require a little more conscientious planning. "It takes effort," says Ward, a registered dietician in Boston. "For instance, you need 1,000 milligrams of calcium, and you can't get enough of that in your prenatal vitamin or supplement, but if you have cereal, milk and a glass of calcium-fortified orange juice for breakfast, right there you're up to about 600 milligrams." You might even use that Starbucks fix to your benefit since a 12-ounce decaf latte has about 400 milligrams of milk, she says.

Snacks can be helpful in squeezing in all the required foods, not to mention beneficial in curbing morning sickness. "Be a nibbler, a grazer," says Anne Dubner, a registered dietician and nutrition consultant in Houston. "If you nibble throughout the day you're more likely to get all the nutrients you need, rather than trying to cram it all into each meal." Yogurt or cheese will boost calcium intake, for instance; an orange will provide extra vitamin C and folic acid.

It may be difficult to get everything you need from your diet, especially essential nutrients such as folic acid and iron, so most providers recommend a prenatal vitamin "as an insurance policy," says Dr. Richard Schwarz, chairman of obstetrics and gynecology at New York Methodist Hospital. Your iron needs to double to 30 milligrams to accommodate increased blood volume during pregnancy; a lack of iron can cause anemia. Women should already be taking a prenatal vitamin with 400 micrograms, or 0.4 milligrams, of folate three months before conception to help prevent neural-tube defects. Your doctor or midwife may recommend supplements if necessary.


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