Pregnancy Nutrition for All 4 Trimesters: Bridget Swinney, MS, RD

Last Editorial Review: 3/24/2004

By Bridget Swinney
WebMD Live Events Transcript

The opinions expressed in this transcript are those of the health professional and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician.

What should you be eating? And what should you feed the baby? When should you start your baby on solids? How many feedings a day? We discussed these questions and more when Bridget Swinney, MS, RD, dropped by the WebMD University Student Lounge to offer her expert advice.

Moderator: Welcome to WebMD University: "Four Weeks to a Healthy Pregnancy." Our instructor today is Bridget Swinney, MS, RD, author of Eating Expectantly and Healthy Food for Healthy Kids.

Member: Can you take iron tablets in the first trimester?

Swinney: Yes, you can. In fact when you first go to your ob-gyn's office they will suggest you first take a prenatal vitamin containing iron; however, an iron tablet by itself is probably not warranted. It's a good idea to take a vitamin supplement containing 400 micrograms of folic acid before you become pregnant. And also, taking a vitamin supplement with iron before pregnancy will help boost your iron stores.

Moderator: Should nursing moms keep taking that prenatal vitamin after delivery?

Swinney: Yes, that is also a good idea. Although you don't need quite so much iron. After delivery, constipation can be a problem and the extra iron could make it worse. So you may want to switch to just a regular high-potency multivitamin while you are breastfeeding.

Member: What if morning sickness is so severe that my wife cannot keep vitamins down?

Swinney: She might want to try taking it at bedtime. This works for many women. Also, some women have had good luck with chewable children's vitamins.

Member: My wife is experiencing extreme morning sickness during this, her first trimester (and first child of ours). What can she do to keep her nutrition "up," outside of a D-5 IV?

Swinney: It's great to have a dad in the chat room. I appreciate your concern for your wife, as sometimes morning sickness can be scary. The main thing to remember is that during the first trimester, weight gain is not a priority. Keeping hydrated is. Some suggestions for keeping liquids down in nutritious form are eating nutritious fruits such as grapes, cantaloupe, watermelon, and any other fruit that sounds good. Also, some women have had luck just eating whatever sounds good. This could be potato chips, pretzels, or pickles. Once a woman eats what she is craving, sometimes her nausea subsides and she can go on to eating something more nutritious.

Another thing you might want to look at is your wife's environment. Some women are sensitive to noise or light, and some are extremely sensitive to smell, such as even the person who is smoking in the house next door.

Also some of the tried and true suggestions you may have already tried, but that may help other women, are:

  • Eating small, frequent meals
  • Avoiding spicy and greasy meals
  • Eating cold bland foods

Again, drinking enough is extremely important. Some women find that lemonade and the smell of lemons is appealing and helps their nausea. Some research has shown that the smell and taste of lemons for some reason helps calm nausea. There are probably certain smells that some women are more bothered by, so finding those smells and getting rid of them could also help.

Member: I'm brewing my coffee outside of the house from now on!

Swinney: Good!

Moderator: Are there any other foods that help reduce nausea that you would recommend, such as ginger tea?

Swinney: I have heard that ginger is also good for nausea. Some examples would be ginger ale and ginger snaps. However, I tend to shy away from herbal teas for pregnant women because some herbs have pharmaceutical actions.

Member: What are the recommended daily vitamins one should take during pregnancy? And are there certain vitamins you should not take?

Swinney: What is recommended in terms of vitamins for pregnancy is a prenatal multivitamin. The only other vitamin or mineral you might need is calcium. And if you are a vegetarian you might need vitamin D and/or vitamin B-12. In general you should avoid other individual vitamin supplements because too much of a single vitamin can interfere with the absorption of other vitamins. And some vitamins can be harmful in large amounts. For example, vitamin A has been shown to cause birth defects when taken doses several times larger than the RDA.

Member: Is there any difference between prenatal multivitamins and regular multivitamins besides the amount of daily values percentages? Because I'm using my regular multivitamins and they have more amount per serving than the prenatal multivitamins. Can this be a risk for my pregnancy?

Swinney: Your general multivitamin is probably fine except you might want to check how much more than the RDA the vitamin contains. Try not to have vitamins that are two times the RDA for pregnancy. If it's more than that you might want to switch to a prenatal vitamin.

Member: What causes different cravings with different pregnancies? Is it our bodies trying to get certain nutrients for each particular pregnancy? While pregnant with my daughter, I was hooked on peanut butter. While pregnant with my son, it was a red beans and rice craving. Was this because my body really wanted protein?

Swinney: I can relate to that! I craved grapefruit with my first child and bean burritos with my second. I don't think anyone knows exactly what causes cravings. But it probably has something to do with all those raging hormones. I can tell you that when you crave carbohydrates it's probably because you have low blood sugar. That's why it's important to eat regular meals with snacks in between to get all the nutrition you need without having to run to the store at midnight for the chocolate fudge ice cream.

Member: I am considered clinically obese, over 300 pounds and 5'8". I have just discovered that I am about three weeks pregnant. I obviously need to lose weight quickly. What diet would you suggest? I have been told to avoid diet soda. Why?

Swinney: Although you are overweight, weight loss is not recommended during pregnancy. You should talk to your physician about how much weight he or she wants you to gain. Generally, the minimum recommended weight gain for women who are overweight is 15 pounds. It's really important to talk to your healthcare provider about these questions.

Because diet sodas have artificial sweeteners, you don't want to have too much. And when choosing food with artificial sweeteners, Nutrasweet or Sucralose are the recommended ones.

Member: I find I cannot eat all of the food that is recommended. I just feel too full. I have tried eating small amounts through the day, but I still can't eat as many servings of the different food groups as I am supposed to. Help!

Swinney: Yes, it's true that it's sometimes hard to eat everything you should. If you are gaining weight adequately then I would eat as healthy as possible but follow your appetite.

Member: Does what I eat while I am pregnant affect what my baby will enjoy when she starts to eat? What about what I eat while nursing? If I eat lots of veggies will she grow up liking veggies because she has already had them, in a way?

Swinney: Actually, yes. There is some new research that shows that women who eat a variety of fruits and vegetables have children who are more likely to like those foods because they have already had a taste (so to speak!).

Member: Can you eat too much fruit while pregnant? Strawberries mainly.

Swinney: Well, the only problem with eating too much fruit is that it might give you diarrhea and then you will not be absorbing the nutrients you need. So perhaps try not to eat them all at once.

Member: I know alcohol is bad for the baby, but is a small glass of wine once in a while during pregnancy OK?

Swinney: As you know, health professionals recommend no alcohol during pregnancy. However, most women will have a sip or two occasionally. I remember when I was pregnant I had a few sips of champagne to toast in the New Year. The main thing to remember is that during the first trimester, any alcohol or drugs could have a more detrimental effect on the baby. I would also discuss this question with your healthcare provider.

Member: Can you suggest some healthy snacks that are easy to grab and go? I'm tired of graham crackers and carrot sticks and I don't like yogurt.

Swinney: How about a smoothie "to go" -- just put one cup of frozen fruit such as strawberries, banana, peaches, or pineapple into the blender with one cup of liquid. This can be milk, yogurt, or juice. You can make this in advance and keep it in your freezer and defrost slightly in your microwave before you go.

Some other grab and go snacks would be:

  • Granola bars
  • String cheese
  • Whole wheat crackers
  • Bananas
  • A sandwich

Moderator: Do nutritional needs change during pregnancy? Do growing fetuses need more protein the first trimester than the third, for example? Or is healthy eating just healthy eating whatever week or month you're in?

Swinney: The needs of the baby probably do change from the first trimester when he is very tiny to the last trimester. For example, during the last trimester, the baby's bones grow tremendously. However, the nutritional recommendations for pregnancy take all of this into account because if you have a lot of calcium in the first trimester this will help your bones become stronger so that if need be your baby can use some of the calcium stored in your bones in the last trimester.

Member: I know it isn't good to give babies too much fruit juice, but it gets really hot and muggy here in the summer. Can I let my baby suck on frozen fruit juice bars? Or frozen yogurt bars?

Swinney: In general, fruit juice is not recommended until 6 months, and then it's only recommended in small amounts. No more than 8 ounces per day. Too much juice keeps the baby from eating food that is more nutritious. Also, fruit juice can often take the place of milk, which contains the calcium, protein, and other nutrients needed for growth. In hot climates I would suggest that parents give their babies plenty of water or you can also make your own Popsicles using water with just small amounts of juice. Or, you could add some pureed fruit to the Popsicle mix. How old is your baby?

Member: She is 14 months old. And I have another on the way!

Swinney: For babies over a year, it is OK to give them fruit juice bars or yogurt bars, but you still want to encourage mostly water. During the hot summer months, frozen fruit cut up into small pieces would also be appealing to toddlers. For examples, sliced frozen strawberries, cantaloupe, or grapes are a fun way to get your fluid.

Member: Are there any foods I should not eat while nursing?

Swinney: The only thing you should avoid are fish that have large amounts of chemicals. These are shark, swordfish, king mackerel, and tilefish. You should also try to keep your exposure to environmental chemicals to a minimum. For example, wash your produce very well or buy organic. Also, avoid using lawn and garden pesticides, or exterminating, if possible.

Member: My husband likes to hunt and fish. Do you see any problem with me eating game or wild fish while pregnant or nursing?

Swinney: You should have your husband read the posting where he fishes. There is usually a sign that says if there is a danger for children or pregnant women. You can also contact your state fisheries department or look on the internet. The EPA website has a lot of information about freshwater lakes and rivers that are polluted. The FDA has now suggested that besides avoiding the fish mentioned earlier, pregnant women should also limit their total fish consumption to 12 ounces a week. If you are big fish eaters, it might be easy to go over this limit.

Moderator: Do babies need anything besides breast milk or formula for the first four to six months? There seem to be a lot of opinions out there (from mothers-in-law to pediatricians) about the pros and cons of giving water, adding cereal to bottles, etc. What's your stance?

Swinney: Well, you are right about lots of different opinions. The American Academy of Pediatrics suggests that you add a source of iron to your baby's diet by 6 months of age. The reason is that your baby's iron stores are depleted by this time. Because infant cereal is easy to digest, this is generally the first type of solid given. You will know when your baby is ready for cereal when she can hold her head up, when she can take food from a spoon, can move her tongue back and forth, and can draw in her lower lip as the spoon is removed. Another indicator that she is ready for solids is when she still seems hungry after eight to 10 feedings of breast milk or 40 ounces of formula in 24 hours. The reason people often give cereal in a bottle is because they are not developmentally ready to take it from a spoon, and they think it will help their baby sleep through the night. This has not proved to be true. I would listen and watch my baby for the signs that she is ready for solids.

Member: Why is rice cereal always mentioned as the first solid food?

Swinney: Rice cereal is the cereal least likely to cause an allergic reaction. Wheat cereal is more likely to cause an allergic reaction and for this reason it is usually delayed until seven to nine months.

Member: What are the best early finger foods?

Swinney: Good finger foods include:

  • Soft, cooked vegetables such as peas, carrots, and green beans
  • Fruit that is soft and cut into cubes or strips
  • Macaroni or spaghetti (cut in small pieces)
  • Small pieces of cheese
  • Toast cut in strips

I will also take this opportunity to mention foods that are a choking hazard:

  • Fruits and vegetables with seeds
  • Peanut butter
  • Grapes
  • Hot dogs
  • Nuts
  • Popcorn
  • Other hard, round foods (such as raw carrots and hard candy)

It's important to always be present when your child is eating and to keep her seated while she is eating to avoid choking.

Moderator: Before we wrap up for today, do you have any final comments for us, Bridget?

Swinney: You only get one chance to make a healthy baby, so give it your best shot. Try to start before pregnancy by eating well, not only you but also your partner. And during pregnancy, remember that a variety of foods is important, especially fruits, vegetables, and milk. The good habits that you practice now can be passed on to your children. And that is a wonderful gift.

Moderator: We are out of time. Thanks to Bridget Swinney, MS, RD, for being our guest, and thank you, members, for joining us today. For more information, please read Eating Expectantly and Healthy Food for Healthy Kids.

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