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Prenatal Nutrition

Eating an overall nutritious, balanced, and adequate diet is one of the most important ways to take care of you and your growing baby. Nutrition influences the development of all body systems, as well as physiological processes like metabolism.

Choosing healthy foods that are rich in key nutrients will help nourish you and your baby during your pregnancy journey.


Healthy Diet and Supplements Before Pregnancy

Prenatal nutrition is not just crucial while pregnant, but before becoming pregnant too.


Before pregnancy, a nutrient-dense diet not only meets your needs, but also lays down stores essential for a future baby’s development.


In addition to eating healthy foods, the American College of Obstetricians and Gynecologists (ACOG) recommends taking a daily prenatal vitamin with at least 400 micrograms of folic acid starting at least 1 month before pregnancy. Consult your practitioner about the appropriate supplement for you.


Key Nutrients in the Prenatal Diet: Protein

While your entire eating pattern is relevant before and during pregnancy, there are a few key nutrients to focus on.


As your baby grows, protein needs increase. Protein acts as a building block for muscle, skin, blood, and other cells.


To meet protein needs in the prenatal period, eat a variety of protein sources such as fish, meat, poultry, eggs, dairy products, beans, lentils, tofu, edamame, nuts, and seeds.


If you are a vegetarian or vegan, it is still possible to meet protein needs during pregnancy with a carefully planned diet. Speak to a registered dietitian to assess your way of eating.


Key Nutrients in the Prenatal Diet: Omega-3 Fatty Acids

Early in pregnancy, your baby’s developing brain requires omega-3 fatty acids.



During pregnancy, consuming adequate omega-3s is associated with reduced maternal depression, a decrease in the incidence of preterm birth, reduced allergies and asthma in children, and improved neurocognitive outcomes in children.


There are three main types of omega-3s: alpha-linoleic acid (ALA) found primarily in nuts and seeds, and docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) found in oily fish like salmon, tuna, and sardines.


DHA and EPA are more important than ALA during the prenatal period. If you do not eat fish, discuss an omega-3 supplement with your practitioner.


Key Nutrients in the Prenatal Diet: Micronutrients

Protein and omega-3 fatty acids aren’t the only essential nutrients during pregnancy. Deficiencies of folate, iron, calcium, and vitamin D in a mother can affect fetal development and have long-term health consequences for both mother and baby.


Folate

In addition to omega-3s, a developing baby’s brain requires folate, a B-vitamin. Folate is also involved in cell division, which occurs at a rapid

pace during pregnancy.


Folic acid is the synthetic form of folate found in supplements and fortified foods. The body can absorb folic acid better than folate found in whole foods.


The recommended dietary allowance (RDA) for folate in women of childbearing age is 400 micrograms per day, and this increases to 600 micrograms per day during pregnancy. Some studies recommend getting 400 micrograms of folic acid in a prenatal supplement and eating foods rich in folate like leafy greens, peas, beans, and lentils.


Iron

Iron is a mineral that makes up hemoglobin, which transports oxygen to body cells.


Iron status is imperative for both mothers and babies. Without proper iron stores before pregnancy, it is unlikely that the mother and baby will meet iron needs during pregnancy. Unfortunately, iron deficiency is a widespread problem, affecting over 30% of pregnant women in developed countries and up to 50% of pregnant women worldwide.


Iron deficiency can have significant health consequences. For mothers, iron deficiency during pregnancy is associated with decreased immune function and a future increased risk of heart disease. For babies, iron deficiency is associated with an increased risk for preterm birth, low birth weight, and abnormal development and cognitive function.



In the prenatal period, the RDA for iron increases by 50% from 18 mg to 27 mg per day. Choose a variety of foods with iron such as fish, meat, dark leafy greens, beans, lentils, and fortified foods. Iron in animal foods is more easily absorbed than iron in plant foods; to improve iron absorption in plant foods, add sources of vitamin C like citrus, peppers, broccoli, and cauliflower.


Ask your practitioner about testing your iron status and evaluating the need for supplemental iron.


Calcium and Vitamin D

Calcium is an important mineral in the prenatal diet because it supports bone, teeth, heart, nervous system, and muscle development.

Inadequate calcium intake during pregnancy can affect both mothers and babies. Mothers not consuming enough calcium are at higher risk for hypertension and osteopenia, a we

akening of the bones, as well as muscle conditions. Their babies may be at a higher risk for delayed growth, low birthweight, and poor bone mineralization.


For pregnant women, the RDA for calcium is between 1,000 and 1,300 mg per day depending on age. The need for calcium is paramount during the third trimester when bone mineralization occurs at the most rapid pace.


Calcium is found in dairy products, plant foods including leafy green vegetables and nuts, and fortified foods such as some soy milks. Increased calcium needs can usually be met by diet alone, though supplementation may be recommended for some.


The body needs vitamin D to absorb calcium. For women of childbearing age and pregnant women, the RDA for vitamin D is 15 micrograms per day. You can get vitamin D from sunlight, foods, and supplements. Fatty fish such as salmon and fortified dairy products are the best sources of vitamin D. However, it can be difficult to reach needs through sunlight and food alone. Talk to your practitioner about whether a vitamin D supplement is right for you.



Foods to Limit or Avoid in the Prenatal Diet


Fish High in Mercury

Fish is a great source of protein and many species of fish have omega-3s that are essential for fetal development. However, some species of fish are high in mercury, a harmful toxin found in high levels in swordfish, tilefish, bigeye tuna, and more. Select 2-3 servings per week of fish lowest in mercury such as salmon, sardines, canned light tuna, shrimp, cod, and haddock.


Foods Linked to Listeriosis

Listeria is a bacterium found in soil, water, and some animals that causes listeriosis, a foodborne infection that can be detrimental and potentially fatal to a growing baby. To prevent listeriosis, avoid eating unpasteurized milk and cheese, pate and meat spreads, and smoked seafood. Cook hot dogs and deli meats to steaming hot just before serving. Wash fruits and vegetables before eating in addition to other food safety practices.


Foods High in Added Sugars, Refined Grains, and Saturated Fat

A prenatal diet should be centered on nutrient-dense foods including vegetables, fruit, lean proteins, whole grains, nuts, legumes, seeds, and low-fat or nonfat dairy products. Tea and coffee can also be part of a prenatal diet. It is recommended to consume under 200 milligrams of caffeine per day during pregnancy.

Other foods and drinks high in refined carbohydrates and saturated fat like candy, soda, energy drinks, snack foods, butter, red meat, and full-fat dairy products should be limited in a prenatal diet.


Prenatal Weight

Practicing healthy lifestyle habits prior to pregnancy will help achieve the recommended weight gain.

Your doctor will advise on a pregnancy weight gain goal, as determined by your pre-pregnancy Body Mass Index (BMI). Excess weight gain is a predictor of pregnancy complications and a child’s future health risks including risk of obesity.

Early in pregnancy, your body does not need extra calories. Energy requirements only increase once the second trimester begins. For the most part, satisfy physical hunger with nutrient-dense foods rich in key nutrients.


Final thoughts

If you are trying to have a baby or if you are pregnant, there is so much that can feel out of your control. However, you can choose what you eat. A balanced prenatal way of eating can suit all cuisines, preferences, and budgets.

Take it one meal at a time. Each meal is an opportunity to nourish yourself and your growing baby.


References:

Alwan NA and Hamamy H. Maternal Iron Status in Pregnancy and Long-Term Health Outcomes in the Offspring. J Pediatr Genet 2015;4:111-123.

The American College of Obstetricians and Gynecologists. Committee Opinion: Weight Gain During Pregnancy. 2018. Available from: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Weight-Gain-During-Pregnancy?IsMobileSet=false

The American College of Obstetricians and Gynecologists. Listeria and Pregnancy. 2018. Available from: https://www.acog.org/womens-health/faqs/listeria-and-pregnancy

The American College of Obstetricians and Gynecologists. How much coffee can I drink while I’m pregnant? 2020. Available from: https://www.acog.org/womens-health/experts-and-stories/ask-acog/how-much-coffee-can-i-drink-while-pregnant


Cetin I et al. Impact of Micronutrient Status during Pregnancy on Early Nutrition Programming. Annals of Nutrition & Metabolism 2019;74:269-278.

Craemer KA et al. Nutrition and Exercise Strategies to Prevent Excessive Pregnancy Weight Gain: A Meta-analysis. Am J Perinatol Rep 2019;9:e92-e120.

Danielewicz H et al. Diet in pregnancy - more than food. Eur J Pediatr 2017;176:1573-1579.

FDA. Eating Fish: What Pregnant Women and Parents Should Know. 2018. Available from: https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm393070.htm

Gammone MA et al. Omega-3 Polyunsaturated Fatty Acids: Benefits and Endpoints in Sport. Nutrients 2019;11(1):46.

Klemm S. Eating Right During Pregnancy. Eat Right: Academy of Nutrition and Dietetics. 2019. Available from: https://www.eatright.org/health/pregnancy/what-to-eat-when-expecting/eating-right-during-pregnancy

Mousa A, Naqash A and Lim S. Macronutrient and Micronutrient Intake during Pregnancy: An Overview of Recent Evidence. Nutrients 2019;11:443.

Nordgren T et al. Omega-3 Fatty Acid Intake of Pregnant Women and Women of Childbearing Age in the United States: Potential for Deficiency? Nutrients 2017;9(3):197.

Tahir M et al. Higher Maternal Diet Quality during Pregnancy and Lactation is Associated with Lower Infant Weight-For-Length, Body Fat Percent, and Fat Mass in Early Postnatal Life. Nutrients 2019;11:632.

USDA Agricultural Research Service. National Nutrient Database for Standard Reference Legacy Release. April 2018. Available from:https://ndb.nal.usda.gov/ndb/

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