Tuesday, July 21, 2009

Eating for Two?

By Alison

I am a mom-to-be and registered dietitian (that's me in the picture). So, I follow a very perfect diet and never fall prey to the pickles and ice cream calling my name late at night. Yeah, right!

While studying nutrition, pregnancy was a small chunk of the curriculum, squeezed among various science, management, food science and medical nutrition therapy courses. The true hands-on training for eating while pregnant came during my stint as a clinical dietitian counseling expectant mommies and now my own personal experience as a mom-to-be.

As a clinical dietitian, I was assigned to the antepartum (prenatal) unit where expectant mothers with complications such as gestational diabetes, preeclampsia, hyperemesis gravidarum (constant nausea and vomiting) were treated. My job was to counsel them specifically on their current condition. For example, explaining a low-sugar, low refined carbohydrate, high fiber diet to a gestational diabetic (woman with diabetes while pregnant).

Each counseling experience was an opportunity for me to also go over the general guidelines of healthy eating during pregnancy. I am never one to use the word "no" when it comes to food. Unfortunately, in the case of expecting mothers, there are some temporary diet no-no's to avoid in order for mom and the developing fetus to keep safe. I was surprised to find out how many women, well into their second and third trimesters, were misinformed or never truly informed at all. Some were eating cold cuts, soft cheeses, and gaining weight like rapid fire. Others thought "limiting high mercury fish" meant stop eating fish completely.

Here's some enlightenment from an RD mom-to-be:

You Are Not Always Eating for Two
You ARE eating for two when it comes to consuming foods and drinks that are beneficial to you and your developing baby. But when it comes to consuming calories, pregnancy is not a license to inhale any donut or ice cream sundae that isn't bolted down. In the first trimester, most don't even need many extra calories from what they were eating prior to becoming pregnant. Average weight gain in the first trimester is approximately one pound per MONTH (not week). If you are underweight, you may want to have 100 extra calories/day during the first trimester. If you suffer from "morning sickness", or as I experienced, all-day sickness, you may actually eat less than normal and lose some weight. This shouldn't be an issue once the nausea subsides; hopefully you'll make up for eating in your second trimester.

Once the second and third trimester hit, you only need approximately 300 extra calories per day. This is not a blanket statement to be followed by all pregnant women. I hate giving calorie levels and weight markers. Numbers tend to make women crazy and it is truly an individualized formula based on several factors including pre-pregnancy weight, exercise levels, and current diseases (e.g., diabetes).

When it comes to eating, listen to your body. Now in my second trimester, I'm definitely hungrier and feel like I'm eating the same way I did when I trained for the marathon a few years ago.

If you want to use the extra 300 calories/day as a guide, here's a snapshot of what that can be:
  • Add a small handful nuts (2 Tbsp) to your morning cereal = 100 calories
  • 6oz low-fat Stonyfield yogurt for an afternoon snack = 135 calories
  • 8oz glass of non-fat milk with dinner = 90 calories
There's your extra 300 calories! It's actually 225 calories, but this is what I mean about not getting all crazy with the calculator. Have a general idea of what you're eating. If you're taking in 600 extra calories a day, and your OB/GYN makes a comment about your weight gain being on the high side, it's time to cut back a bit.

I'll Have a Roast Beef Sandwich, Please
Sometimes you just want a good turkey or roast beef sandwich. This is a luxury that experts advise to avoid while pregnant. Deli meats and hot dogs can harbor listeria. Listeria may cause miscarriage, premature delivery, infection or in some cases, stillbirth. Many expecting moms I talk to have heard of avoiding soft cheeses (brie, goat, feta) for this reason, but so many never heard of the cold cut issue. It is reported that you can safely eat cold cuts if they're re-heated to a steaming hot temperature. I nuked my turkey one day until it resembled raw hide. I'm not sure the end result was worth it!

What? No Sushi?
It seems to make sense that raw fish may not be a good idea while pregnant. I found a way to still enjoy sushi - I order a vegetable roll, avocado roll, or tempura-style roll (tempura = fried, so it's cooked).

Most pregnant women know about the mercury content in fish. For some reason, women hear "watch your fish intake" and interpret it as "don't eat fish at all". If you enjoy seafood, you should certainly fit it into your diet. There are numerous health benefits for you and your developing baby when fish is consumed in moderation. The omega-3 fatty acid content of fish can help fetal brain development and may be associated with higher IQs, less behavioral problems and better verbal skills.

If you want to avoid fish, keep away from large ones like swordfish, shark, king mackerel and tile fish. The larger the fish, the more mercury it may contain. You can safely eat 12oz/week of low-mercury fish such as shrimp, canned light tuna, salmon, catfish and cod.

Caffeine & Alcohol Buzz
The latest low-down on caffeine is that women can safely drink approximately 150-300 mg of caffeine per day while pregnant. To put this into perspective, a regular-sized Dunkin' Donuts coffee has 210mg caffeine. Check out this chart to find out the caffeine content of your favorite beverages, from coffee to tea, soda and even chocolate: http://www.cspinet.org/new/cafchart.htm

Ah, and then there is alcohol. My husband and I have been to the California wine country twice, the eastern Long Island vineyards countless times, and we have one of those nifty refrigerated wine cellars in our home. Needless to say, cutting out the wine habit has been a tough one for me. While there is no solid evidence that having one or two alcoholic drinks (6oz wine, 1 shot liquor, or 12 oz beer) per week can cause fetal damage, mostly any recommendation out there says to avoid it at all costs.

Alcohol, along with all other nutritional recommendations, obviously come down to the mother's choice. The evidence is there, and you need to make a decision. Do I have that champagne toast on New Years? Do I eat the turkey sandwich? Should I stuff my face anyway and risk getting gestational diabetes because, heck, I'm pregnant!?!?

The choice is that of the mother. In general there are many "food rules" for us to follow all of our lives, pregnant or not, and it can make your head spin.

Be sensible. Think healthy. Here's to a healthy pregnancy!

Baldauf, S. (2009, April 16). Eating Fish During Pregnancy: What's the Right Approach?. Retrieved July 21, 2009, from US News and World Report Web site: http://health.usnews.com/articles/health/diet-fitness/2009/04/16/eating-fish-during-pregnancy-whats-the-right-approach.html

Listeria and Pregnancy (2008, October). Retrieved July 21, 2009, from Americanpregnancy.org Web site: http://www.americanpregnancy.org/pregnancycomplications/listeria.html

Pregnancy Nutrition: Foods to avoid during pregnancy (2009, May 30). Retrieved July 21, 2009, from Mayoclinic.com Web site: http://www.mayoclinic.com/health/pregnancy-nutrition/PR00109


  1. lovely post and nice idea for a blog, i have a 11 month old you are going to love it Rebecca a fellow RD

  2. such great information. I developed gestational diabetes while pregnant with my daughter - I was so upset. Turned out to be a blessing in disguise because it was then that I started paying attention to what I was eating. I'll be sure to keep you posted when I'm pregnant with #2!

  3. Hi Alison,

    To get my Omega 3's in, my midwife has suggested that I take separate Omega 3 pills. I still try to eat fish once every two weeks - even though I typically eat only a vegetarian diet. However, sometimes, I just crave fish.

    Happy Running,

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