pregnancy nutrition (part II)

What happens to your body during pregnancy?

These changes are normal, and certain nutrients/behaviors should be adopted or considered to help your body adjust, allowing the baby to grow. (1)

• Weight gain is normal and should happen at a rate dependent on what your physician recommends. Unfortunately, these recommendations are based on BMI, which is not a good health indicator. However, there is research that supports too much or too little weight gain leads to dangerous health outcomes of the mother and baby.
• Hormonal changes are also prominent during pregnancy. Estrogen, progesterone and prolactin increase, playing fundamental roles in placenta development and uterine lining thickening.
• Hematological changes like a decrease in hemoglobin concentration, hematocrit, and red blood cell count. Platelet count decreases at the end of pregnancy, but usually remains within normal limits.
• As the baby grows, when you lie down there is a pressure exerted on the inferior vena cava, leading to decrease in venous return of blood to right side of heart. This hypotension explains the frequency of edemas observed in the lower limbs.
• Oxygen demand increases by 20-30%. The increased level of progesterone plays a role in increasing respiratory rate and increased ventilation. Because of this hyperventilation, some body changes occur but it explains why some women are short of breath
• A significant amount of GI changes occurs, leading to frequent nausea and vomiting during the first trimester and can be explained by the hCG peak (about the 10th week of pregnancy). hCG levels will gradually decline until birth.

Nutrient needs of pregnant women increase during gestation and lactation. It’s important to prioritize a balanced diet, micronutrients (i.e., vitamins and minerals), healthy fats and fiber as the foundation for your health during gestation, and then, when necessary, supplement with additional nutrients.

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RELEVANT Q & A (1-4)

FIRST. Is weight gain necessary? Why and how much?

First look to pre-pregnancy health status – beyond weight. The first question is, are you eating a balanced diet that is adequately varied in nutrients and meeting your own energy needs? If uncertain, consult with a dietitian. Clinicians look to BMI for a health status, and while it’s an easy way to categorize risk and how much weight should be gained, I challenge that.

1. The notion that a woman should be “eating for 2” is an easy way to get in the mindset of eating more than the child needs, which could put the baby and mother’s future health at risk. The reality is that an increase in calorie intake is required later in pregnancy. The International Federation of Gynecology and Obstetrics (FIGO) recommend:
   1. First trimester: 85 kcal per day additional
   2. Second trimester: 285 kcal per day additional
   3. Third trimester: 475 kcal per day additional
2. To put it in perspective, 1/3 of a pint of Ben and Jerry’s Ice cream is ~450 kcal. While this is an extreme example, 1 ounce of beef jerky is ~80 kcal (about a small handful).

All this to say, rather than stress about weight gain (too much or too little), during the early parts of pregnancy channel your focus on a balanced diet full of nutrients to support early growth, and then add a nutritious snack during the later stages of pregnancy.

SECOND. Which nutrients are especially needed?

First, this list is only for women who are at risk of deficiency of these micronutrients (also included are iodine, vitamin B12, zinc and magnesium). Some of these micronutrients are toxic at high levels, and your pregnancy would be at risk if you reached those levels. Don’t go overboard! Consult with your physician and dietitian if you want an assessment to see what/if you’re missing anything.

1. Iron (5)
   • Iron plays a major role in oxygen delivery and when growing a fetus, there is an increased need for blood mass and its development. Iron requirements could increase from 18 mg per day to 22-27 mg per day. Getting enough iron will decrease your likelihood of having a low-birthweight baby or premature delivery.
   • Animal sources of iron are more bioavailable (heme sources), like oysters, mussels, bison, beef, lamb and turkey. However, you can get iron from plants (non-heme sources), like spinach, artichokes, soybeans, lima beans, swiss chard, and other beans and lentils. These sources aren’t as easily absorbed, but you can eat them with a source of vitamin C for enhanced absorption – like citrus fruit, red bell peppers, and strawberries. You can also obtain iron from fortified sources like grains and cereals.
   • Polyphenols from tea and coffee can decrease iron’s absorption ability. Avoid drinking coffee or tea when consuming iron foods. Eat/drink them at separate times during the day!
2. Calcium & Vitamin D
   • Vitamin D is only necessary to supplement if a deficiency is discovered. It helps calcium absorption, which can be crucial for fetal development. Once levels are tested, if supplementation is necessary 1000-2000 IU per day should suffice, depending on revealed levels in testing!
   • The skeleton of a full-term baby contains about 30 grams of calcium, and three-quarters of this mineral content is deposited during the last trimester of pregnancy. During these later stages, it’s imperative to get 1000 to 1200 mg calcium per day. Dairy food like milk, yogurt and cheese are main sources, but calcium can also be obtained from kale, broccoli, soy foods, and seafood with edible soft bones (like sardines and canned salmon).
3. Omega 3 (particularly DHA)
   • DHA is a supplement that actually is recommended to take, in addition to dietary sources. Women should aim for at least 300 mg DHA per day, in addition to dietary intake. DHA is a healthy fat formed from omega-3s that helps with healthy brain development in the fetus, additionally decreasing the likelihood of pre-term delivery and pre-eclampsia.
   • To meet your DHA needs and avoid fish containing high levels of mercury:
     1. Eat salmon, anchovies, sardines and herring 2 times per week (3-4 oz or about the size of your palm). Other sources of DHA include shellfish (cooked), omega-3 enriched eggs, walnuts and chia seeds.
     2. Mercury is not easily excreted in these predatory fish, and there are different species of tuna that have more mercury than others. It’s safer to avoid consumption of these predatory fish to reduce likelihood of mercury intake.
4. Folic acid/Folate
   • Folate, also known as vitamin B9, is the form found in foods. Folate is more bioavailable than folic acid, meaning it gets absorbed by the body more readily. Folic acid is found in supplements.
   • It is recommended women get at least 400 micrograms of folic acid daily – especially in the early stages of pregnancy and before getting pregnant.
     1. Inadequate folate status contributes to congenital birth defects.
     2. Before conception (see part I of this series), focus on folate from food sources like green leafy vegetables, berries, nuts, beans, citrus fruits, and fortified breakfast cereals. If you’re not eating a plethora of these foods during pregnancy, a supplement might be needed.
5. Vitamin A (6)
   • This vitamin helps with cell differentiation and proliferation, as well as development of the eyes, heart, ears and spine. Too much vitamin A is associated with cranial-facial and cardiac birth defects.
   • Vitamin A supplementation is only recommended in areas where vitamin A deficiency is a serious public health problem, with aim of preventing night blindness – it is better to obtain enough vitamin A from food sources like sweet potatoes, spinach, pumpkin, carrots, and cantaloupe. Essentially, aim to eat food that is red or orange in color!

THIRD. Should I avoid any foods?

• Unpasteurized foods like milk and soft cheeses (unless labeled “made with pasteurized milk”)
• Hot dogs and luncheon meats, unless heated until steaming hot before serving
• Raw and undercooked seafood, eggs and meat (however, cooked sushi is safe)
• Refrigerated pate, meat spreads, and refrigerated smoked seafood

Ensure you are following safe food handling procedures like washing all raw produce, cleaning hands, knives, cutting boards and countertops, cooking all food thoroughly to safe internal temperatures, and promptly refrigerating all perishable food!

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Sources.

(1)	Jouanne, M.; Oddoux, S.; Noël, A.; Voisin-Chiret, A.S. Nutrient Requirements during Pregnancy and Lactation. Nutrients 2021, 13, 692. https://doi.org/10.3390/nu13020692
(2)	Ann Nutr Metab 2019;74:93–106 | DOI: 10.1159/000496471
(3)	Med Clin North Am. 2016 November ; 100(6): 1199–1215. doi:10.1016/j.mcna.2016.06.004
(4)	Nutrition During Pregnancy | Johns Hopkins Medicine
(5)	Food Sources of Iron | Dietary Guidelines for Americans
(6)	Vitamin A – Health Professional Fact Sheet (nih.gov)