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Nutrition and Pregnancy: Ask the Nutritionist

Registered dietitian Carolyn O'Neil answers your questions on nutrition and pregnancy.

Question:
What is the importance of getting enough folic acid during pregnancy? What are the best sources for it?
Answer:

Folic acid, or folate, is important for overall health. But it is especially important for women during their childbearing years to help prevent neural tube birth defects, such as spina bifida. Folic acid is found in melons, strawberries, bananas, citrus fruit and drinks, beans, legumes, eggs, liver, and green leafy vegetables. You can also find it in breads, cereals, and other types of products that are fortified and enriched.

Question:
I'm a vegetarian and 4 months pregnant. I've only been able to keep down a small variety of foods during these four months, but I want to make sure I stay healthy for my baby. Are there any specific foods that you recommend I get every day? I do include eggs and cheese in my diet.
Answer:

If appetite is a problem, it's good to eat smaller meals every 3 to 4 hours, rather than three big meals every day. Make sure each meal and snack includes a source of whole grains, fruit and/or vegetables, and a lean protein such as the eggs you enjoy. Cheese is a good source of protein, too. Other vegetarian protein options include tofu, beans, and lentils.

Question:
I'm 5 months pregnant and I've lost 15 pounds during my pregnancy due to constant nausea. My ob-gyn hasn't found anything wrong with my baby. How should I be eating to help me avoid losing any more weight?
Answer:

I recommend eating small meals that include the foods you can tolerate. Strong-smelling foods -- such as vegetables like broccoli or Brussels sprouts -- may be difficult to tolerate. Stay in close contact with your ob-gyn to monitor your weight and find solutions for the nausea. The expectation is that the nausea will subside as your pregnancy continues. If nausea leads to vomiting, you are at risk for dehydration, which can be serious. You might try sipping ginger ale to help with your nausea. And be sure to sip your fluids slowly.

Question:
I've been a vegetarian for 7 years. Could becoming a vegan during my pregnancy cause problems for me and my baby?
Answer:

Vitamin B12 is found in animal products, including fish and shellfish, eggs, and dairy products. So vegans often have trouble getting enough vitamin B12 in their diets. Make sure your physician knows you are eating a vegan diet so he/she can provide supplements to fill in the nutritional gaps where needed.

Question:
I get plenty of vitamin C, but not enough D. On top of my prenatal vitamins, what are the best sources for vitamin D?
Answer:

Good sources for vitamin D include fortified milk, yogurt, and other dairy products. You can also buy fortified orange juice. And salmon and sardines also contain vitamin D.

Question:
Are there any nutrients that I should be getting more of as my pregnancy progresses?
Answer:

It is important to eat nutritious and well-balanced meals throughout your pregnancy. You will need to increase your intake of certain vitamins and minerals, including iron, calcium, and folic acid. Also, it's generally recommended that women consume between 100 and 300 calories more per day while pregnant. Try to limit the amount of sweets and junk food you eat, as they offer mostly empty calories with little to no nutritional value.

Question:
I just found out that I'm 8 weeks pregnant. I'm a swimmer and I plan to continue swimming during my pregnancy. Are there any foods or nutrients I should be getting more of than what's recommended for other, less-active moms-to-be?
Answer:

It's generally recommended that pregnant women consume between 100 and 300 more calories per day. So if you are an active swimmer, you should consume around 300 more calories a day. No specific extra food or nutrient recommendations; just a larger serving of the healthy foods recommended for a balanced diet.  

Question:
Of all the supplements you can take to increase your energy, which ones are normally safe to take during pregnancy?
Answer:

Many herbal compounds and supplements are not safe to take during pregnancy. Be sure to check with your doctor before taking any new supplements. A well-balanced diet -- including lean protein, whole grains, fruits and vegetables -- should give you all the energy you need. Remember that dehydration can make your feel tired, too. So make sure you drink plenty of fluids to support the increased blood volume you'll develop during your pregnancy. 

Question:
In addition to alcohol and certain seafood, what other foods and drinks should I limit or avoid while pregnant?
Answer:

Limit salty foods. Salt causes your body to retain water. Although there is no documented risk to mother or baby, you might want to limit extra salty foods to avoid feeling bloated. Do not completely refrain from salt unless instructed to do so by your health care provider.

Limit caffeine to no more than 200 mg per day. In addition to coffee, teas, and soda, remember that chocolate contains caffeine, too. The amount of caffeine in a chocolate bar can be equal to the caffeine in 1/4 cup of coffee.

Question:
My feet swell a lot since I became pregnant. Can I change something about my diet to reduce the swelling?
Answer:

Be sure to avoid salty foods -- foods with high levels of sodium listed on their nutrition facts labels. Get plenty of fluids to help you maintain a healthy fluid balance in your body. That includes the fluids from fresh fruits and vegetables. Fruits and veggies also contain potassium to help with healthy fluid balance and alleviate swelling. Keep in close contact with your doctor to monitor your swelling and to make sure you are not at risk for preeclampsia.

Question:
I'm due any day now. What changes should I make to my diet after I give birth and start breastfeeding?
Answer:

Breastfeeding increases daily caloric needs between 200 and 500 calories. Make sure to consume plenty of fluids to support the production of breast milk.

Question:
I read that pregnant women are at greater risk for food-borne illness. What can I do to protect myself and my baby?
Answer:

Everyone's at risk, but those at greater risk are infants, young children, pregnant women and their unborn babies, older adults, and people with weakened immune systems (for example, those with HIV/AIDS, cancer, diabetes, kidney disease, and transplant patients). Some people may become ill after ingesting only a few harmful bacteria. Others may remain symptom-free after ingesting thousands. To prevent food-borne illness, keep these key actions in mind:

  • Wash your hands.
  • Keep raw meats and ready-to-eat foods -- like salads -- separated during preparation.
  • Cook foods to the proper temperature by using a food thermometer.
  • Refrigerate foods promptly and reheat leftovers to 165 degrees Fahrenheit.
Question:
Real ginger ale (without all the sugar) helps ease my nausea. But could the carbonation be harmful to me or my baby?
Answer:

Carbonation does not present a health risk. In fact, sparkling mineral water sometimes contains a little calcium and magnesium, which are healthy minerals needed for the development of bones.

Question:
I usually eat meat substitutes like tofu or seitan. Do I need to eat meat instead while pregnant?
Answer:

Your baby can receive nutrients for growth and develop while you follow a vegetarian meal plan. Instead of meat, you can continue to eat good sources of vegetable-based protein, including beans, peas, nuts, and seeds.

Question:
I know that fries aren't the healthiest food, but I'm really craving them. Are they that bad for me or my baby?
Answer:

French fries are basically potatoes cooked in vegetable oil and often sprinkled with salt. Sometimes consuming too much fat can lead to indigestion in pregnant women. So be sure to limit your portion sizes and go easy on the salt, which can lead to water retention, bloating, and possibly ankle swelling. 

Question:
How can I get enough choline in my diet if I don't eat eggs or liver?
Answer:

Choline is a nutrient important for brain development, so it is vital during pregnancy. While eggs are one of the most concentrated sources, other food sources of choline include salmon, wheat germ, and vegetables such as broccoli and spinach.

Question:
Is it unhealthy for an expecting mother to eat microwaved foods on a regular basis?
Answer:

There are no health concerns for an expecting mother to eat microwaved foods on a regular basis. In fact, microwave cooking of vegetables -- such as steaming broccoli or green beans, or using the microwave to quickly prepare frozen vegetables -- is a great way for busy moms-to-be to include more healthy vegetables in their diets.

Question:
Can I alter my diet prior to and/or while pregnant to decrease my risk of gestational diabetes? If so, how?
Answer:

Most health care providers test for gestational diabetes mellitus (GDM) between 24 and 28 weeks of pregnancy.  GDM is diabetes that occurs in pregnant women who have not had diabetes before becoming pregnant. With GDM your body has a hard time using the insulin it needs to get energy from food you eat. The American Diabetes Association estimates that 18% of pregnancies are affected by gestational diabetes. You can lower your risk of gestational diabetes by losing excess weight, getting 30 minutes of physical activity on most days, and by following a balanced eating plan with a variety of foods. Choose foods high in fiber and low in fat and calories. And be sure to focus on fruits, vegetables, and whole grains.

Question:
What is a healthy amount of sugar to consume every day while pregnant? My sweet tooth is out of control!
Answer:

The 2010 Dietary Guidelines allow room for discretionary calories to help satisfy your sweet tooth. Ten to fifteen percent of calories can be used for sweets and treats, as long as you reach your quotas for healthy foods like fruits, vegetables, low fat dairy, lean protein, and whole grains. If you need 2,000 calories per day, you can enjoy almost 300 discretionary calories. Try to satisfy your sweet tooth with foods and beverages that also contain nutrients you need, such as:

  • low-fat milk with a teaspoon or two of chocolate, strawberry, or vanilla syrup
  • low-fat plain yogurt mixed with fruit, honey, or low-sugar fruit preserves
  • added fresh or dried fruit in cereals
  • whole grain graham crackers or fig bars snack
  • frozen grapes
  • fruit smoothies

Thank you for joining us for WebMD Ask the Nutritionist. Be sure to check in on Wednesday, Jan. 11, at 1 p.m. ET when we discuss nutrition for exercise and sports. Sign up if you'd like an email reminder the day before the event.

WebMD Ask the Specialist Transcript

Reviewed by Carolyn O'Neil, MS, RD on December 14, 2011

The opinions expressed in this section are of the Specialist and the Specialist alone. They do not reflect the opinions of WebMD and they have not been reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance or objectivity. WebMD is not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your doctor or other qualified health provider because of something you have read on WebMD. 

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