Elizabeth Ward is the guru on nutrition during pregnancy. She wrote the book on it, literally. So what did the author of the American Dietetic Association's "Pregnancy Nutrition: Good Health for You and Your Baby" eat during her pregnancies? Doughnuts -- and lots of 'em.
"I had to have a doughnut just about every day about midmorning during my first trimester. It was the fat -- I love fat when I get pregnant," Ward concedes. "Especially with my third pregnancy. I was so sick for about the first four months that I ate whatever struck me. I had to get through the day, and I didn't stop to worry that I wasn't eating an orange or eating my carrots."
Don't misunderstand. It's not that Ward pushes a steady diet of crullers and cinnamon twists for pregnancy. A balanced diet, plenty of calcium and iron, and fluids are still essential for moms-to-be and the healthy growth of their babies, she says. Pregnant women who eat right and gain the recommended weight have fewer pregnancy complications, easier deliveries and lose the extra pounds faster. Malnourished babies are at greater risk for health problems and developmental difficulties, and large babies are harder to deliver.
But don't sweat it those first few months if you can't stomach everything you're supposed to eat, either. The nutritional needs of a tiny fetus are minimal then, and especially if you're taking a multivitamin, you'll be compensating for some of your dietary deficiencies. "If someone's well-nourished to begin with, they can really coast that first trimester," says Katherine Puls, a certified nurse-midwife in Evanston, Ill. "It's more a matter of not getting dehydrated and eating what appeals to you." Here are some nutrition tips to follow during pregnancy, as soon as you can.
Eat Twice as Well, Not Twice as Much
You may be eating for two now, but don't get psyched for that double-chocolate sundae -- an extra glass of milk is better. Nutritional needs during pregnancy only go up about 300 extra calories, which should generally be spread out over all the basic food groups. The only "extras" are another serving of milk or dairy for the necessary calcium (mostly to build strong bones) and about 10 more grams of protein (for cell formation) than your basic USDA food pyramid recommendations for women who are not pregnant.
For women who are already used to eating a balanced diet with plenty of breads and grain, fresh fruits and vegetables, dairy products, and some meat or protein, the change won't be dramatic. Fats should remain at about 30% or less of total calories, although fat restriction shouldn't be a major concern during pregnancy. Vegetarians should be able to get the nutrients they need from careful food choices, although those who don't eat animal products may need an iron supplement.
But since so many of us don't always get the recommended servings when we're not pregnant, eating right during pregnancy may require a little more conscientious planning. "It takes effort," says Ward, a registered dietician in Boston. "For instance, you need 1,000 milligrams of calcium, and you can't get enough of that in your prenatal vitamin or supplement, but if you have cereal, milk and a glass of calcium-fortified orange juice for breakfast, right there you're up to about 600 milligrams." You might even use that Starbucks fix to your benefit since a 12-ounce decaf latte has about 400 milligrams of milk, she says.
Snacks can be helpful in squeezing in all the required foods, not to mention beneficial in curbing morning sickness. "Be a nibbler, a grazer," says Anne Dubner, a registered dietician and nutrition consultant in Houston. "If you nibble throughout the day you're more likely to get all the nutrients you need, rather than trying to cram it all into each meal." Yogurt or cheese will boost calcium intake, for instance; an orange will provide extra vitamin C and folic acid.
It may be difficult to get everything you need from your diet, especially essential nutrients such as folic acid and iron, so most providers recommend a prenatal vitamin "as an insurance policy," says Dr. Richard Schwarz, chairman of obstetrics and gynecology at New York Methodist Hospital. Your iron needs to double to 30 milligrams to accommodate increased blood volume during pregnancy; a lack of iron can cause anemia. Women should already be taking a prenatal vitamin with 400 micrograms, or 0.4 milligrams, of folate three months before conception to help prevent neural-tube defects. Your doctor or midwife may recommend supplements if necessary.
You should also be drinking at least eight 8-ounce glasses of fluid a day, mostly water if possible, since dehydration can bring on premature labor. Fluids also will help reduce muscle cramps, swelling and urinary tract infections. "I tell patients to drink, drink, drink. Their urine should be so pale they can't see it in the toilet," says certified nurse-midwife Katherine Puls. If drinking with food exacerbates morning sickness, try filling your quota between meals rather than with them.
A Pregnant Pause on Thinness
One thing to keep in mind is that you'll gain about 25 to 35 pounds during your pregnancy. That isn't always easy to take, especially as the scale tips into never-before-seen territory, and you start feeling more and more like a beached whale. Most women will gain about 2 to 4 pounds during the first trimester, although some will stay the same or even lose a few pounds until morning sickness passes. A weekly gain of 1 pound during the second and third trimesters is common as your baby grows faster.
"Women get really uptight because for so long they've been fighting to keep their weight in line and now all of a sudden we're telling them to gain this much weight," says Ward. "But if you don't eat enough and gain enough weight, you'll have a baby that could be affected for the rest of its life because you wanted to preserve your figure." Women who don't gain enough weight in pregnancy are more likely to have small babies, and those smaller than 5 ½ pounds have a harder time surviving.
The gain can be especially difficult for those who battle anorexia or bulimia, but often the responsibility of bringing a new life safely into the world is enough impetus for women to overcome their eating disorders, if only temporarily. Puls often recommends keeping a daily planner to record what you've eaten, since eating disorders are often associated with control.
"I was not going to hurt my babies," says one woman, who did not want her name used because she still battles anorexia. During both her pregnancies, she managed to eat three meals a day and get the recommended nutrition. She gained 33 pounds each time, and her babies, both healthy, weighed 8 pounds. "Those are the only times since I was 18 years old that I didn't have an eating disorder," she concedes. Still, it was a struggle, and she obsessed about her weight. "I was really paranoid. But if I was good ... then on the days I weighed in, I'd go to the bakery after and reward myself with a smiley cookie."
If you are either under- or overweight, make sure you've discussed with your doctor or midwife an appropriate weight range to target. Women who start out underweight will probably have to gain more than the average mom-to-be, and those who weigh too much may be advised to gain less, in addition to being monitored for associated problems, such as high blood pressure and diabetes. If you're carrying twins, the American College of Obstetricians and Gynecologists recommends a weight gain of 45 pounds.
Don't get too hung up over every pound, though. "To me, the scale is not the end point," says Puls, who practices with two obstetricians. "The scale is an indicator, and if it's going up too fast then you have to look at nutrition and exercise. If it's not going up fast enough, then you need to look at nutrition. I don't use the scale to say, 'Oh, you gained too much' or 'Oh, you gained too little.'"
And remember: You can get your figure back; it just might take a year to lose all the weight and to regain muscle tone, Ward says. Within six weeks, you'll probably lose 15 to 20 pounds (from the baby, placenta, extra blood volume and fluids), although if you breast-feed, those last pounds may linger until you've weaned your baby. Milk production requires about 800 calories a day, with only about 300 available from stored fat. That's 500 extra calories derived from your diet -- 200 more than you needed while pregnant.
Foods With an Rx
The term "comfort food" takes on a whole new meaning when you're pregnant, since certain foods or eating habits can actually help ward off some of the aches and pains of pregnancy. To quell morning sickness, heartburn and indigestion, eat small, frequent meals with bland starches, such as rice, bread or pasta, and avoid greasy or spicy foods. Herbal teas, like ginger root and lemon herb, can soothe your stomach, as can antacids, which also are a source of calcium.
Experts advise women to consult their doctor or midwife -- and find a reputable herbalist -- before using herbs while you're pregnant. Although they're natural, not all of them are harmless. Some may cause allergic reactions, and some may even be harmful to your growing fetus, especially those that act as strong laxatives or promote uterine contractions. Puls often recommends Susun Weed's "Wise Woman Herbal for the Childbearing Year" for information on herbs that can be used during pregnancy.
Constipation and hemorrhoids often experienced during pregnancy can be alleviated by a diet rich in fiber, which comes from whole grains, fruits, vegetables, legumes, nuts and seeds. Leg cramps, which might be caused by a shortage of calcium or magnesium, may be minimized by adding dairy foods, dark green vegetables, calcium-enriched foods like orange juice, or even antacids.
Pregnant women also should avoid raw or undercooked meat, poultry, eggs and seafood (like sushi), as well as unpasteurized juice and milk, and soft cheeses, such as brie, feta and Camembert. These foods may contain bacteria that could be hazardous to you and your baby. Try limiting junk food, too, because it fills you with empty calories; you're better off getting in those healthy foods first. "There's some room for junk food if you've already satisfied your nutritional requirements, but if you're eating a candy bar instead of yogurt everyday, that's not good," Ward says.
As for caffeine, studies haven't offered reliable evidence linking it to cancer, miscarriage or birth defects, but since caffeine can constrict blood vessels, increase heart rate and cause your body to lose water, doctors and midwives still recommend switching to decaf or cutting back to no more than 300 milligrams a day. That's the equivalent of three 8-ounce cups of coffee. Don't forget that other substances contain caffeine: A 12-ounce can of cola contains almost 50 milligrams of caffeine, and one ounce of dark chocolate has 20.
"Nutrition during pregnancy is really a matter of balance," says nutritionist Anne Dubner. "If you would usually have a sandwich for lunch, then you may want to add a glass of milk or cup of yogurt, or put a little extra meat inside." Who knows -- the eating habits you develop might be a welcome change. "During pregnancy you should eat better than you ever have," Dubner says. "Then just hold that thought -- keep it going for the rest of your life."