Eating Healthy for You and Baby, Too – Prenatal Nutrition with Maggie McHugh, MS, RD, CDN

Maggie McHugh is a registered dietitian and certified nutritionist with extensive experience in community nutrition education and clinical practice. Maggie is founding partner of Eating for You (and baby too), inc., which provides educational resources on nutrition for women before, during and after pregnancy. Maggie earned a BS degree in dietetics and nutritional science from the University of Vermont and a MS degree in dietetics from D’Youville College in Buffalo, New York. She is a member of the American Dietetic Association and an educational affiliate member of the American College of Obstetricians and Gynecologists (ACOG). She is also recognized as a certified dietitian nutritionist through the New York State Department of Education. Recently, we talked with Maggie about important issues related to preconception, prenatal and postpartum nutrition.

Q. Why is preconception nutrition important?

A. Nutritional-related issues can interfere with conception, making it difficult to become pregnant. These include poor diet, dehydration, heavy caffeine or alcohol intake, and being either underweight or obese. Women who don’t get proper nutrients from their diet or are chronically dehydrated are more likely to have irregular ovulation. Dehydration also decreases the amount and quality of cervical fluids that carry sperm to the egg before conception. We still have much to learn about the many factors affecting conception, but some studies have suggested that high caffeine consumption (for example, five cups of coffee per day or more) is correlated with delayed conception, and other researchers have found that women’s fertility decreases with consumption of just five alcoholic drinks per week. Many women also don’t know that being either overweight or too thin can cause hormonal imbalances that disrupt ovulation. Women should achieve a healthy weight before trying to conceive.

Q. What are the primary nutritional recommendations for a woman trying to conceive or who is already pregnant?

A. A healthy prenatal diet looks a lot like the ideal diet we should all adopt as a lifestyle. Just as it is for children and adults of all ages, a balanced diet with foods dense in nutrients is ideal for conception and a healthy pregnancy. This diet should include lots of high-quality fuel, including fresh fruits and vegetables, whole grains, beans, fish, low-fat meats and dairy products. A variety of foods is key. While a pregnant woman does have some unique nutritional needs, it’s a mistake to equate “eating for two” with doubling her food intake. In fact, most pregnant women need only an extra 300 calories per day during the second and third trimester. It’s also important to get adequate fluids – especially water, at about 64 ounces per day. And I recommend starting on a prenatal multivitamin before conceiving. Pregnant women need more of some nutrients, such as iron, vitamin C, protein and folic acid. Folic acid in particular is crucial to the fetus’ development in the earliest days and weeks after conception, before a woman may know she is pregnant. Also, staying hydrated during pregnancy is one of the best nutritional choices you can make, just as it is for all of us – children and adults alike. Specifically, drinking plenty of water during pregnancy can help to prevent urinary tract infections, hemorrhoids and the severe dehydration that can cause contractions leading to preterm labor. For women who don’t like the taste of water during pregnancy, I suggest adding a wedge of lemon/lime or adding frozen juice cubes, which often makes it more appealing.

Q. What do women need to know about prenatal vitamins?

A. Women should check the label to be sure the multivitamin contains 400 micrograms of folic acid. However, they shouldn’t expect a multivitamin to provide 100 percent of the DV (daily value) of calcium, since most do not. A health care provider may recommend a calcium supplement along with the multivitamin, and a pregnant woman should also eat calcium-rich foods like milk, yogurt and cheese. Even some vegetables contain calcium, like broccoli and kale. However, there are now many foods and beverages that are fortified with calcium, like orange juice and breakfast bars. Since some vitamins and minerals – such as iron, chromium, selenium and vitamin A – are dangerous in high doses for women and developing fetuses, women should avoid taking more than 100 percent of the DV unless advised by a health care provider. It is also wise to choose a prenatal vitamin that contains vitamin A in the beta-carotene form versus retinol form (the Supplement Facts label will state this information). Consumers should also check the expiration date, since multivitamins can lose their potency, especially in hot and humid environments. Along the same lines, the bathroom is not the best place to store a bottle of vitamins. Instead, keep them somewhere dry and cool. Also, purchase a supplement that has a “USP” (U.S. Pharmacopoeia) on the label. This ensures that the vitamin meets standards for strength, purity, disintegration and dissolution. Taking a prenatal vitamin after a meal will help with vitamin absorption.

Q. How do you advise women experiencing “morning sickness” that affects their diet during pregnancy?

A. “Morning sickness,” which is most common in early pregnancy and can occur at any time of day, can often be managed by adjusting what a woman eats, and when. Switching to six to eight smaller meals per day can help. Drinking fluids between (but not with) meals and not letting her stomach get completely empty may also decrease the nausea, as well as avoiding greasy or spicy foods. For most women, morning sickness does not become severe enough to interfere with adequate nutrition or gaining enough weight during pregnancy. For the woman who really has trouble holding anything down, I suggest foods with a high water content to ease dehydration that both aggravates nausea and is made worse by vomiting. These can include melons, grapes, frozen fruit bars, apples, pears, celery, yogurt, and lettuce. Many women also find comfort from eating ginger (in the form of ginger snaps or tea), lemon drops, frozen yogurt, applesauce, soda crackers and yogurt smoothies. Even foods that are high in vitamin B6 can help such as dry cereal, bananas, and nuts. Some studies even show that tart lemonade and something salty can reduce symptoms.

Q. Which foods and drinks should be avoided during pregnancy?

A. Alcoholic beverages in any amount are off limits during pregnancy, since alcohol can cause birth defects and developmental problems for the developing fetus. Unpasteurized dairy products (including unpasteurized soft cheeses) and rare meat can cause a bacterial form of food poisoning called listeriosis, which can cause miscarriage, premature delivery or stillbirth. Deli meats are considered low-risk. However, they should be heated until steamy before eating, to prevent any contamination. Raw or undercooked meat, poultry and eggs, as well as unwashed fruits and vegetables, should be avoided because they can carry E. coli, salmonella and toxoplasma. In addition, fish with high mercury levels (such as shark, swordfish, king mackerel and tilefish) should be avoided. High levels of mercury are linked to a lower birthweight and learning problems in the infant. Another area of caution is in consuming herbal products. Certain herbs have been associated with serious side effects during pregnancy. Women should check with their healthcare provider prior to taking any herbal products. In general, foods high in fat and added sugar should be limited during pregnancy, though an occasional splurge is nothing to worry about.

Q. Is a vegetarian diet safe during pregnancy?

A. Many women are concerned that they don’t get enough protein because they eat little or no meat. However, meat is not the only source of protein, and a non-meat-eater can still have a healthy prenatal diet. All types of dry beans, eggs, nuts, milk, cheese, tofu and yogurt are protein-dense, providing protein that is easily digested and absorbed. Foods like bread, cereal, rice, pasta and vegetables also provide protein, though in smaller amounts. Generally, a non-pregnant woman needs 60 grams per day of protein, while a pregnant woman needs 70 grams and a breastfeeding woman needs 75 grams. These nutritional needs can certainly be met without meat. For example, one cup of cooked dry soybeans provides 29 grams of protein, two ounces of cheese provides 13 grams and one cup of yogurt provides eight grams. If a pregnant woman eats a balanced diet and gets adequate protein, she can certainly have a healthy vegetarian pregnancy. Pregnant women should pay special attention to their iron, B12 and zinc intake, because these nutrients are mainly found in animal products. Iron can be found in non-animal sources such as whole grains, dried fruit and beans; vitamin B12 can be found in cereals, soy milk and eggs; and zinc can be found in peas, beans, nuts and tofu. These particular nutrients can be provided through a vitamin supplement as well. However, food is the best source of nutrients.

Q. How do you respond to women who are concerned about weight gain during pregnancy?

A. Women who are at a healthy weight before pregnancy should gain 25 to 35 pounds, while women who were underweight before pregnancy should gain 28 to 40 pounds, and a woman who was overweight before pregnancy should gain 15 to 25 pounds. But regardless of a woman’s weight before conception, dieting during pregnancy is never safe. At no time during pregnancy should a woman restrict her calories and try to lose weight, since inadequate nutrients can harm the development of the fetus. The fact is, women will gain weight in different amounts and at different rates during pregnancy. Some women may gain earlier in pregnancy than others. Weight gain can be attributed to not only the fetus, but to the placenta, the uterus, increased blood volume and increased breast size. The most important thing is to eat healthy and keep active. A woman who eats a balanced diet, takes a vitamin supplement, stays hydrated and gets exercise during pregnancy should relax about weight gain and know that she is on the right track!

Q. What determines postpartum weight loss?

A. Several factors. Hormones can have an effect on postpartum weight loss. In addition, some breastfeeding mothers find that they don’t lose “those last few pounds” until weaning, since a woman’s body works to maintain a certain level of fat while producing breast milk. (It is also important to note that women who severely restrict calories below 1,500 per day can hinder their milk supply.) Diet and exercise will play a role in how soon a woman returns to her pre-pregnancy weight. For most women, postpartum weight loss becomes more gradual after the first month. Some may experience a one- to two-pound loss per month, while others may lose two to four pounds per month. It’s important to remember that all women lose weight at different rates during the postpartum period, and the same woman may even lose weight at varying rates after different pregnancies.

Q. What is the safest and most effective approach for achieving pre-pregnancy weight?

A. Women who lose weight too quickly or fall below their healthy weight may not get the nutrients they need to stay healthy and fight the effects of stress, especially after giving birth. To continue weight loss in the postpartum months and reach her ideal weight, a woman should limit foods high in fat and sugar and low in nutrients. Consuming foods high in fiber (such as whole grains, beans, berries and nuts) can help shed unwanted pounds. An active lifestyle is also important.

Q. How can HMHB members and partners advocate for preconception, prenatal and postpartum nutrition?

A. Pregnancy is such a demanding time nutritionally on a woman’s body. If she can make even one positive change, it can make all the difference in her health, as well in the health of her developing child. There are very few things that a woman has control over during her pregnancy; however, she does have control over what and how she eats. Changing or adjusting just a few eating habits before, during and after pregnancy can make a huge difference in affecting a woman’s quality of life. Eating right will eventually become a habit that can be taught to her children and family, too. As a child grows up, she will watch her mother – as a role model – on how to eat well. Children learn their eating habits from their parents. This will instill in them the importance of eating healthy snacks, not skipping breakfast, drinking water and more.

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