In 2015, more than half the pregnancies in the US were unplanned! Yes, you read that right! 51% to be exact! And many women aren’t even aware they’re pregnant until the end of the first trimester! This means that a high percent of pregnant women are eating, drinking, and generally living their lives unaware that they are putting their unborn babies at risk during the most vulnerable stage of development. I can’t tell you how many women have called or visited me, having found out they were pregnant and now horrified at the things they had eaten or drunk, or NOT eaten!
To address this issue, numerous public health agencies, including the highly respected federal Centers for Disease Control and Prevention (the CDC for short) and the World Health Organization (WHO), have issued guidelines for women and their doctors, to help ensure preparation for a healthy pregnancy. But if you Google advice on nutrition for pregnancy or the “preconception period,” as it’s known, you will find a head-spinning amount of advice about what you should and shouldn’t eat, posted by what seems like every woman who has ever been pregnant, and half of it seems to contradict the other half. So here are the things you really need to be concerned about–if you’re trying to get pregnant or if you just aren’t using birth control or doing anything to avoid getting pregnant–and the information you need to get your baby off to the best start if you do get pregnant!
Folate. One of the greatest discoveries of the late 20th century was the important role of an ordinary B vitamin, folate (or when it is part of a vitamin pill, folic acid), in the development of the fetal nervous system. Folate deficiency can lead to a group of devastating birth defects called neural tube defects (defects that affect the proper development of your baby’s nervous system). Guidelines recommend that women consume 400 micrograms of folate a day in the months prior to getting pregnant, in the form of a vitamin pill or a little more when it is consumed in food (prenatal vitamins provide 600 micrograms of folic acid daily). So, if you’re trying to get pregnant or not doing anything to avoid getting pregnant, you should start taking folate now (a daily multivitamin/mineral that provides 100% of the Daily Values is fine). Don’t wait until you’re actually pregnant to start!
What’s more, folate deficiency, which was unusual during the latter half of the 20th century, has suddenly become a concern among a small segment of our population! Why??? Low carb diets and gluten avoidance! One of the main sources of folate in the foods Americans’ eat have been bread, cereal and other foods made of wheat flour: Wheat flour, cornmeal, pasta, rice, and other grain products are enriched with B vitamins, including folate, to replace B vitamins that have been removed during the milling process. So if you’re shunning bread products because you’re trying to lose weight or you’ve read somewhere that low carb diets are better, you may risk folate deficiency. Likewise, folks who are cutting out wheat products in the belief that they should avoid gluten also risk folate deficiency. The only people who should avoid gluten (which is simply a protein) are those who have been diagnosed with celiac disease (CD), a condition in which eating this protein causes a variety of serious health consequences. If you have been diagnosed with CD, please talk with your doctor, as CD, itself, is associated with a variety of risks for giving birth to an unhealthy baby..
Certain drugs can also affect whether our bodies have enough folate, especially drugs used to control epilepsy and other seizure disorders. More young women with seizure disorders that are under control are considering pregnancy or simply not preventing it. But many doctors are not aware of the effects the most commonly used anti-seizure drugs have on folic acid. And just taking extra folic acid can affect the way the drugs work. Therefore, it’s vital that a woman with a seizure disorder who could get pregnant speak with her doctor about how to manage her condition while ensuring the health of an unborn baby.
Protein. The recommended protein intake for a pregnant woman is 50% more than prepregnancy levels. In spite of what seems to be an epidemic of worry, most Americans, including vegetarians and vegans, get more than enough protein from their daily food intake to satisfy the protein needs of their bodies.
Vitamin B12, iron, zinc, vitamin D, and calcium. Without careful food choices, vegans and even vegetarians run the risk of being deficient in a number of vitamins and minerals usually provided by meat and dairy products. Vitamin B12 and the minerals iron and zinc are in particularly short supply in the vegan diet and of special concern for women who could become pregnant. Although recommended levels of calcium and vitamin D are not increased during pregnancy, most women consume too little calcium, which is difficult to obtain from food alone. A cup of yogurt a day provides about one fourth of a day’s calcium needs and dark leafy green vegetables (like kale and collard greens) provide small amounts, but most women may benefit from a calcium supplement, and if you are a vegan or vegetarian, you might also benefit from a vitamin/mineral supplement that provides 100% of the Daily Value for vitamin B12, iron, and zinc.
Omega-3 fatty acids. An important component of our cells, Omega-3s, are a type of fat found in abundance in some fish (especially salmon and tuna) as well as flax seeds, walnuts, and several other foods in smaller amounts. During pregnancy, they’re thought to be especially important for the developing fetal brain and vision, as well as supporting general fetal growth and possibly the immune system. Research on infants whose mothers took omega-3 fatty acid supplements during pregnancy seems to support at least some of these effects. Some prenatal vitamin supplements contain omega-3 fatty acids. If you are trying to get pregnant or at least not trying to avoid becoming pregnant, it might be helpful to take a daily supplement of fish oil (1 gram daily), which contains forms of omega-3 fatty acids thought to be the most active. BUT, because dietary supplements like omega-3 fatty acids are not required by the government to prove they contain what their labels say, it’s imperative to buy a brand that has been certified by the US Pharmacopeia, a not-for-profit lab that certifies the contents of dietary supplements; you’ll recognize these products by their “USP-Certified” emblem on the label. Better yet, if you are not following a vegan diet, eat two servings of dark fish (like salmon and tuna) a week.
Fiber is a type of carbohydrate that we don’t actually digest, so by itself, it provides no calories, but it serves vital functions in our bodies. Fiber helps keep things moving through the intestines. and may also help support the friendly micro-organisms that reside in our intestines. Most people consume too little fiber-containing foods, and pregnant women need at least 50% more fiber than non-pregnant folks, partly because pregnancy tends to cause constipation. So you need to start finding ways to increase your fiber intake. You’ll find fiber in fruits, vegetables, whole grain breads, cereals, and legumes (like garbanzo beans and lentils), all of which provide additional nutrients.
Drinking: coffee, water, soda, energy drinks, alcohol. What’s ok to drink if you’re trying to get pregnant or not actively avoiding trying to get pregnant?
Coffee is showing more and more possible health benefits these days but if you’re trying to get pregnant and having trouble, check your coffee drinking: some research suggests heavy coffee drinking can interfere with getting pregnant. Moderate coffee drinking seems not to be harmful before or during pregnancy. If you drink more than 2 cups of coffee a day (like a grandé), I recommend slowly decreasing your intake; discontinuing coffee quickly or completely can result in headaches and trouble concentrating.
We hear and read a lot about how we should all be drinking more water, but no one is really sure if that’s true. How much water you need depends on your activity level, because you lose water through sweat. Much of the weight gained during pregnancy is water, so your need for water apparently increases during pregnancy. One thing that is certain is that our bodies are pretty good at telling us if we’re close to dehydration and need to drink more. Another couple of factors to consider are that water helps stave off hunger and also might help prevent the constipation that can happen later in pregnancy.
Should you stop drinking soda, either sugar-sweetened or artificially sweetened? Here is my summary of the evidence in a nutshell: Sugar is a source of energy that we have been consuming for thousands of years with no ill effects. Having said that, if you are trying to lose weight or maintain your weight, a 12-ounce can of non-diet soda packs 140 calories with no other nutrients of any real benefit: you’re better off drinking a glass of water. Fruit juice and juice drinks are also high in calories and provide relatively few nutrients for the calories they pack. As for artificially sweetened sodas, no studies have demonstrated any harm to unborn babies from drinking moderate amounts of artificially sweetened beverages, but the key word here is moderate. Again, if you’re a big diet soda drinker, wean yourself to one a day!
Energy drinks pack a combination of sugar and caffeine. Although the amounts of sugar and caffeine may not be more than the average cup of coffee, energy drinks tend to be quickly chugged, introducing a dangerously large dose of caffeine to your body in a short time. Unless you sip yours slowly, like a cup of hot coffee, lay off the energy drinks. Sports drinks also provide unneeded sugar and electrolytes (sodium, potassium, chloride) unless you’re running a marathon or engaged in a lengthy bout of aerobic exercise.
Milk is a good way to get some protein, calcium, vitamin D, and water. The research is murky right now on the relative merits of nonfat, lowfat, and full fat milk, so choose the one that tastes best to you. If you’re trying to lose weight, you might want to steer away from whole (fullfat) milk, because the calorie difference can add up.
Ok, now we come to the question of alcohol. For years, we have known that women who drink large amounts of alcohol during pregnancy have a greater chance of giving birth to an infant with a special set of potentially devastating birth defects. In the US, guidelines do not recommend that any amount of alcohol is safe for pregnant women and their infants Seven or more drinks a week is considered heavy drinking. If you think you might be drinking too much, more than one 6-ounce glass of wine a day, you need to take steps to cut back on how much alcohol you drink. If you get pregnant and you have been drinking no more than two to three 6-ounce glasses of wine a week (or the equivalent in beer or hard liquor), you are probably not at risk of harming your fetus.
Foods that Might Be Unsafe if You’re Pregnant. Drinks aren’t the only things that can be unsafe for your unborn baby. Certain foods, those that can easily go bad, that are likely to be contaminated, or that naturally contain certain toxins, can cause very serious harm to a vulnerable fetus. These are the foods to avoid: meats and cheeses that you buy at the supermarket deli counter (or sandwiches made with these items), soft cheeses and those made from raw (unpasteurized) milk (like camembert and brie and cheeses labeled as being made from raw milk) as well as raw milk itself, sushi (raw fish), and certain fish that tend to contain dangerously high levels of mercury, which can cause nerve damage: swordfish, shark, king mackerel, and tilefish.
If you’re thinking about getting pregnant and are not getting any exercise, start moving now, even if it’s just walking a couple blocks, parking a little further from where you’re going. Why? Because doctors and guidelines suggest not starting an exercise program during pregnancy, but exercise is vital to feeling well and having a healthy pregnancy and baby.
And finally, if you have a health condition such as high blood pressure, diabetes, thyroid disease, lupus, rheumatoid arthritis, or depression, and especially if you regularly take a prescription medication to control a health condition, please talk with your doctor or other health care provider if you are thinking about getting pregnant, to make sure everything is under control and your treatment regimen is the safest possible.
Think of preconception as the time to start making permanent changes in your eating, drinking, and exercise habits that will not only help you and your baby throughout your pregnancy but will be passed on to your toddler when the time comes!