Today’s guest post is from Emily Wax, an RD from Brooklyn and the blogger behind Eating Chalk. Emily and I have actually gotten to meet in person! I love that she loves sardines like me. Having just gone through a pregnancy (ok, wow, it was actually almost two years ago!), I loved reading her post. Hope you will too!
Hi, Kath Eats readers! I’m Emily, a Registered Dietitian from NYC who works primarily in outpatient women’s health with prenatal patients. I’ve spent a lot of time thinking about exactly what moms-to-be need to know about nutrition. It can be a pretty involved topic and your specific needs and recommendations will depend on a myriad of factors that should be discussed with your OB-GYN and one-on-on with a RD. For this post, I will stick with some of the basics of nutrition for a healthy pregnancy. I will not be addressing anemia, preeclampsia, gestational diabetes, or multiple gestations, but please feel free to ask questions that go beyond this post in the comments.
A Weighty Topic
Weight gain is an inevitable part of all pregnancies. If you’ve been in weight loss mode this can be a hard switch mentally, so it is helpful to picture exactly where the weight is going.
The Institute of Medicine weight gain recommendations for single fetus pregnancies are based on pregnancy body mass index (BMI), as recommended by the World Health Organization.
While each patient is treated on a case-by-case basis, you’ll notice that the general recommendation is always to gain weight, even for women who are obese before they get pregnant. Remember that BMI is not an appropriate metric to use during pregnancy once weight gain has begun.
Can you think of any condition other than pregnancy that causes perfect strangers to think it’s acceptable to rub another adult’s belly? Our society has a nasty habit of attempting to assert personal beliefs on women’s bodies. Note to the general public – if you are not part of the medical team and you were not part of the conception, your opinion probably isn’t necessary.
There are too many old wives’ tales concerning pregnancy to list here; I’ve heard everything from “my mom says I can’t have pineapple or hot sauce” to “when you’re pregnant you cannot digest pork and it rots in your stomach!” I just want to address some of the more common misconceptions.
· “You should not eat any seafood when you’re pregnant.” - On the contrary, seafood can be a healthy source of lean protein and iron and it is the only unfortified source of DHA, an omega-3 fatty acid that is essential for fetal brain development. You just don’t want to overdo it because seafood can contain mercury, a heavy metal that can build up in your blood. The general recommendation is to avoid fish that are high in mercury and aim for about 12 ounces/week of safe seafood. I included my recipe for pasta sauce with sardines at the bottom of this post.
· “You’ll have to cut coffee cold-turkey.” – Not if you don’t want to. The recommendation is to stay under 300 mg of caffeine a day, so a small cup of Joe can healthfully fit in to your diet. Worth noting – a Grande brewed coffee at Starbucks has 330 mg of caffeine vs. 190 mg in 16 oz brewed of most generic brands.
· “Ginger ale has no caffeine so drink as much as you want.” – It still has calories/added sugar and no nutritional benefits. If you are having morning sickness and it’s a choice between ginger ale and puking? Drink the ginger ale. Otherwise? Go for something else most of the time.
· “You have to eat meat when you’re pregnant.” – Nope. It is the position of the Academy of Nutrition and Dietetics that “Well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy [and] lactation.” You can easily meet your increased protein needs without turning to animal proteins. Vegans will need supplemental vitamin B-12 and anyone who doesn’t eat seafood should take a fish oil supplement. Vegetarians who are uncomfortable with the supplement should take care to consume walnuts, flax seeds, and chia seeds – but be aware that the conversion rate of ALA to DHA is estimated at only about 10%.
· “You are ‘eating for two’ now.” – Sadly, no. In the first trimester you don’t need any more calories than you did before you were pregnant. You only need about 340 additional kcal/day in the second trimester and 450 additional kcal/day in the third trimester. Your nutrient needs increase during pregnancy so if anything you have less wiggle room for junk food, not more.
The Diet “Traffic Light” for a Healthy Pregnancy
Recent studies have shown that presenting nutrition guidelines in a “traffic light” form can make them easier to digest, so to speak, so that is one of the ways I present information to my patients and the way and I will do it here.
Many of your vitamin and mineral needs increase during pregnancy – particularly calcium, folate, and iron – and it is important that you eat the foods that will meet those increased needs. That said, soon it will be summer and pregnant women tend to run hot, it will probably be pretty important for you to eat a bowl of ice cream too! I certainly don’t eat a perfect diet, and I don’t expect you to either. I tell my patients that “junk” (aka foods that make you happy but don’t provide any protein, vitamins, or minerals) is ok once or twice a week as long as they make sure they meet their needs first.
Stop: Do not consume these foods when you are pregnant
- Fish that are high in mercury: shark, swordfish, king mackerel, and tilefish
- Cold cuts/sandwich meat/deli meat that are served cold – these products have an increased risk of carrying a type of bacteria that grows at refrigerator-temperatures and should only be consumed steaming hot
- Raw or undercooked meat and poultry such as a medium-rare burger or steak tartare
- Raw or undercooked eggs such as soft-boiled eggs, sunny side up eggs, or hollandaise sauce
- Raw or undercooked fish, like sushi or lox
- Raw sprouts
- Raw or unpasteurized milk, unpasteurized cider or juices
- Dairy products made from raw or unpasteurized milk – many cheeses sold in America, including blues and Bries, have been pasteurized and are fine to have
- Alcoholic beverages; such as beer, wine, or spirits
- Any herbal supplements or teas that you have not checked with your healthcare provider
I don’t expect pregnant women to live in a bubble. There is inherent risk in leading a normal life. Riding in a car can be risky, but also fairly unavoidable. Ultimately you will have to weigh the costs/benefits of your choices yourself. My list of favorite foods is topped by coffee, diet soda, and soft-boiled eggs; perhaps when I’m pregnant I’ll decide the risk of me stabbing my husband in the face outweighs the risk of salmonella.
Caution: Limit these foods to once or twice per week
- Coffee and tea – you want to stay under 300 mg of caffeine/day
- Soda and other sweetened beverages
- Diet soda and other beverages with nonnutritive sweeteners – fake sugars are fine in moderation. The FDA has approved aspartame, acesulfame potassium, sucralose, saccharin, and neotame for general use. The American Medical Association advises avoiding saccharin due to possible slow fetal clearance.
- 100% fruit juice – consume no more than 8 oz of juice per day
- Albacore tuna and Atlantic salmon – consume no more than 6 oz/week of these “medium-mercury” sources
- Fried foods
- Refined grains like white bread and “sugar cereals”
- Empty calories; things like chips, fries, candy, baked goods, and bacon
Go: Eat these foods every day
- Low-fat or fat-free milk, yogurt, cottage cheese, and cheese, and/or calcium-fortified soy milk – at least three servings a day
- Fruit: fresh, frozen, dried, or canned in juice or water – at least two servings a day
- Vegetables: fresh or frozen – at least three servings a day; aim for one dark green veggie every day
- Whole grains such as bread, cereal, rice, pasta, oats, popcorn, and fortified cereals – you and your baby require at least 175 grams of carbohydrate per day
- Lean meat, low-mercury seafood, eggs, nuts, beans and legumes, and/or tofu
Finally, regular exercise is recommended for most pregnant women. If you are having a normal, healthy pregnancy – i.e. no bleeding, no bedrest, no insufficient cervical cerclage, and you’ve been cleared by your doctor – you should aim for at least 30 minutes of physical activity on most days of the week. Exercise can help reduce stress and constipation, lead to better sleep, and allow you to eat what you need to eat without excess weight gain. Don’t lie on your stomach or lie on your back after the 1st trimester. Don’t do anything where you might fall on or hit your stomach. Walking, swimming, yoga, supervised strength training, and use of the elliptical, treadmill, and stationary bike are all encouraged.
A Recipe! Sardine Mushroom Tomato Pasta Sauce
Sardines are one of the most concentrated sources of the omega-3 fatty acids EPA and DHA. These fantastic fishes also a good source of calcium and B-12. I find them to be a little scary straight from the can, this sauce is much less threatening.
Prep Time: <5 minutes
Cook Time: 20-25
- 2 tsp olive oil
- 1 Tbsp butter
- (2) pints sliced, white mushrooms
- pinch salt
- (2) 3.75 ounce cans water-packed sardines, drained
- 2 cups of your favorite tomato sauce
- Melt 1 tsp oil and 1/2 Tbsp butter in a large sauté pan over medium-high heat.
- Add mushrooms and salt to pan. Cook mushrooms, stirring regularly, for 10-15 minutes or until caramelized. Mushrooms should be reduced in size by about half and have developed a deeper brown color and amazing scent.
- Remove mushrooms from pan and reduce heat to medium.
- Melt remaining 1 tsp of oil and 1/2 Tbsp of butter (in the same pan you used for the mushrooms).
- Add sardines to pan and cook 3 minutes. Use the edge of a wooden spoon or spatula to break up the sardines into a paste.
- Reduce heat to low and return mushrooms to pan. Add tomato sauce, stirring carefully to combine. Cook another 2-4 minutes until the sauce has been fully heated through.
- Serve on top of whole-wheat pasta.
- Kaiser L, Allen LH. Position of the American Dietetic Association: nutrition and lifestyle for a healthy pregnancy outcome. Journal of the Am Dietetic Assoc. 2008; 108: 553-561.
- Academy of Nutrition and Dietetics. Academy of Nutrition and Dietetics Evidence Analysis Library. Accessed March 27, 2014.
- Academy of Nutrition and Dietetics. Nutrition Care Manual. http://nutritioncaremanual.org. Accessed March 28, 2014.
Emily Wax, RD, is a clinical Dietitian at a hospital in Brooklyn, NY, working primarily with prenatal patients in the outpatient Women’s Health Clinic. She worked as a teacher in East New York before returning to school for a 2nd degree, and she is thrilled to be back in NYC. She blogs sporadically at Eating Chalk about her life as a Registered Dietitian with a realistic diet.