Nutritional Programs for Pregnancy

  • Nutrient Program for Pregnancy (Range – RDA to Optimum)

    Nutrition during pregnancy is probably the most important aspect of this magical creation of life. Good nutrition before and during pregnancy can make the difference between health and sickness and support the general constitution of your child for life. The key word for pregnancy is EAT—and that means to eat well, not overeat or eat junky, high-calorie, empty nutrient, or high-fat or salty foods, but highly nourishing foods. The woman’s body needs more of everything—calories, protein, calcium, iron, zinc, B vitamins, and most other vitamins and minerals.

    A very important factor in a healthy pregnancy is the woman’s pre-pregnancy condition. The risk of nutrient depletions is greatly enhanced during pregnancy and lactation. To enter this demanding period with illness, bad habits, or any nutritional deficiency, such as anemia, may mean a troublesome pregnancy and years of recovery. So if you are thinking about having children, even vaguely considering the possibility, begin early to care for yourself. This applies to men as well. Nutritionally healthy men will provide healthier, more functional sperm and probably healthier children. My advice to people planning a pregnancy is to prepare themselves by having a complete evaluation—physical, general biochemistry, diet and nutrient analyses—and then get on a good diet and supplement program. Changing health-damaging habits such as smoking, regular alcohol or caffeine use, and other drug use is definitely a wise move.

    In Nutrition in Health and Disease, Myron Winick, M.D., calculates that it takes an estimated 75,000 calories to make a baby, or about 300–400 extra calories per day. The average woman will need 2,400–2,600 calories per day during pregnancy, and even more in the last trimester. This means about 15–20 percent more calories than usual. An extra few hundred calories can be consumed pretty easily, but if they come from sweets or other empty-calorie foods, they will not provide the extra nourishment needed. Wholesome foods are a necessity, and concentrated or nutrient-dense foods are crucial if a mother-to-be wants to get much of her requirements from food. Women need a higher nutrient/calorie ratio in pregnancy.

    Protein. Besides more food and more calories, pregnant women need nearly twice as much protein as the 45 grams usually required; 75–85 (even up to 100) grams of protein are needed daily during pregnancy. Some preliminary research, however, points out that too much protein intake during pregnancy can lead to some problems, such as larger babies and thus, more difficult birthings, and postmature babies. This area needs further study. During pregnancy, women need adequate good quality protein within a balanced diet. This protein supports the tissue growth of both the fetus and the new tissues made by the mother. Common protein foods are meat, fish and poultry, eggs, and dairy foods. Nuts, seeds, grains, and legumes are also important. The lacto-ovo-vegetarian will need sufficient grains, legumes, seeds, nuts, eggs, and dairy foods. I do not suggest strict veganism during pregnancy. Although it can be done, it does not have the same degree of safety as eating a wider range of protein foods, let alone the added calcium and iron needed. Even though vitamin B12 may be absorbed better by vegetarians than by meat-eaters because of their needs, it is not found in many vegetable foods. Traces may be found in foods such as peanuts, sunflower seeds, sprouts, kelp and other seaweeds, and soybean products, particularly tempeh, miso, and soy sauce. Seafood, however, has much higher levels of vitamin B12.

    Calcium is also very important. Calcium needs in general are more than 50 percent greater during pregnancy, particularly the second half. If the mother is not obtaining sufficient calcium, her body will pull it from her bones to nourish the growing fetus. At least 1,200 mg. of calcium are needed daily, and this is difficult to obtain from the diet alone unless more dairy products and fish are eaten. Calcium helps form the baby’s bones and teeth and aids muscle and heart function, blood clotting, and nerve transmission. Besides fish and milk products, calcium foods include whole grains, nuts and seeds, leafy greens, sea vegetables, and other vegetables. Meats contain some calcium, but their high phosphorus level may interfere with calcium utilization.

    Iron is another crucial nutrient, needed to help build blood cells in the mother and fetus. Iron also aids in disease resistance and elimination. The iron needs more than double, to at least 30–60 mg. per day and likely more. Estimates suggest that women need somewhere between 15–20 mg. absorbed, and absorption is only about 10–20 percent of that ingested, thus pregnant women need an intake likely over 100 mg. daily (and if anemic, probably more). It is difficult to get that high an iron intake from the diet alone unless we live on liver, molasses, wheat germ, and eggs, and most of us would not enjoy that much. If the mother-to-be does not obtain enough iron from her diet, she will deplete her iron stores. With these reduced, her demands to make more blood cells will not be met, and anemia will occur, usually accompanied by fatigue and poor endurance. Thus, almost all pregnant women take an iron supplement with their vitamin program. Since iron is not absorbed efficiently, more is needed to increase its availability; taking it two or three times daily also improves the chances of obtaining enough. Some women have trouble handling iron supplements; certain formulas may be handled more easily than others (again, see the Iron discussion in Chapter 6, on Minerals). Good animal sources of iron include beef liver, red meats (beef, lamb, and pork), eggs, chicken, and salmon. Vegetable sources are: seaweed, brewer’s yeast, molasses, millet, prunes, raisins, mushrooms, chard, spinach, and most nuts, seeds, and legumes.

    Zinc is another important mineral that can be deficient in pregnancy and is needed to aid normal development of the immune system in the fetus. Zinc is found in the same foods in which iron is found, with additional amounts in shellfish, especially oysters.

    Folic acid is another crucial nutrient during pregnancy. It is needed to help form red blood cells, to aid the growth and reproduction of other cells, and to support the development of the nervous system in the fetus. Folic acid also helps stimulate the mother’s appetite. Needs are doubled during pregnancy, to 800 mcg. daily. Folic acid is found in leafy green vegetables, whole grains, yeast, fish, dairy foods, and organ meats.

    Other nutrients are also needed at increased levels. The needs for vitamins A, C, E, and B6 all go up. I do not suggest megadoses of vitamin C during pregnancy because the effects of this have not been clearly determined. However, regular intake of 50–100 mg. several times daily will help utilize iron, calcium and magnesium, folic acid, zinc, and vitamin A. Other minerals, such as iodine, magnesium, and sodium, are also needed in increased amounts. For years, obstetricians were advising pregnant women to avoid sodium, but now they are suggesting that they use it as usual. For most women, some added salt is fine, and they can eat foods that naturally contain sodium, such as celery, beets, red meats, cheese, eggs, and scallops. The craving that some women have for pickles, olives, or sauerkraut may be related to a need for sodium. While more salt is needed to build the blood volume, there are limits, and very salty foods, such as potato chips and pretzels, should be avoided. Excessive salt intake can lead to problems of water retention, elevated blood pressure, and further risks to the mother and baby.

    Another change that has been suggested in the field of obstetrics involves the healthy level of weight gain during pregnancy. Even 20 years ago, doctors suggested that women limit their weight gain to 20 pounds, and even a limit of 10–15 pounds might be suggested. Now the goal is more like 20–25 pounds, or about 20 percent of ideal weight, and it has recently been shown that women who gain even 30–40 pounds, especially from good food, deliver larger and very healthy babies. The average weight gain is around 25 pounds, but 25–35 is fine. Most of the weight (10–13 pounds) is gained in the last trimester, about 8–12 pounds during the mid trimester, and only 3–4 pounds during the first three months.

    As emphasized, the mother needs more of everything during pregnancy because she has to make a new being. And Mother Nature has provided the inner baby with the mechanisms to get what it needs from the mother whether she has extra or not. As I have stated, the baby can pull minerals, vitamins, and protein from the mother’s bones, organs, tissues, and other storage areas. This can leave the mother depleted, which can take a long time, even years, to correct. Besides making a new baby, these nutrients are needed to form the placenta, to increase the size of the uterus and breast tissue, and to create amniotic fluid. Mother’s blood volume increases by 25–50 percent, and more fluids, iron, B12, folic acid, zinc and copper, calcium, magnesium, and proteins are needed to support this new blood. Storage levels of most nutrients must be obtained from the diet as well.

    So what is the best diet for our mother-to-be? First, she should eat a well-balanced diet containing all the food nutrients, with an increased amount of calories, usually about 300–400 more per day than usual. Weight-reduction programs during pregnancy are definitely taboo except for the obese and under careful supervision. (Weight Watcher’s actually has a program for pregnant and nursing women.) There is much less worry about weight gain and sodium use now than there was years ago, as both these factors may contribute to a healthy pregnancy and child. It is really the quality of the weight gain that is important—that is, the building of the necessary tissues rather than just adding fat.

    A wholesome diet is crucial to avoid wasted calories from junk foods and sugary snacks and to provide plenty of nutrient-rich foods to satisfy the increased needs for most of the vitamins, minerals, and protein. More dairy products, animal meats, whole grains, and vegetables will help a lot. Nutrient-rich foods for pregnancy that will help guard against dietary deficiencies include eggs, fish, poultry, organ meats, milk products, red meats, whole grains, wheat germ, nuts and seeds, yeast, molasses, seaweeds, and leafy green vegetables. Some of these should be eaten daily.

    Nutrient-Rich Foods that Will Help Guard Against
    Dietary Deficiencies During Pregnancy

    eggswhole grains
    fishwheat germ
    organ meats*molasses
    milk productsseaweeds
    red meatsleafy green vegetables
    nuts and seeds

    *only from organically raised animals; these foods are really more like medicines

    A high-fiber diet with whole grains, fruits, and vegetables is also important for good bowel function to avoid constipation, a common problem of pregnancy. At least six to eight glasses of good drinking water should be consumed daily besides some milk and herb teas. The top herbal choice is raspberry leaf tea, which is thought to tone up the uterus. Herbal folklore claims that a cup of raspberry leaf tea drunk daily during pregnancy will assure a healthy labor.

    Exercise is also very important during pregnancy, as always. Keeping the body limber, loose, and toned is necessary to a healthy pregnancy. Do exercise; don’t get lazy. It is important for good circulation, and can help prevent constipation, varicose veins, and a flabby tummy. Regular stretching, movement classes, and even aerobic-type activities, such as indoor and outdoor bicycling, swimming, and hiking, will help maintain vitality. If you have not been exercising much prior to becoming pregnant, begin slowly with stretching and light activities. Also, avoid impact aerobics, jumping rope, and horseback riding—but keep moving. Regular, quiet internal “exercises,” such as meditation and visualizations, are important to prepare for all the body changes, emotional shifts, and a smooth labor and healthy baby.

    It is particularly important during pregnancy to avoid drugs of all kinds. Caffeine and alcohol should be minimized to occasional use only and are better avoided completely. Nicotine use is best eliminated, as it is associated with many problems in the pregnancy, birth, and health of the infant as well as the mother. It is also wise to avoid chemicals of all kinds—in foods, at work, and in the home. Many chemicals will pass through the placenta to the baby. Though the placenta protects the baby from many harmful substances, there are very few that it blocks completely. Pesticides or metals can be concentrated in the fetus. Sugar substitutes such as saccharin, artificial flavors, food dyes, and nitrites should be eliminated from the diet. Nitrosamines formed from nitrates and nitrites (found in hot dogs, bacon, and other lunch meats) have been shown in animal studies to produce cancer in the offspring. Good levels of vitamin C in the body can block nitrosamine formation.

    Any pharmaceutical drug use should be carefully monitored by the doctor or midwife. All drugs would be best avoided if possible. Many drugs may interact with body nutrients and increase the risk of deficiency. Pregnant women need to be very careful to avoid drug and chemical exposure, because it is very hard to do any detoxification during pregnancy. The body is in a building up, gathering state and will utilize most everything that comes into it or store it away for later use.

    Nutritional changes and support may help remedy some of the common problems of pregnancy. Morning sickness with nausea and vomiting is especially common during the first few months. This problem is likely a result of biliary or liver activity. During the night, the liver works to eliminate toxins, which are thus in the system on awakening. A good diet and avoidance of fatty foods, alcohol, and other liver-irritating drugs before pregnancy is helpful in minimizing morning sickness. Vitamin B6 aids liver metabolism. The active metabolic form is the pyridoxine precursor, pyridoxal-5-phosphate (P5P), because it enters directly into the functioning metabolic cycle. Usually, supplementing 25–50 mg. of B6 three times daily will help reduce the symptoms of morning sickness. Occasionally, higher amounts are needed. If these higher levels are used, it is wise to continue smaller amounts for a while to prevent pyridoxine withdrawal in mother or baby; higher dosages, however, are usually not required all the way up to delivery time, because intestinal symptoms decrease after the first few months. Other supplements helpful in morning sickness include vitamins B12, C, and E and extra magnesium and potassium. Herbs are often helpful as well. Raspberry leaf, peppermint, or ginger root teas have been effective for some women.

    Dietary changes are the best way to handle morning sickness. A reduction of fatty food intake and an increase in carbohydrates may be helpful. A higher fiber intake keeps intestines moving, which helps elimination and detoxification. Acidic foods, such as citrus fruits or juice, and iron supplements or milk may increase nausea and vomiting. Small, frequent meals and snacks of carbohydrate or protein can be best tolerated. Munching on a few soda crackers or dry toast upon awakening may help alleviate early morning nausea. Don’t worry, this too shall pass; and breathing and relaxing also help.

    Pregnant women and their husbands and families need to be understanding and adaptable, especially in regard to diet. Food cravings can be wild, food consumption goes up, and sometimes a woman’s whole life becomes centered around food. And these can be obstacles. The digestive tract is more sensitive, and as the pregnancy progresses, the size of the stomach shrinks due to the growing womb. Often food intolerances or many new likes and dislikes develop. To adapt, the diet may shift to frequent small and simple, but nourishing meals. Nutritious liquid meals are a good choice. From protein powders to fruit or vegetable smoothies, these drinks can be packed with nutrients. One possibility for building and nourishing mother and baby is the “Baby Shake,” an adaptation of the “Pregnancy Cocktail” described by Fred Rohe in The Complete Book of Natural Foods.

    The Baby Shake

    Blend Together:
    ½–1 cup apple juice1–2 teaspoons blackstrap molasses
    1 banana1–2 teaspoons nutritional yeast
    ½–1 cup yogurt1 Tablespoon wheat germ
    1 raw egg1-2 Tablespoons honey or pure maple syrup
    ½–1 cup low-fat milk1/3 teaspoon kelp

    This can be adapted to your special desires and the flavors you can tolerate. If something in the drink doesn’t appeal to you, avoid it and try something else. Other fruits or juices can be used, or no juice and just milk, a banana, or another fruit as a base. Adding water will make it more dilute, which some women will tolerate better. Flavorings such as vanilla or almond or a handful of raw almonds, coconut, or sunflower seeds can be added and blended. In regard to food-combining, when different foods are blended together as a drink, they seem to be better tolerated. However, if you do not handle this mixture well, simplify the drink and just use a banana, yogurt, and milk or water, along with some yeast or wheat germ and a little sweetener. Overall, your Baby Shake can be very tasty and nourishing.

    Later in pregnancy, when labor is just beginning, take some extra calcium-magnesium to help reduce the pain of contractions and muscle aches and spasm. About 1,500–2,000 mg. of each has been helpful to some women. This can be repeated later if labor is extended. If a caesarean section is going to be done, it is wise to take extra tissue-healing nutrients (vitamins A and C, and zinc) prior to and after the procedure, for several days to several weeks if possible. (See the Nutrient Program for Pre- and Post Surgery.)

    As for regular supplements during pregnancy, usually a high-potency multiple or special prenatal formula with plenty of iron should be taken. If nausea occurs with the supplement, try to take it later in the day with meals. The nutrient plan shown in the table gives the ranges from the MDR (minimum daily requirement) for pregnancy to what I feel is the optimum insurance level.

    For special problems, such as anemia, more iron may be needed. Consult your doctor or midwife. Of course, not all of these nutrients will be used as supplements. Many of them, such as sodium, chloride, fluoride, and potassium are obtained from the diet. However, depending on the dietary intake of various nutrients, such as calcium, zinc, or B vitamins, or individual blood measurements, any specific nutrient can be further increased by supplement use to give the necessary intake.

    (Also note: in the next program, Lactation, more specifics of the pregnancy diet are discussed.)

    Nutrient Program for Pregnancy
    (Range — RDA to Optimum)

    Calories* 2,300–3,200
    Fiber 10–15 g.
    Protein* 75–90 g.
    Vitamin A*6,000–10,000 IUs Calcium*1,200–1,600 mg.
    Beta-carotene10,000–15,000 IUs Chloride+2–4 g.
    Vitamin D400–600 IUs Chromium200–400 mcg.
    Vitamin E*50–400 IUs Copper2–3 mg.
    Vitamin K100–400 mcg. Fluoride+1.5–3.5 mg.
    Thiamine (B1)1.5–50 mg. Iodine*+175–350 mcg.
    Riboflavin (B2)1.5–30 mg. Iron*#40–80 mg.
    Niacin (B3)16–100 mg. Magnesium*450–1,000 mg.
    Pantothenic acid (B5)7–250 mg. Manganese2.5–15 mg.
    Pyridoxine (B6)2.6–100 mg. Molybdenum150–500 mcg.
    Cobalamin (B12)4–200 mcg. Phosphorus*+1,200–1,600 mg.
    Folic acid*800–1,200 mcg. Potassium+2–5 g.
    Biotin200–500 mcg. Selenium150–300 mcg.
    Choline50–250 mg. Sodium*+2.5–4.0 g.
    Inositol50–250 mg. Zinc*20–40 mg.
    PABA10–50 mg. Essential fatty acids**2–3 teaspoons
    Vitamin C*++80–1,000 mg.
    Bioflavonoids100–250 mg.

    *Requirements for these nutrients are increased during pregnancy.

    +These nutrients are required for health, yet are not usually taken as additional supplements.
    #Iron intakes include diet plus additional supplementation of 30–60 mg. daily.

    ++More vitamin C can be used for short periods for colds, flu, and so on.

    **Fatty acids come from olive oil, flaxseed oil, or other nutritious cold-pressed vegetable oils.

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    Written by Elson M. Haas MD