For my next blog, I'm going back to the beginning of pregnancy. One of the more common questions asked at the first OB visit is, "what can't I eat now that I'm pregnant?" Well, there are some simple rules and some myths that I'd like to dispel.
Is there any special diet you should be on in pregnancy? The short answer is no. Just eat healthy. At the beginning, most women aren't hungry for much, and that's normal. Don't force yourself to eat, it'll just make you sick. Once the morning sickness wears off, a normal diet along with a prenatal vitamin supplies all you need. If you are worried about weight gain, I tell women that babies really like carbohydrates. The American diet is very high on simple sugars/carbs, and these are the easiest foods to break down into sugar. This would include white breads, white rice, and pasta, which will increase your insulin levels and make you more prone to gain extra weight. Try switching to brown rice and whole grain or wheat breads. The ideal weight gain during pregnancy is 25-35# for women of ideal weight, 15-25# for those overweight, and 15# for obese women. Gaining over 40# in a pregnancy puts you at higher risk for larger babies and c-section.
Ok, so what DO I need in pregnancy? The average woman needs somewhere between 1800-2200 calories a day depending on how active you are. Pregnancy adds 300 calories a day. That's like a peanut butter and jelly sandwich. The main extra nutrients you need are iron and folic acid. Iron is incorporated into red blood cells, and since you increase your blood volume an extra 50% in pregnancy, without extra iron you will become anemic. Here's a list of foods high in iron. Folic acid prevents neural tube defects. The current recommendation is 400 micrograms (0.4mg) a day. Start this months BEFORE you are pregnant to get the best effects. Some women need extra folic acid (those with seizure disorders, on certain medicines, or those with a history of spina bifida), ask your doctor if you think you fall into this category.
What about CAFFEINE????? The good news is, moderate caffeine intake in pregnancy is safe. This would be 200mg a day, equivalent to 2 1/2 sodas or 2 cups of coffee. The caffeine scare came from studies that showed that rats given very large amounts of caffeine had a higher rate of miscarriage. So 1. don't be a rat, and 2. don't be drinking pots of coffee a day. Immediately stopping all caffeine early in pregnancy is a common cause of headaches, so if you do want to cut down, do so gradually.
Fish? Yes, there is a limit on fish intake in pregnancy. This is because human beings have poisoned our water with mercury over the years, and fish tend to absorb it. Fish that are "bottom feeders" or filter feeders tend to have a higher concentration, so those are limited more than others. Remember, fish LOW in mercury are good for you. Fish contain omega-3 fatty acids, which is good for brain and nervous system development. That is basically what that DHA supplement is in those prenatal vitamins (ever wonder why you burp up fishy breath after taking them?) Two 6 oz meals a week of the low mercury fish, and none of the high mercury fish. Here is a great website about this, and it lists all the fish in those two categories.
Deli meats? When I first heard this I did a double take. People always tell me once they get pregnant they're going to miss going to Subway. Huh? It took me a while to figure that one out. I think I've got it now. Back in the '50s or so, listeria was a big problem. Listeria is a bacteria contracted by eating undercooked food. It can cause miscarriage. It also causes fever, muscle aches, nausea, diarrhea. This is what contaminated cantaloupes earlier this year. Listeria is NOT killed by refrigeration or freezing, but it IS killed by heat. Anything not pasteurized should be avoided in pregnancy- soft cheeses, some juice. The only other rule of thumb is to cook food well. Don't eat raw eggs, raw meat, etc. Hot dogs need to be steaming. I should tell you to heat all lunch meat until steaming, but I love Subway, and in 15 years I've never seen someone with listeria, so I say if you are eating from a reputable place, go ahead. Just exercise the usual caution you would take if not pregnant- if you don't know where it came from, best to avoid it.
Special diets are generally fine in pregnancy. Vegetarians and vegans have very happy and healthy pregnancies. If you do not eat meat, make sure you eat a lot of tofu or beans to keep up with your iron demand.
Post-gastric bypass women do well in pregnancy also. There have been numerous studies lately showing that pregnancy after gastric bypass is not only safe, but preferred over morbid obesity. Simply follow your gastric doctors orders well as far as nutrition intake, some women end up having problems absorbing things like vitamin B-12. Lots of women are worried about dumping syndrome while doing their glucose tolerance test at 26-28 weeks. If you already get dumping syndrome, then we can find ways to get around the test. If you don't get it, then the test probably won't affect you.
So, thus ends blog #2. Hope this cleared up some things about nutrition. Remember, stay active, keep exercising, and everything in moderation. In other words, do as I say, not as I do, because those who know me can attest to the fact that I eat everything in sight. I'll have to really tone it down next time I'm pregnant...