I did then what I knew how to do.
Now that I know better, I do better.
- Maya Angelou
Being strong, fit and healthy during pregnancy increases your odds of a healthy delivery and healthy baby. The simple principles of eat well, move well, sleep well, soar on are good for any age and any condition.
There are some subtle differences though that I’d like to touch on specifically for pregnancy. We will break down the four simple principles in order for you to optimize your health and wellness during pregnancy and your developing fetus. Ideally, you want to address each principle before pregnancy. Yet, no matter your stage of pregnancy, it is never too late to start.
In order to eat well, you need to eat real, whole food. Real food is as close to nature as possible without chemicals and processing. Eating real food also maximizes nutrient richness. The vitamins and minerals in whole food are also most bioavailable for absorption for you and your fetus.
Why is this important?
Your body, without your knowledge or control, will provide optimal nutrients to the developing fetus. If you are eating a nutrient poor diet, the fetus with take what it needs from other places in the your body. That means, if the developing fetus needs calcium, it will take it from your bones or teeth if you are not ingesting adequate amounts in the food you eat.
The below Table 1 summarizes the daily calorie requirements and some vital whole food vitamin and mineral needs for optimal fetus growth. 1 These values are based on Recommended Dietary Allowances (RDA) and Adequate Intakes (AI) as determined to be adequate intake to meet the needs of most healthy people. You may need more depending on your health status prior to becoming pregnant. It is also best to meet or exceed these mineral requirements especially during the second trimester. 1
Age 19-30 31-50
Water 3 3
Energy 2743 2855
Carbs 175 175
Fiber 28 28
Protein 71 71
Linoleic acid 13 13
Linolenic acid 1.4 1.4
Calcium 1000 1000
Magnesium 350 360
Iron 27 27
Folate 600 600
Table 1: Adequate nutrition during pregnancy as outlined in Nutritional Sciences 1
Water is essential to maintain the blood volume for circulation to your body and that of the growing fetus as well as electrolyte balance throughout the 9 mos.
Energy intake is greater during pregnancy in order to adequately fuel the rapid growth. During the first trimester, the increased energy is less critical as much as optimizing your whole foods intake. Increased calorie intake is critical during the second (+350 kcal/day) and third trimesters (+450 kcal/day) compared to non-pregnant women of similar age and activity level. 1
Carbohydrate should be 40-65% of total calories during pregnancy. Carbohydrates, simple glucose energy, are the primary energy source for you and the baby. Best sources of whole foods carbohydrates are fresh fruit (berries, apples, banana), starchy vegetables (sweet potato, red potato), and naturally gluten free whole-grains (brown rice). Organic produce is best, but if financially this is difficult, then follow the Clean Fifteen and Dirty Dozen outlined by the Environmental Working Group.
Dirty Dozen Clean Fifteen
Cherry tomatoes Cabbage
Snap Peas Mangoes
Spinach/kale/collard greens Onions
Sweet bell peppers/hot peppers Pineapples
Table 2: The “Dirty Dozen” (highest pesticide residue, buy organic) and “Clean Fifteen” (least pesticide residue, safe nonorganic) fruits and vegetables, courtesy of www.ewg.org
Fiber is critical for digestive health including bowel movements. It is a common complaint during pregnancy to become constipated. The extra fiber helps keep the bowels regular and moving.
Protein is needed for forming fetal tissue, including muscle. In order to develop normal muscles and tendons you need a complete essential amino acid profile that only animal products can supply. The best sources of protein are meat, eggs, whole milk and fish. If being vegan or vegetarian is part of your lifestyle than you must be sure to balance your essential amino acids carefully using plant based proteins and complementation (i.e. legumes paired with whole grains). Discuss this with your physician or health care provider to monitor closely.
Essential Fatty Acids (EFA) are also know as arachodonic acid, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Linoleic and linolenic acid are the precursors to EPA and DHA prior to the body’s conversion. These EFAs are critical to fetal brain development and formation of the retina. 1 Best dietary sources of EFA are omega-3 rich oils (flaxseed oils and fish oil) or fish. Be careful to consume only those fish that have the lowest levels of mercury like salmon, tuna, sardines and mackerel. 2 The Weston A Price Foundation has also performed an analysis that grass-fed, grass-finished beef is another safe source of EFA in the form of Omega 3. 3 Consuming low mercury fish once per week is critical to optimal brain development. Speak to your healthcare provider if you have concerns or are unable to eat fish. The importance of these essential fatty acids cannot be overstated.
Calcium, although not necessarily increased during pregnancy, is important for normal growth and development properly. Like mentioned earlier, if not continuing to have adequate intake, then the fetus will rob the mother’s body of this vital nutrient via bone and teeth. Besides full fat dairy products, collard greens, broccoli, kale, edamame, figs, oranges, sardines and salmon are all good sources of natural calcium. 4
Magnesium is a mineral that works alongside calcium to maintain strong bones and teeth. It also helps keep muscles working properly. Foods that are rich in magnesium are whole dairy, meats, seafood, nuts, and seeds as well as whole grain rice. 4
Iron is critical for the formation of hemoglobin and growth of the placneta (which feeds the fetus). Best sources of iron are red meat (especially liver), poultry, fish, eggs, leafy vegetables, and potatoes. 4
Folate is especially important for cell division, which is happening rapidly for the growing fetus. Specifically, folate helps to close the neural tube. Deficiencies of folate have been associated with spina bifida, a condition where the neural tube of the fetus remains open. Food sources of folate/folic acid are liver, deep green leafy vegetables (spinach, kale, beet greens), asparagus, and broccoli. 4 Eating a combination of raw green vegetables and cooked will help maximize your folate intake.
However, should you be unable to eat a nutrient rich whole-foods diet or are struggling with a health condition, then multivitamin-mineral supplementation should be considered carefully. A prenatal vitamin without added fillers and sugars is considered safe during pregnancy. In fact, a single-blind randomized clinical study demonstrated increased birth weight and head circumference as well as length of the baby from mothers taking a multivitamin-mineral supplementation for 5 months during pregnancy including the last trimester. 5-7
There are many symptoms associated with pregnancy like morning sickness, nausea, and constipation among others. I caution pregnant mothers from consuming “natural” relief of pregnancy-related symptoms by consuming herbal remedies. Common herbal remedies are ginger, propolis, aloe, valerian root, fennel, dandelion, thyme and Echinacea. 8-11 Surprisingly, there have been links to pre-term delivery, lower birth weight and lower length of newborn with consistent and regular consumption throughout pregnancy of the benign herb chamomile and ginger root. 9,12 A literature survey done by midwives drew questions about the safety of herbal remedies during pregnancy. 10 As an occasional treatment for the upset stomach, homemade whole fresh ginger tea is likely harmless. But to use herbal remedies as consistently as we use pharmaceuticals does in fact have a potential negative impact on the developing fetus.
You can’t supplement yourself out of a bad diet
You can’t “naturally” herb or supplement or medicate yourself out of a bad diet pregnant or not. Unfortunately, the risk of doing so while pregnant may have negative effects on the baby. Please speak to your physician or licensed health care provider before starting any new “natural” remedies or over the counter medications.
In the end, eating a rainbow of fruits and vegetables along with healthy sources of protein will help keep mother and baby healthy before, during and after pregnancy.
Remove. Replace. Restore.
Remove refined sugar, processed foods, tobacco, artificial sweeteners and unnecessary medications or herbal supplements under a physician’s guidance.
Replace with plenty whole, nutrient rich foods like fruits, vegetables and meat. Go for organic when possible, but follow the Clean Fifteen and Dirty Dozen. Eat the rainbow.
Restore a healthy pregnancy, healthy baby development and likely reduce pregnancy related symptoms.
Eat Well. Move Well. Sleep Well. Soar On……even during pregnancy
Photo Credit: Flikr Commons, Tatiana Vdb, License
1. McGuire M, Beerman K, eds. Nutritional sciences; from fundamentals to food. Third Edition ed. Wadsworth; 2013.
2. U.S. Department of Health and Human Services. What you need to know about mercury in fish and shellfish. https://foh.hhs.gov/NYCU/mercury.pdf. Updated 2004, March. Accessed 2016, January, .
3. Masterjohn C. Fatty acid analysis of grass-fed and grain-fed beef tallow. http://www.westonaprice.org/know-your-fats/fatty-acid-analysis-of-grass-fed-and-grain-fed-beef-tallow/. Updated 2014, January2014.
4. Lieberman S, Bruning N. The real vitamin and mineral book. New York, New York: The Penguin Group; 2007.
5. Taghizadeh M, Samimi M, Tabassi Z, Heidarzadeh Z, Asemi Z. Effect of multivitamin-mineral versus multivitamin supplementation on maternal, newborns' biochemical indicators and birth size: A double-blind randomized clinical trial. Oman Med J. 2014;29(2):123-129.
6. Asemi,Z., Samimi, M., Tabassi, Z., Ahmad, E. Multivitamin versus multivitamin-mineral supplementation and pregnancy outcomes: A single-blind randomized clinical trial. Int J Prev Med. 2014;5(4):439-46.
7. McAlpine J, Scoot R, Scuffham P, Perkins A, Vanderlelie J. The association between third trimester multivitamin/mineral supplements and gestational lenth in uncomplicated pregnancies. Women Birth. 2015;15.
8. Yasser I, Nadia F, Mohamed I. Use of herbal medicines among pregnant women attending family health centers in alexandria. Middle East Fertility Society Journal. 2014;19(1):42-50.
9. Zaffani S, Cuzzolin L, Benoni G. Herbal products: Behaviors and beliefs among italian women. Pharmacoepidemiol Drug Saf. 2006;15(5):354-9.
10. Wilkinson J. What do we know about herbal morning sickness treatments? A literature survey. Midwifery. 2000;16(3):224-8.
11. Cuzzolin L, Francini-Pesenti F, Verlato G, Joppi M, Baldelli P, Benoni G. Use of herbal products among 392 italian pregnant women: Focus on pregnancy outcome. Pharmacoepidemiol Drug Saf. 2010;19(11):1151-8.
12. Trabace L, Tucci P, Ciuffreda L, et al. "Natural" relief of pregnancy-related symptoms and nenonatal outcomes: Above all do no harm. J Ethnopharmacol. 2015;174:396-402.
Dr Carolyn Dolan DPT, Cert MDT, MSHN
Where physical therapy, nutrition and lifestyle meet, because how you live your life determines whether or not you soar. Inspiring action with information so you can reduce pain, optimize healing and improve function naturally during recovery from injury, surgery or painful condition. This is a website for the open-minded; obstinate need not apply.