As recently as ten years ago it wasn’t easy to find good advice on nutrition during pregnancy. It was assumed that a mother’s diet would be adequate and that women didn’t need to know the details. For generations, when people routinely cooked at home and a typical meal delivered a rich assortment of nutrients, that was probably true. But now that microwave dinners and fast food have become the routine menu for a great many busy families, excellent nutrition can no longer be taken for granted. Developing babies, unfortunately, refuse to fall in with this trend. They still prefer a good, plain, home-cooked meal. Pregnancy provides women with a wonderful incentive to return to the basics.
What does this mean in terms of your daily meal-planning? Here’s a quick overview of the major dietary guidelines you need to keep in mind.
The primary dietary rule during pregnancy is to eat healthfully every day. Quality in the appropriate quantity will never be as important as it is now. You will “eat for two” (or more!) not by doubling your usual amount of food but by accepting primary responsibility for nourishing the two of you.
During pregnancy, your body will work hard to help the baby grow. You’ll often feel tired and need the natural boost that an excellent diet can provide. In fact, you’ll be doing a lot more than eating for two; you’ll be living for two. That’s an awesome job. In addition, the growth of your uterus and the extent of its muscular strength during labor will depend in large part on how well you have nourished it. Fuel your engine with the highest octane that’s available.
A toddler rejecting food will throw it on the floor or spit it out. The baby in the uterus eats whatever is served. From the moment of conception, your baby’s growth and development rely entirely on what you provide. If you eat fresh, well-prepared foods, so will your baby. If you fail to take in crucial vitamins and minerals, the baby will miss them—at a time of development when such a loss can never be corrected. If you smoke, drink, or take medications or drugs, your baby will, too.
Although major body parts exist more or less from the beginning of the baby’s development, certain organs and other components take shape at different times: the heart, brain, teeth, and facial features, for example. Some of this growth takes place during the first weeks of pregnancy, before most women even realize they’re expecting. That’s why it’s wise to think carefully about the implications of pregnancy before you conceive. If you want to stop smoking, there will never be a better time. If you drink a fair amount of alcohol, cut down before you start the baby.
It takes time to establish the strength you’ll need for pregnancy, labor, and the first weeks after delivery. If you plan to breastfeed, you can help insure success by laying in stores of nutrients and fat during pregnancy to aid milk production later.
Your Baby’s Special Dietary Demands
Our understanding of why it’s vital to eat an adequate diet during pregnancy comes from studies showing what happens when women don’t. Many such studies have taken place during times of famine or economic deprivation or among societies where certain foods weren’t available at all. Poor nutrition can lead to miscarriage, high blood pressure, and a condition in which the placenta separates from the uterus too early (often requiring an emergency delivery).
From your baby’s perspective, a constant influx of nourishing food is crucial. If severely deprived of needed nutrients, the baby’s organs might not develop properly. That could lead to potentially serious problems, perhaps persisting for life. Abnormalities in the baby’s body at birth may require surgery or even be impossible to correct. Abnormal development can also continue long after birth if the developing baby received an inadequate diet.
If you are pregnant, your diet must include:
Protein. Pregnancy increases your protein requirements, but by how much is controversial. Some say you need 27 percent more protein than usual; others, 50 percent more. One standard pronouncement is to eat 50 grams a day during the first trimester (three months) and 60 grams a day for the rest of your pregnancy.
Contrary to what many people tell pregnant women, protein should still represent no more than 15% of their total diet, according to Dr. Judith B. Roepke. Roepke, a registered dietitian and professor of home economics at Ball State University, is also a consultant to the board of La Leche League International, a breastfeeding advocacy group. She notes that most sources of protein are high in fat, and therefore detrimental to your own health. Since fat is not transported well across the placenta, she observes, most of the fat you eat won’t benefit the baby either.
For the protein you do need to take in, the best sources include beans, grains, meat, milk, yogurt, and tofu. Two small cubes of cheddar cheese contain the same amount of protein as a small glass of milk. Do not attempt to boost your intake with a specially formulated high protein supplement. Most pregnant women can easily meet their protein requirements through their regular diet, and according to the National Academy of Sciences, the supplements pose a risk of harm to the unborn child.
Carbohydrates. Whole-grain breads, cereals, pasta, rice, and other carbohydrates provide the primary source of energy for the developing baby. Carbohydrates also insure that the body uses protein efficiently. Roepke recommends keeping your diet high in carbohydrates, modest in protein, and low in fat.
Vitamins and minerals. Pregnancy increases the body’s need for vitamins and minerals. But, as with other supplements and medications, more is not necessarily better. Large amounts (megadoses) of many vitamins and minerals can be worse than taking none at all. Check with your doctor about any supplements you plan to take.
Iron. The baby draws on the mother’s iron reserves, storing enough in its liver to last for several months after birth. This protects the baby against iron deficiency while living on breast milk, which contains very little iron. Most prenatal vitamin tablets contain more than enough iron to meet your needs. Another good way to add it to your diet is to use iron cooking pots. Some of the iron is absorbed by food as it cooks, increasing iron content by 3 to 30 times. Because vitamin C helps your body absorb iron, taking an iron pill with a glass of orange or grapefruit juice increases its effectiveness. Don’t take iron with milk, though, which has the opposite effect.
Vitamins and Minerals: Your Daily Needs
Recommended Dietary Allowances during normal pregnancy and breastfeeding
Source: Food and Nutrition Board, National Research Council, Institute of Medicine, Recommended Dietary Allowances, 10th ed, 1989
Folate (also called folic acid or folacin). Inadequate folate during the first 4 weeks of pregnancy (before many women even realize they’re pregnant) appears to produce neural tube defects in the fetus. These are serious, even fatal problems, to be avoided if at all possible. The baby’s head may not develop, so that the baby is never really alive. Or the baby may have spina bifida, which is an incompletely closed spinal cord. The U.S. Centers for Disease Control and Prevention recommend that all women old enough to become pregnant should consume 0.4 milligrams of folate every day, either through diet or with a vitamin pill. The protection supplied by folate is especially important before conception and during early pregnancy. Folate isn’t stored in the body for very long, so it must be replaced every day. Pregnant women need to make sure they keep getting enough because they excrete four to five times the normal amount. To get enough folate in your diet, eat plenty of greens, remembering that the word “folate” comes from the same Latin root as “foliage:” folium, or “leaf.” The many other good sources include orange juice, brewer’s yeast, soybeans and other beans, cauliflower, and whole-grain breads and cereals.
Calcium. All women need calcium, and pregnant women need more. During the second and third trimesters, you need to increase your body’s calcium stores to draw on while breastfeeding. At the beginning, the baby’s calcium requirement is small, but teeth and bones need calcium when they start to form at 4 to 6 weeks after conception. By week 25, when the baby’s bone growth is in full swing, your calcium requirements will have more than doubled. To absorb calcium, the body needs vitamin D. You get it from the sun, from fortified milk, and from vitamin supplements.
You don’t like milk or can’t digest it? No problem. Rich sources of calcium include broccoli, leafy vegetables (spinach and collard greens), legumes (soybeans, peanuts, pinto beans, black beans), and certain fish. A cup of cooked broccoli has two-thirds the calcium content of a glass of milk. A cup of cooked salmon, sardines, or garbanzo beans (chickpeas) contains more calcium than a glass of milk. Half a cup of ground sesame seeds contains twice the calcium of a glass of milk! Try cooking with tahini, a sesame paste used in such tasty Middle Eastern dishes as hummus, a chickpea dip or spread.
Fiber and fluids. Eating whole grains and raw vegetables and fruits will help prevent constipation and hemorrhoids. Drink a lot of fluids, especially water. You’ll flush out your system and aid digestion and elimination. The National Cancer Institute recommends consuming 20 to 35 grams of fiber per day.
A note about salt. The greatly increased amount of fluid carried around inside a pregnant woman dilutes the salt in her body. While eating a tremendous amount of salt is never wise, especially in anyone with high blood pressure, concentrating on low-sodium foods is not necessary during pregnancy. It might even be harmful if taken to an extreme. Experts now recommend that you salt food to taste during your pregnancy.
If it’s important to keep your diet as healthy as possible while you are pregnant, it’s just as vital to avoid those contaminants, additives, and harmful environmental effects that can hurt your baby. You must also watch out for certain foods that might be perfectly okay when you’re not pregnant, but are a good idea to avoid when carrying a child.
There’s no firm evidence that the additives in processed foods cause any harm to a developing baby. But if there’s even a remote possibility, why gamble? Eating basic, natural food for nine months really isn’t that much of a hardship. If you want to be absolutely certain of your baby’s safety, avoid chemicals, dyes, and additives.
To dispense with surface contaminants, such as pesticides, wash and wipe dry all fresh fruits and vegetables just before preparing them. Peel off any waxed coverings on cucumbers and other fruits and vegetables. Seek greater variation in the foods you eat. Fresh foods at farm stands are less likely to have been sprayed for a long shelf life than those in supermarkets.
Don’t eat fish that may have been caught from lakes or rivers contaminated by PCBs (polychlorinated biphenyls). Avoid exposure to industrial chemicals and pesticides. Be alert for substances at your workplace that might cause birth defects. Under federal law, a pregnant woman in such a situation must be reassigned at her request.
Alcohol ranks third among the congenital conditions associated with mental retardation—and it is the only preventable one. Babies of mothers who consume too much alcohol, especially six or more drinks a day, are prone to fetal alcohol syndrome (FAS), sadly found in one out of every 750 babies born in the U.S.
Signs of FAS besides mental retardation include:
|•||Too little growth before birth (intrauterine growth retardation)|
|•||Growth deficiencies in infancy and childhood|
|•||A combination of certain facial features: small eyes, flat nose, drooping eyelids, and crossed eyes|
|•||Ten times the number of babies born with FAS have other problems caused by their mothers’ drinking of alcohol. The Institute of Medicine sets as a maximum daily amount 2 to two-and-a-half ounces of alcohol, 8 ounces of table wine, or 2 cans of beer. A one-time binge can be as harmful as steady drinking throughout the pregnancy.|
Because the effects of alcohol are most serious in the first two months of pregnancy, when the baby’s organs are developing, women who are even considering becoming pregnant should take no more than an occasional glass of beer or wine or a very small mixed drink—if that. Many doctors and nutritionists feel strongly that the safest route is to avoid alcohol completely, even for cooking, during pregnancy and for months before it might occur. Drinking heavily while pregnant can also trigger a miscarriage.
All this doesn’t mean that having indulged in a few isolated glasses of wine before you learned you were pregnant should ring loud alarm bells. If you’re concerned, tell your doctor exactly how much you drank to find out whether it could have made any difference.
Babies tend to be small if their mothers smoked during pregnancy. Breathing the smoke puffed by others (passive smoke) is almost as bad—and the developing baby breathes it as much as the mother. Smoking doubles the risk of miscarriage, especially in the first trimester. It also doubles the chances of third-trimester bleeding and increases the risk of preterm delivery. Nicotine speeds up the baby’s heart, interrupts its breathing and interferes with its nutrition. As blood vessels constrict in the placenta, less oxygen and fewer nutrients reach the fetus. Every cigarette preempts 250 milligrams of vitamin C as well as smaller amounts of folate, thiamin, and calcium. It has been estimated that if no one smoked, there would be 10 percent fewer infant deaths and 25 percent fewer low-birthweight babies in the United States each year. Quitting smoking—even toward the end of pregnancy—will benefit your baby.
Counting Up Your Caffeine Load
Adapted from “Caffeine: How Little, How Much for You and Your Family?”, American Dietetic Association, (booklet) 1988.
As far back as 1981, the Food and Drug Administration recommended avoiding caffeine during pregnancy. More recently, the Center for Science in the Public Interest, a nutrition watchdog group, collected more than 40 research reports stating that caffeine consumption, even in small amounts, may be linked to miscarriage and fetal growth retardation.
Nevertheless, the subject remains controversial. Some experts regard the evidence as inconclusive, and feel that only large amounts of caffeine will do any harm. Debate still rages over how much you’d have to drink (in coffee, tea, or cola), eat (in chocolate), or otherwise swallow (in “wake-up” pills or candies and certain headache remedies) before anything bad happens.
Possible effects of large amounts include premature birth and stillbirth. Drinking more than 400 milligrams (four cups) a day—that’s virtually every day, not just once—may prevent the fetus from growing properly. But many doctors still feel it’s safe to drink up to two cups (not mugs) of regular coffee (not espresso), or the equivalent amount of caffeine in another form (see the table nearby), each day. That’s around 200 milligrams of caffeine daily. To be sure, relishing an occasional cup of coffee or tea or a small chocolate bar won’t do your baby any harm. But if you’re accustomed to drinking coffee or tea all day long, it is advisable to switch to the decaffeinated type (slowly, to prevent withdrawal symptoms). Consider these reasons:
|•||Non-diet colas and other sodas containing caffeine also contain sugar, which fills your body with empty calories and temporarily reduces your interest in eating something nutritious.|
|•||Many diet sodas contain an artificial sweetener called aspartame, sold under the brand name NutraSweet. There’s no proof that this is harmful, except in huge amounts in rats. Indeed, several studies have found that aspartame, consumed in small quantities as an artificial sweetener, appears to be safe during pregnancy. Still, you may want to avoid any unnecessary risk.|
|•||In both mother and baby, caffeine speeds up the heartbeat. The possible effects of very large amounts include heartbeat irregularities, ulcers, and high blood pressure.|
|•||Caffeine has physical effects similar to some natural symptoms of pregnancy, such as anxiety, sleep disturbances, headache, and stomach ache. Pregnant women need as many good nights’ sleep as they can get. With a jittery baby, rest becomes harder to achieve.|
|•||Coffee and tea are diuretics, causing the body to lose fluids rather than retain them. Yet the pregnant body needs increased fluids.|
|•||Sensitivity to caffeine may increase during pregnancy.|
|•||Sensitivity may also grow with age, so that the two factors together may increase the wallop a cup of coffee packs for older pregnant women.|
|•||Coffee creates acid in the stomach, an environment already ripe for nausea and vomiting during pregnancy.|
What about herbal teas? Most standard brands are fine, but watch what you sip. Caffeine isn’t the only potential culprit. Some teas sold in health food stores contain plant matter that might be harmful to the baby or to you. Examples are sassafras and mistletoe. If the tea is suspect or its contents are poorly labeled, don’t drink it.
Doctors have flip-flopped for generations about how many pounds a pregnant woman should gain. It is generally agreed that both too little and too much weight should be avoided. Just what that means is subject to interpretation.
The current thinking is that if your weight is normal for your height you should gain 25 to 35 pounds during pregnancy. If you were underweight to begin with, you should gain more (28 to 40 pounds); if overweight, less (15 to 25 pounds). Women carrying twins may gain 35 to 45 pounds, averaging a gain of 1-1/2 pounds a week in the last 6 months. Twins and triplets are usually born 2 to 3 weeks before the due date and should be helped to grow as big as possible, within reason, before delivery.
The usual breakdown for weight gain is 2 to 4 pounds in the first trimester and three-quarters to 1 pound a week in the second and third. The fastest weight gain usually takes place from weeks 24 to 32, when your appetite increases.
More than half of your total gain consists of the baby, enlarged uterus, placenta, and extra fluids. At delivery, about 10-1/2 pounds will come out: 7-1/2 pounds for the baby, 1 pound for the placenta, and 2 pounds for amniotic fluid—the liquid surrounding and protecting the baby in the uterus. The remaining weight you put on includes 4 to 6 pounds of fat and nutrient stores, 5 to 7 pounds of extra blood and fluid accumulated during pregnancy, a uterus that has grown to 2-1/2 pounds in giving the baby a home, and 2 pounds of enlarged breast tissue.
By 6 months after delivery, you typically will retain about 3 extra pounds. Breastfeeding, which burns lots of calories and fat, can help melt away some of the pounds.
Where Those Extra Pounds Reside
|Just prior to delivery, a typical mother has put on 25 to 35 pounds. Here’s where the extra weight is found.|
If you need to lose weight. Women for whom excess pounds are a problem should make a real effort to lose weight before becoming pregnant. Being overweight increases the risk of developing certain problems during pregnancy, such as high blood pressure and gestational diabetes (discussed later). These conditions in turn may cause the baby to grow too large to be born vaginally or may trigger other potentially dangerous situations. Too much weight can prolong labor and even lead to a cesarean section in a woman who might otherwise not have needed one. Medical experts speculate that fat accumulated between the muscle fibers of the uterus, blocks them from contracting hard enough to expel the baby.
Nevertheless, do not diet during pregnancy. A developing baby can’t “live off its mother’s fat,” but requires an ample supply of fresh foods in order to grow. Advance planning and dieting are best. During pregnancy, follow your doctor’s advice about weight gain or ask for the name of a professional dietitian if you think that would help.
If you need to gain weight. Maybe a pregnant woman, like anyone else, can’t be “too rich,” but she can definitely be too thin. An underweight mother is more likely to have a small baby, but that will not make delivery easier for you; it just makes life harder on the baby. Infants weighing less than 5-1/2 pounds at birth are subject to many ills.
If you are underweight, you are more likely to be anemic and to deliver prematurely. Your baby will be at increased risk of being born with heart or lung problems or even brain damage. Death within a few weeks of birth is 30 times greater in low-birthweight babies than in larger ones. If you are a very thin woman who intends to start a baby in the next year or so, consult a doctor and gain some weight before becoming pregnant. Adding a little body fat will help you conceive, too.
Getting 300 Calories Extra: Here’s a Few of the Ways
A nonpregnant woman of average height and weight needs about 2,200 calories a day. During the second and third trimesters (last 6 months) of pregnancy, her energy requirements increase by about 15 percent, creating the need for an additional 300 calories a day.
Those extra calories are not a “bonus” to add thoughtlessly. Nearly every bite you take should be calculated to create a strong, healthy baby and fortify your own body. If you don’t watch your food intake from the beginning, you may gain too much weight by the end of the second trimester and be instructed to start eating more thoughtfully. Instead, do it from the start.
You don’t have to install a calculator next to your plate to monitor your calorie intake. Just remembering which of your favorite foods can be enjoyed in large quantities and which must be restricted is sufficient to keep your weight at acceptable levels while making sure you never go hungry or feel deprived.
Nutritional value is a vital consideration. Here’s an example. White bread contains 70 percent to 80 percent less of the important B vitamins than whole-wheat bread. In addition, whole-wheat bread contains lots of fiber, which promotes digestion, aids bowel movements, protects against some forms of cancer, and at 67 calories per slice is a relative dietary bargain. Which will you choose?
As for those 300 extra calories a day, consider the combinations shown in the nearby box. Each group represents about 300 calories (the numbers aren’t precise). As you can see, they add up to approximately one meal or two or three snacks each day.
What to Eat, Cut Back, and Cut Out
Your body is changing, your life is changing—why not your eating habits? Listen attentively to your body’s signals. As soon as you feel hungry or thirsty, eat or drink. Having small, frequent meals improves bowel regularity, reduces morning sickness, and sends a constant flow of nutrients to the baby.
Stash nourishing, nonperishable tidbits wherever you spend time, including at work or even in the car. Good choices include small boxes of raisins and packets of other dried fruit. People instinctively make allowances for pregnant women’s eating habits. Have fun taking advantage of your special time. You may not want to wolf down a slab of cold meatloaf during a business meeting, but you can nibble a few grapes or crackers with peanut butter at your desk before it starts. Know what times of day (or night) hunger tends to strike, and be prepared.
Don’t hesitate to be different. Breakfast on vegetable soup, hot or cold, if it appeals to you. Pour out two big bowls of whole-grain cereal with fruit and lowfat milk for your supper. Don’t force yourself to eat anything that repels you; alternatives exist for every necessary nutrient.
Try These Vitamin-rich Snacks
For a warming, filling meal or snack at any time of day, bake a few potatoes and store them in the refrigerator. Steam and refrigerate some fresh chopped broccoli as well. When hungry, sprinkle broccoli over a potato and heat. Then plop some plain yogurt on top for a powerhouse potato plate that is low in calories!
Probably because of its overuse in commercials for junk foods, snacking has gotten a bad name, but pregnant women should snack often, particularly in the latter half of pregnancy. Here’s how nutritionist Roepke outlines an optimal diet for the mother-to-be: breakfast, snack, lunch, snack, dinner, snack, snack. What makes all the difference is the content of those snacks.
Anyone who’s in a snacking mood wants to grab something fast. She doesn’t feel like making a salad from scratch, although she might eat one if it already existed. The key is to prepare healthful snacks in advance. It’s easy to scrub carrots and cut up zucchini, broccoli, and celery while doing other things in the kitchen. Fresh vegetables, herbed yogurt dip, and fruit juices become as “instant” as cookies and soda if they stand waiting and ready. Keep a few hard-boiled eggs on hand, too.
A supplement is nutrition from something other than food, usually in the form of a pill. Opinions on the value of supplements for pregnant women are mixed. Some people insist that women can get all the nourishment they need from food, except perhaps iron and folic acid. But that assumes all pregnant women eat five servings of fresh fruits and vegetables a day, plenty of protein, lots of fiber, half a gallon of fluid, and so on—unrealistic for many.
It’s accepted that supplements are important for women who are malnourished, severely underweight, greatly stressed, or “run down,” as well as those who routinely ate an unbalanced diet before conceiving. Pregnant teenagers, who are still growing, need supplements as well. Pregnant women who have previously had twins or triplets or who have had a miscarriage or stillbirth are believed to benefit from taking supplements.
Pregnant women who drink or smoke heavily, who must take medication for a chronic condition, or who are unable to digest wheat, cow’s milk, or other key foods need supplements to maintain enough vitamins and minerals to nourish their babies. Healthy women who eat no meat have certain needs during pregnancy that only supplements are likely to provide.
After considering your individual situation, your doctor will suggest—or insist—that you take vitamin and mineral supplements. This might be in the form of a prenatal multivitamin taken once a day, as is the case for some 90 percent of pregnant women in the United States; as an iron or calcium pill taken by itself; or a combination. Results of blood tests and other medical assessments will contribute to the decision.
Even normal, healthy pregnancies tend to involve at least a little discomfort. Some of this is related to eating and may be relieved by diet. Here are some cures for the most common.
Morning sickness. While most women who suffer nausea and vomiting during pregnancy—and many never do—usually feel worst in the morning, symptoms can strike at any time of day. Although that experience typically occurs during the first three months of pregnancy, it can stop sooner or, more rarely, continue much longer.
Morning sickness has accompanied pregnancy for so many centuries that women have been driven to seek their own solutions. None of the following can harm you, and most will help in other ways. Try each of them until something works.
|•||Eat small, frequent meals, so that your stomach never contains a huge amount of food.|
|•||Drink a lot of liquids to keep your digestive system active.|
|•||Stay away from whatever “trigger foods” make you gag, such as rich, creamy, spicy, or greasy foods. Try to avoid odors that repel you, such as cigarette smoke or fried food.|
|•||Don’t drink coffee, which stimulates the secretion of stomach acid, already higher during pregnancy.|
|•||Eat a high-protein snack shortly before bedtime to stabilize your blood sugar.|
|•||Keep dry crackers or cereal next to your bed and nibble some before you get up in the morning. The dry food will absorb stomach acid that has built up overnight.|
|•||Get out of bed slowly. Air out your bedroom frequently.|
|•||Take your iron supplements 1 hour before a meal or 2 hours after it. Iron is best absorbed on an empty stomach.|
|•||Pour boiling water over a slice of raw ginger and sip slowly. Or buy ginger capsules at a health food store and take one daily.|
|•||Increase your intake of vitamin B6, contained in wheat germ, liver, kidney, oatmeal and other whole-grain cereals and breads, bananas, nuts and seeds, bran, and green leafy vegetables.|
Heartburn. As the growing baby presses against your stomach, acid can be forced up into your esophagus. The burning sensation you may feel in your chest and throat after meals—especially toward the end of pregnancy, when the uterus is at its largest—can be most unpleasant.
Eat smaller meals, eat them slowly, and chew them well, especially raw fruits and vegetables. Avoid greasy and spicy foods. Don’t lie down for at least an hour after any meal, to allow enough time for the digestive process to get into gear. At night, elevate your head and shoulders with pillows.
Wear loose clothes. To pick something off the floor, bend your knees rather than bending over. Ask your doctor if you may chew or swallow ordinary antacids. Some contain calcium, needed more during pregnancy.
Constipation and gas. Large amounts of a hormone called progesterone surging through the pregnant body slow down natural bowel contractions, making bowel movements more difficult. Methods for correcting this uncomfortable problem are no different for pregnant women than for anyone else.
Eat lots of fiber, found in bran, raw vegetables, fresh fruits, prunes, and figs. Drink at least eight 8-ounce glasses of fluid a day. Prune juice is a time-honored friend of the constipated. Another remedy: Boil water, pour it into a cup, add a slice of lemon or a few drops of lemon juice, and sip.
Walk up to 2 miles, or at least around the block, every day. Exercise flexes the intestinal muscles as well as those in the legs. Go to the bathroom promptly when nature calls, taking something to read or a crossword puzzle. Since iron tends to be constipating, ask your doctor if your iron supplements can be adjusted. Don’t take any laxatives without your doctor’s permission.
Hemorrhoids. As the uterus presses against the veins in the rectum, they can become sore and enlarged, especially toward the end of pregnancy. These are hemorrhoids. You’re more likely to have them during pregnancy if you’ve had them before.
Even if a bowel movement won’t move, try to relax rather than straining. Be patient; eventually, gravity will help out. Warm soaks in the bathtub are soothing. Pain-killing creams, stool softeners, or appropriate suppositories may help, if your doctor approves.
Gestational diabetes. About 2 to 3 percent of women in the U.S. develop diabetes during pregnancy. It usually disappears after delivery, although many of those women develop diabetes again later in life.
Because the symptoms of gestational diabetes—fatigue and frequent urination—are also typical of pregnancy itself, it’s difficult for most women to recognize the signs of this disorder. The problem is most likely to be detected during one of the blood tests conducted regularly throughout pregnancy. If it’s discovered, you will need to follow the instructions of an expert in the field, such as a diabetologist, endocrinologist, or an internist or obstetrician-gynecologist who has special training. Women with gestational diabetes are given strict advice about their diets, especially the amount of sugar they eat. They learn to obtain and test samples of their own blood every day with a device available in drugstores.
Once the condition is under control, the doctor keeps track of the baby’s size. If the child is getting too large, a cesarean section before the due date may be necessary.
Cravings. Variations on the old pickles-and-ice-cream theme have supplied millions of husbands with stories about their pregnant wives’ demands for unusual foods in the middle of the night. It’s true that pregnancy affects the tastebuds, making some foods and smells irresistible and others revolting. If what you yearn for is an ordinary food that won’t hurt in moderation, go ahead.
Less common but far from unique is the confusing compulsion to eat substances such as white clay and laundry starch. Such a habit could signal iron-deficiency anemia. If it happens to you, don’t be embarrassed—just talk with your doctor.
Bed rest. If your pregnancy is considered at high risk for certain reasons such as vaginal bleeding, high blood pressure, or a previous miscarriage, you may be told to lie on your left side pretty much all the time. This can last for a couple of days or go on for months. To deal with the lack of appetite, constipation, inability to get up and cook, and other diet-related complications of lying still, consider consulting a dietitian who specializes in such conditions. An organization called Sidelines provides advice to bed resters nationwide.
Breast milk is often called the perfect food for the baby. It’s perfect for the mother, too, since she doesn’t have to buy it, cook it, store it, or clean up after it. What she does have to do is create it, and that requires a healthy diet.
Human milk supplies enough carbohydrates, fat, protein, and most minerals to meet your infant’s needs. You’ll need a fair amount of extra vitamin A, C, and niacin and a little more vitamin E, thiamin, and riboflavin. Iron supplements are usually a good idea.
Although nature has contrived it so that even a mother who doesn’t eat very well will make nourishing breast milk, she will feel fatigued, irritable, and “drained” in more ways than one. Furthermore, she’s unlikely to make as much milk as if she were well-fed and relaxed. The typical result is a hungry, cranky baby whose discomfort may worry the mother into switching to formula.
The answer is to pay at least as much attention to the quality and quantity of your food as you did while pregnant. While being underweight may produce an inadequate supply of milk, being overweight can no longer harm the baby. As a new mother, your priority needs to be health, not looks. Just don’t overeat to an extent you’ll regret later on. You can compensate with certain postpartum exercises as soon as a couple of weeks after delivery, if you’re feeling up to it. Actual dieting, however, should wait until the baby is at least 6 weeks old, and then be done in consultation with your doctor.
A vegetarian who breastfeeds needs to pay special attention to calcium, riboflavin, and thiamin. She may need B12 supplements to prevent anemia in herself and her baby. As always, the high-quality protein she needs can be found in grains, nuts, vegetables, beans, and dairy products.
To make enough milk and remain hydrated herself, a nursing mother needs to drink at least 2 quarts of fluid every day—more in hot weather. Exactly what those fluids consist of is up to you, as long as they’re good for you. Keep a supply of lowfat milk and a variety of fruit juices in the refrigerator and indulge often. Many women pour themselves a tall glass of milk, juice, or water on the way to each nursing session. You have to replace the approximately 23 ounces of milk your baby will drink every day.
One substance you’ll need a great deal of is calcium. If you can’t or won’t drink milk, eat a lot of other calcium-rich foods. The table “Vitamins and Minerals: Your Daily Needs” lists recommended vitamin and mineral requirements for nursing mothers during the first and second 6 months of breastfeeding. If your diet doesn’t provide enough vitamin D (dairy products), vitamin B12 (meat), or iron, your doctor may prescribe a supplement. Many nursing mothers continue to take prenatal vitamin and mineral supplements that provide approximately the recommended dietary allowance. That certainly can’t hurt; only huge amounts (megadoses) are harmful. Taking a pill, however, isn’t enough to boost the quality of your milk. Only good food can do that.
Nursing mothers secrete 420 to 700 calories into their breast milk every day. To make those calories, they must eat even more. (Mothers nursing twins or triplets need professional advice about how much to eat.)
The standard advice for women who breastfeed is to eat about 500 extra calories a day, or about 2,700 altogether—a little more than during pregnancy. The idea is that weight loss will follow naturally as your breast milk passes along lots of those calories to the baby. If you gained weight during your pregnancy within a normal range, your 8 pounds of fat reserves will be depleted by breastfeeding within 3 months.
While that’s a reasonable rule of thumb, it doesn’t work equally for everyone, warns dietitian and mother Eileen Behan, the author of Eat Well, Lose Weight While Breastfeeding. Behan notes that some women must hold their intake to far fewer calories in order to lose weight. If you have stopped exercising, for example, 2,200 calories a day may be sufficient, as long as those calories are packed with excellent nutrition. If you jog every day, you may need many more.
Age, body size, and metabolism all affect your ability to lose weight. If you’re concerned about your weight, monitor what you eat and what you weigh. Eliminating sugar, which contains about 15 calories per teaspoon, and keeping fat to a reasonable proportion of daily calories will lower your calorie count without affecting the baby.
Of your total calories, 50 to 60 percent should be carbohydrates, 20 percent protein, and no more than 30 percent fat. Babies eat about 45 calories per day per pound of their weight. A 10-pound baby (at, say, two months of age) will swallow about 450 calories of breast milk a day. That’s directly subtracted from what you eat yourself.
Be guided by essentially the same principles you followed during your pregnancy. Avoid additives, dyes, and chemicals, including artificial sweeteners, and stay away from tobacco smoke.
Drink alcohol in moderation or not at all. Although fetal alcohol syndrome affects only fetuses, alcohol is thought to “turn babies off” by giving breast milk a flavor they don’t like.
Sipping beer while nursing used to be a standard recommendation. A small glass of beer every once in a while might be all right, but don’t let yourself become woozy or rely on it to relax. While beer is a source of carbohydrates and fluids, other liquids and a bounty of nutritious foods provide the same benefits.
As for coffee, tea, and other substances containing caffeine, drinking more than a little is still not a good idea. Caffeine leaves your bloodstream within 3 to 5 hours but remains in the baby’s for 80 to 97 hours. That means even 3 cups of coffee a day can make a baby irritable. Don’t drink coffee just so you can remain awake as you and baby pace the floor—that might be the reason you’re pacing!
Spicy or strongly flavored foods may lend your milk a different flavor or give your baby an upset stomach. Many other foods can cause gas or colic in the baby. Leading culprits include garlic, onions, cabbage, turnips, broccoli, prunes, beans, and very large amounts of fruit. These effects are entirely individual. If you suspect that any particular food disagrees with your baby’s digestion, which is still developing and pretty gassy anyway, try leaving it out of your diet for a couple of weeks and see if the situation improves. In one study, babies consistently remained at the breast longer and drank more milk after their mothers had eaten garlic. You never know.
When you pass along the essence of certain foods in your breastmilk, there’s a chance of causing an adverse reaction. Signs of allergy include frequent greenish stools, gas, stuffy nose, rash, and vomiting. Foods most likely to produce a reaction include eggs, dairy products, peanuts, soybeans, wheat, and fish.
If strong food sensitivities or allergies run in your family, consult a pediatric allergist about whether omitting certain foods from your diet might prevent the baby from developing allergies to them. But don’t avoid a wide range of nourishing food “just in case.” Always act on an expert’s advice.