Although he is willing to provide the numbers about nutrition and pregnancy that expectant women crave in this age of information, Dr. Ed Linn stresses that women need to focus on quality rather than quantity of foods consumed.
“We want patients to limit the empty calories,” said Linn, chairman of the obstetrics and gynecology department at Lutheran General Hospital and Medical Center in Park Ridge. “Stay away from convenience foods and junk snacks. Everything an expectant mother eats should have some nutritional value.”
Researchers have produced numerous studies about nutrition and pregnancy in the last several years. Government health agencies have made changes in recommended daily amounts for certain nutrients. Medical associations have put a sharper focus on eating well during pregnancy. Here is an up-to-date review of major nutrition issues during pregnancy:
Weight gain
Thirty years ago, doctors were actually forbidding patients to gain much more than 18 pounds. Now, the recommended range for a woman of healthy prenatal weight is 25 to 35 pounds, said Dr. Ronald Chez, a researcher at the University of South Florida in Tampa and spokesman for the American College of Obstetricians and Gynecologists.
Gaining enough weight helps prevent premature births, Chez said. It is particularly important for women who were underweight before conceiving; they might best serve their babies and themselves by gaining 28 to 40 pounds. If a patient is overweight, she might be urged to gain no more than 15 to 25 pounds.
Daily calories
“Eating for two” doesn’t necessarily mean eating a great deal more each day, said Lorna Davis, a midwife and partner of Midwife Associates at St. Joseph’s Hospital on the North Side. Most women should consume 200 to 300 extra calories each day, especially beginning in the fourth month.
Fats
A frequent concern among patients is whether they will be able to lose pregnancy weight after the baby is delivered, Linn said. He recommends sensible eating patterns and consuming about 20 percent of daily calories from fat sources as the best way to prevent excessive weight gain without shortchanging the baby. The job of losing those unwanted pounds after delivery will be easier if you establish sensible eating patterns during pregnancy that provide only the extra pounds needed to bear a child.
Protein
Pregnant women require more protein to handle the body’s increased metabolism. Lutheran General patients are advised to increase protein consumption to 40 percent of daily calories, while taking 40 percent of daily calories in carbohydrates and the rest in fat. Davis recommends daily intake of protein at 60 to 80 grams from vegetable sources (especially soy), meat, chicken and low-fat dairy products. Fresh fish is more risky for pregnant women due to uncertainties about mercury content and other possible undesirable biochemicals. Beware of Lake Michigan fish, for example, and make it a point to know the source of any fresh fish. Canned tuna is a better if more boring choice, Davis said.
Carbohydrates
This is usually where expectant mothers make unwise food decisions. They simply eat too many carbohydrates.
“The issue is really less about eating more food as much as what types of food,” Davis said. “If a woman seems to be gaining too much weight, we talk to her about cutting back on simple carbohydrates like (refined flour) breads, pastas and cereals, potatoes, rice, cakes and cookies.
“Lots of pregnant women get thirsty. They are better served consuming water and skim milk than fruit juices.”
Vitamin and mineral supplements
There is overwhelming evidence that proper folate or folic acid intake can prevent first-month defects in the neural tube, which later becomes the spinal cord. It can be difficult for women to get enough folate in the diet; primary sources include asparagus, dark leafy greens, orange juice, lentils and whole-grain breads. A study published this month in the Journal of the American Dietetic Association makes a case for supplementation: It shows that most U.S. women of childbearing age consume only half of the new daily recommended amount of 400 micrograms of folate.
Folate is critical during the early stages of conception, perhaps even during release of the egg within a woman’s body. Consequently, the federal government has established programs for fortifying breads and cereals with folic acid. Doctors such as Linn encourage women trying to conceive to start taking a daily prenatal vitamin with at least 400 micrograms (many formulas have twice that much and some prescription-only prenatal vitamins have 1,000 micrograms, or 1 milligram).
A daily vitamin and mineral supplement is a good idea for any expectant mother. It is vital for women with diets that might be low in iron (some vegetarians) or calcium, Davis said. The daily supplement can help the mother more than the baby, Linn said, because the body gives the growing fetus priority when distri-buting nutrients.
Alcohol and caffeine
Research points squarely to avoiding alcohol-even in moderate amounts. “We don’t know the safe upper limit,” Linn said.
Linn is less persuaded by studies linking coffee and other caffeinated beverages to miscarriages and other pregnancy troubles. Research shows no association between risks to the baby and moderate amounts of coffee or soft drinks, he said-say, to one or two cups of coffee per day (or the amount in one double-shot latte). Some women lose their taste for coffee during pregnancy.
Herbal supplements
Data regarding medicinal herbs during pregnancy is almost non-existent. Pregnant women should avoid them, even those natural remedies for the common cold. Commercial brands of milder herbal teas such as Celestial Seasonings are not a problem. When in doubt, ask a physician, midwife or registered dietitian.
“We don’t have good data on over-the-counter remedies either,” Davis said. “Women should realize herbs can be potent medicine and proceed with caution. In general, no woman should be taking megadoses of any vitamin, mineral or herb while pregnant.”
