You’re not going to like reading this part, but “eating for two,” will not make a healthier baby. However, it will mean you’ll have a bigger baby and a harder time shredding the extra pounds postpartum. A healthy pregnancy depends on enough caloric intake to keep mother energized and baby developing and growing. That caloric demand is dependent on initial baseline maternal weight, the health status of the mother, the number of fetuses, the vocational energy demands of the mother, and underlying medical conditions.
Energy is needed for both mother and fetus which varies throughout the gestation and continues postpartum for lactational needs. The energy requirements of pregnancy are approximately 17% over baseline and amount to an additional 300 calories (kcal) per day on average but is adjusted by trimester. These additional calories should be nutrient-dense as opposed to empty calories from simple sugars. By trimester, caloric intake should stay the same in the first trimester, increase to 342 calories per day in the second trimester and up to 452 calories per day in the third trimester.
According to the Institute of Medicine’s 2009 recommendations and guidelines for pregnancy weight gain, if a mother is carrying one baby and is underweight before pregnancy, an additional 28-40 pounds is a range of weight that will serve the pregnancy well. For normal weight and overweight mothers, the amount of anticipated weight gain is 25-35 and 15-25 pounds, respectively.
The percentage of protein should be about 20% of calories, and carbohydrates should account for 50%, leaving 30% for fats. Protein from animals contains more fat than plant-based forms, and 60 grams is the estimated actual amount of protein that makes up 20% of the calories.
Before a woman becomes pregnant, it is recommended that she begins prenatal vitamins with a minimum of 400 mg of folic acid (folate) to reduce the chance of a neural tube defect or spina bifida. Some causes of spina bifida (30%) are not responsive to folate supplementation and may respond to inositol supplements in the form of myoinositol gelatin capsules because coffee can interfere with inositol absorption.
Prenatal Vitamin Supplements
Most prenatal vitamin formulations consist of atleast these ingredients:
- Zinc – 15 mg
- Calcium – 250 mg
- Iron- 30 mg
- Vitamin B-6 – 2 mg
- Folate – 0.4 mg
- Vitamin C – 50 mg
- Vitamin D – 5 mcg
Food, Vitamins, and Minerals by Trimester
First Trimester Tips
- First off, there are foods and beverages to avoid, such as alcohol, nicotine, and drugs. In the first trimester, when morning sickness can strike hard, avoid fatty and spicy foods like deep-fried foods and processed meat. Caffeine at low doses (200 mg maximum) such as a one or two cups of tea or coffee is allowed.
- Small, bland snacks every couple of hours may stave off nausea and vomiting. Keep well-hydrated to reduce bouts of nausea. Ginger flavored drinks may be helpful. Folate is essential throughout pregnancy and is usually supplemented with prenatal vitamins because it reduces spina bifida, a spinal defect in pregnancy that can cause paralysis and other neurological problems. Sources of folate in food are beans, legumes, citrus fruits, and whole grains. Chicken, pork, and fish are other good sources for folate. Avoid long-living fish from the ocean since they contain higher levels of toxins such as mercury.
- Varieties to avoid include shark, swordfish, mackerel and tuna. Top picks include wild Alaskan salmon, herring, sardines, and anchovies. Check out the Environmental Working Group’s Consumer Guide to Seafood. Fish oil supplements are also safe and recommended in pregnancy because dietary intake is usually too low and mercury contamination is a threat in some types of fish. Omega three fats come in some special forms of prenatal vitamins (usually in packet versions) or as a separate supplement.
- If you don’t prefer animal meat, try items like, tofu, edamame, carrots, yams, mango, peaches, and apricots for protein-rich foods. Better still, the amino acids in protein-rich foods will also aid in the development of your baby’s rapidly reproducing cells. You will find it in tofu and soy products (soy pasta, edamame), beans, lentils, split peas, quinoa, nuts, and seeds.
- Calcium (three servings a day) is a bone-protector found in fortified juices, broccoli, leafy green vegetables, sesame seeds and canned wild-caught salmon.
- The second mineral you need is Manganese (about 2 mg a day) is found in carrots, broccoli, whole grains, nuts, bananas, spinach, and raisins are all excellent sources of manganese.
- Zinc is crucial for conception and the maintenance of pregnancy. Get about 15-20 mg a day via a supplement or by eating any meats, almonds, beans, oatmeal and organic corn.
- Because constipation is a huge problem in pregnancy, fiber is found in fruits, vegetables, legumes, and whole grains, and is essential for your health. The goal is 25 milligrams to 35 milligrams a day with extra water to keep hemorrhoids away.
Second Trimester Tips
- Avoid unpasteurized dairy, raw or seared seafood, rare or underdone meat, hot dogs, raw eggs, high-mercury fish, and raw sprouts.
- Softer cheeses can contain Listeria- bacteria linked to serious infections. Don’t eat feta, Brie, Camembert, goat cheese, blue-veined cheeses, and queso.
- Unpasteurized juices like apple cider should be avoided as well.
- Eat slowly and chew food well are the key to feeling full. Frequent meals keep your blood sugar steady and prevent unexpected low levels that can cause jitteriness or lightheadedness.
- Good sources of protein for vegans are walnuts, cashews, pistachios, almonds, Brazil nuts, pine nuts, sunflower seeds, and pumpkin seeds (pepitas).
- Non-GMO soy products from soy chips, soybeans (roasted as snacks) or steamed edamame, and tempeh (made from fermented soybeans and shaped into a solid patty)
- Constipation, bloat, and burping are common in pregnancy and respond best to fiber, increase fluids, exercise, fruits (plums), vegetables.
- Fresh foods, especially organic, are your best options, frozen is second best, and canned foods should be avoided at all costs. Never eat raw or undercooked meat, eggs, sushi, or oysters. Fish should be cooked to an internal temperature of 145 F and chicken to 165 F.
Third Trimester Tips
- Take nutritious snacks with you. Stock your fridge and pantry with plenty of nutritious nibbles, sized to fit in your purse, briefcase, pocket, glove compartment, desk drawer:
- Blend smoothies before you leave the house
- Homemade ready-to-eat fruit salad
- Granola bars (choose whole-grain, low-sugar varieties)
- Mini-bags or boxes of raisins or nuts
- Cook ahead of time and freeze meals for when you return from the hospital. Cook extra portions.
- Eat smaller portions, more frequently because room is limited due to pressure from the uterus
- Heartburn responds to increased water, avoid spicy foods, sit upright after meals, and antacids like TumsTM or baking soda mixed with water.
Vitamin A, a fat-soluble vitamin, needed for visual function by acting on the retina. Vitamin A is found in green, yellow-orange leafy vegetables. The pregnancy RDA is 770 mcg, a bit over the non-pregnant state. The lactation RDA is 1300 mcg. Alpha-carotene is a form of vitamin A that is not teratogenic.
Vitamin B-1 is known as thiamine, is a water-soluble vitamin. It is involved in carbohydrate breakdown. It is found in milk and raw grains. The RDA is 1.1 mg and goes to 1.4 mg in both pregnancy and lactation. Routine supplementation is not needed unless severe vomiting occurs.
Vitamin B-2 is called riboflavin, another water-soluble B-complex vitamin. It helps release energy from cells. Vitamin B-2 is found in fish, vegetables, milk, eggs, and cheese. The RDA is 1.1 mg. In pregnancy, the RDA increases to 1.4 mg and then 1.6 mg in lactation.
Vitamin B-6 or pyridoxine is a water-soluble vitamin. It is important in all types of food breakdown products, protein, carbohydrate, and lipid. It is also involved in making new red blood cells that are needed to maintain the increased blood volume in pregnancy. Vitamin B-6 is found mostly in vegetables. The RDA is 1.2-1.5 mg. The pregnancy RDA increases to 1.9-2.0 mg.
Vitamin B-12, known as cobalamin, is a water-soluble B vitamin and is essential for embryo growth and differentiation of cells. It helps form red blood cells and nerve cells. It is found in animal proteins. Intestinal problems can lead to a deficiency. Strict vegans may also be deficient. The pregnancy RDA is 2.6 mcg and increases to 2.8 mcg with lactation.
Vitamin C is also called ascorbic acid, another water-soluble vitamin with numerous functions including antioxidant function and collagen formation and the absorption of iron. Vitamin C is found in citrus fruits and vegetables. The pregnancy RDA is 85 mg and increases to 120 mg with breastfeeding.
Vitamin D is a fat-soluble vitamin made by the body when exposed to sunlight.Vitamin D is also responsible for the bone growth, eyesight, and skin in the fetus. The RDA in both pregnancy and lactation is five mcg.
Vitamin E is another fat-soluble vitamin and acts as an important antioxidant. It is found in animal protein and fats. The RDA is 15 mg and is the same in pregnancy. The lactation RDA is increased at 19 mg.
Vitamin K, a fat-soluble vitamin, is required for making clotting factors VII, IX, and X in the blood and needed for normal clotting. It is found in green leafy vegetables, tomatoes and eggs. There is limited maternal transfer to the baby during gestation. In pregnancy and lactation, the RDA is 90 mg, the same as when not pregnant.
Folic acid is Vitamin B9 and is one of the most important vitamins in pregnancy. It is another water-soluble B-complex vitamin and is important for the synthesis of DNA and cell replication. It is found in fortified grains, dried beans, and leafy greens. Serious maternal anemias and neural tube defects in the fetus can be seen with deficiencies. The RDA is 0.4 mg normally and increases to 0.6 mg during pregnancy and lactation. Women who have had a previous child with a neural tube defect need to take 4 grams of folate three months prior to conception. All women should start at least 400 mg of folate before conception.
Minerals and Trace Elements
The RDA for iodine intake is, 220-250 μg in pregnant women and 250-290 μg in breastfeeding women. Sources in the diet include iodized salt, dairy products, some bread, and seafood. Iodine is needed for healthy brain development in the fetus and young child. Without iodine, thyroid hormone is impaired and is associated with an increased risk of pregnancy loss.
Iron is essential for the production of hemoglobin, which carries oxygen in the blood.
Other iron-rich foods as beef, duck, soy products, spinach, potatoes (with the skins on), dried beans and fruits, and food cooked in a cast iron cookware. The absorption of iron is poor, with only 10% being absorbed from the diet. An additional 500 mg of iron is needed to expand the number of red blood cells.
The preparations most commonly used include ferrous sulfate, ferrous fumarate, ferrous gluconate, and polysaccharide iron complex. Pure elemental iron 50-mg caplets are only
10% absorbed, which can be improved with the addition of Vitamin C.
Calcium is a major component of teeth and bones. 1000 mg is needed while pregnant and breastfeeding. Fortunately, the hormones of pregnancy enhance intestinal absorption, so supplementation is rarely needed if leafy green vegetables are eaten, which contain calcium.
Phosphorus is also required for bone formation. Most diets have adequate phosphorus, and supplementation is not needed.
Zinc requirements increase in pregnancy and lactation to 12 mg, up from 8 mg. Zinc supplementation is needed when elemental iron supplementation exceeds 60 mg/d. Copper is needed if zinc is supplemented. Some prenatal vitamins contain copper and zinc.
Sodium is present in large quantities in most diets, especially in processed or prepared foods. No supplementation is needed.
Vegetarian and Vegan Diets
Well-balanced vegetarian diets do not require special supplementation if dairy is included. Vegan diets do not include any meat, dairy, and eggs. A vegan diet may be deficient in calcium, vitamins D and B-12, and essential fatty acids. These deficiencies can be resolved with good supplementation.
This additional caloric intake for multiple gestations requires approximately 150 calories/day more than singleton pregnancies. Women carrying triplets should gain around 50 lbs. The suggested amount of folic acid supplementation is 1 mg/d. Elemental iron requirements are increased with more frequent dosing. An increase in vitamin B-6 is recommended in the amount of 2 mg/d.
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