Nutrition for a healthy pregnancy

Andrea Holwegner, the  Chocoholic Dietitian , is founder and president of  Health Stand Nutrition Consulting Inc. , a member of the Canadian Association of Professional Speakers and a media expert for the Dietitians of Canada. She's the author of Juiced Up Journal: 365 Day Nutrition & Wellness Journal.

Pregnancy is one of the most intense periods of growth and development for both a woman and her baby. Choosing nutritious foods and managing a healthy lifestyle before, during and after you are pregnant is critical for the healthiest outcomes for both you and your baby. 

Pre-pregnancy planning

If you are thinking about getting pregnant one of the most important things you need to do is connect with your doctor about your plans and have a full health checkup. You will of course want to refrain from smoking or using alcohol and be sure to talk to your doctor about medications, herbs and supplements to find out what is safe to consume. 

Talk to your doctor about your current weight and lifestyle habits, and if you are overweight, underweight, have an eating disorder or have a medical concern such as diabetes or high blood pressure, work with a registered dietitian to create a healthy nutrition plan that will give your body the best chance to get pregnant as well as manage a healthy pregnancy. 

It is also an important time to educate yourself about which foods and beverages are safe while pregnant and how much physical activity is safe and beneficial.  Each day, be vigilant about taking a prenatal supplement that has 0.4 mg of folic acid and 18 mg of iron, since these vitamin and minerals are in high demand during pregnancy. 

Make sure you aren't taking a supplement that has more than 10,000 IU (3.33 RE) of vitamin A, since an overdose of this vitamin can cause birth defects. Consume a diet that is rich in whole grains, vegetables, fruits, calcium-rich foods such as dairy or fortified beverages, healthy fats and protein rich foods such as meat, poultry, seafood, legumes, eggs and nuts.  Make sure you are not skipping meals, following a low-calorie diet or a fad diet that limits many different foods. Choose to eat regular meals every 3-5 hours and drink plenty of fluids.

Weight gain during pregnancy

The amount of weight that is healthy to gain during pregnancy depends on how much you weighed before you were pregnant. The following recommendations are based on your Body Mass Index (BMI) before you were pregnant.  BMI is a number based on a comparison of your weight to your height (BMI = weight in kg/height in metres squared). 

To determine your pre-pregnancy BMI, use Health Canada's BMI calculator. 

If you are a healthy weight, you will likely gain a couple of kilograms in the first trimester, and then, on average, a good target is to aim for weight gain of approximately 0.5 kg (1 pound) per week in the second and third trimesters.  If you are underweight, overweight, or obese talk to your doctor about weekly weight gain goals that are specific for you.

If you are pregnant with twins or multiple babies you need to gain more weight than the above table.  Your doctor will help you determine a healthy goal based on your own unique needs.

Nutrients of special concern during pregnancy

Folic acid

This vitamin is especially important in helping to prevent neural tube defects in the developing spine of your baby. All prenatal supplements contain enough folic acid to make sure you have enough before and during your pregnancy. Foods rich in folic acid include orange juice, fortified breakfast cereals and other grains as well as legumes and leafy green vegetables. 

Iron

Iron is really important during pregnancy due to the rapid increases of blood volume.  Prenatal supplements contain a large amount of iron to help make sure you get enough.  Food sources rich in iron include beef, seafood, poultry, fish, soy foods, legumes, fortified breakfast cereals and green vegetables. Foods rich in vitamin C such as citrus, tomatoes, berries and potatoes enhance iron absorption.

Calcium

You need calcium to build your baby's new bones, help maintain your own healthy bones, as well as produce milk for feeding your baby.  Calcium is also important to maintain your blood pressure during and after your pregnancy.  Foods rich in calcium include milk, yogurt, cheese, fortified soy beverages, fortified orange juice, canned fish with bones, almonds, broccoli and legumes. It is important to consume three servings of calcium-rich foods per day or an extra calcium supplement is required since prenatal supplements do not have enough calcium to meet all your daily needs.  One serving of a calcium-rich food is 1 cup (250ml) of milk or fortified soy beverage, 3/4 cup (175 g) yogurt or 1.5 ounces (50g) cheese.

Vitamin D

Vitamin D is very important in helping you absorb more calcium and helps to keep your bones strong.  Although the sun helps us produce vitamin D in the skin it is an unreliable source and it is best to get our vitamin D through foods and supplements.  Prenatal supplements have enough vitamin D for health during pregnancy.  Foods rich in vitamin D include milk, fortified soy/rice beverages, fatty fish and egg yolks.

Omega-3 fats

Omega-3 fats are important to help with the development of your baby's brain, eyes and nervous system. The best sources of omega-3 fats are found in fish and other sources include canola oil, walnuts and ground flax seeds.  Health Canada recommends consuming two servings of fish per week.  One serving of fish is 2.5 ounces (75g). Health Canada also provides recommendations for limiting exposure of certain types of fish for pregnancy due to mercury content. 

Fibre

Many women experience constipation during pregnancy since pregnancy hormones can slow down digestion and your growing baby puts pressure on your intestines making it difficult to have bowel movements.  Getting enough fibre can also help prevent hemorrhoids which are common in pregnancy.  For this reason be sure to increase your consumption of high-fibre foods such as wheat bran cereals, bran muffins, fruits, vegetables, legumes, nuts and seeds.

Fluids

Getting enough fluids during pregnancy is important to prevent constipation, build blood volume for your baby, supply nutrients to your baby and rid waste products away from your baby.  You need three litres (12 cups) of fluid per day during pregnancy. You can count fluid from water, all beverages, soups and the water that is found abundantly in fruits and vegetables. 

Extra calories during pregnancy

While you may be eating for two, it doesn't mean that you need to double your intake.  For a woman with a healthy BMI, during the first trimester no extra calories are typically required compared to your typical intake.  During the second trimester on average you need an extra 350 calories per day and in the third trimester about 450 extra calories are required. 

Breastfeeding women also have higher calorie needs than non-pregnant women and typically require 350-400 extra calories per day for the first year depending on how much milk they produce and how quickly they lose their pregnancy weight.  Most women find it easier to consume small meals and snacks throughout the day rather than large meals to keep their energy up, manage nausea and to avoid feeling too full at once.

Here are some examples of what 350-450 extra healthy calories looks like in food portions:

• 1 cup (250ml of milk or fortified soy beverage) with a banana and 2 slices of toast. 
• 3/4 cup (175 g) of yogurt with 1/2 cup bran cereal and 1 cup of fresh or frozen berries. 
• 1/2 cup of rice/potato or pasta, 2 ounces (60 g) of meat/chicken/fish and 1/2 cup steamed veggies.  
• 1 hard-cooked egg and small bran muffin 
• 1 apple, 1.5 ounces (50 g) of cheese and a handful of crackers 
• 1/4 cup nuts and 1 cup raw veggies with 2 tbsp. reduced-fat dip

Food safety, discomforts, medical complications

For more information about nutrition for a healthy pregnancy, as well as foods that you want to avoid during pregnancy, along with coping with common discomforts such as nausea, vomiting, cravings, constipation, heartburn and medical concerns, visit the Public Health Agency of Canada: Healthy Pregnancy and Health Canada: Healthy Pregnancy 's websites — and talk to your health care provider: