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WEIGHT GAIN IN PREGNANCY
How much weight gain is enough for a healthy pregnancy? That depends. The following weight gain targets are from the American College of Obstetricians and Gynecologists (ACOG). Keep in mind that these are guidelines only. Every woman is unique, and so is every pregnancy. For example, taller women, African American women, and teens may be advised to gain more. Ask your midwife what's right for you.
If you are... Then gain... Normal weight before conceiving 25 to 35 pounds Overweight before conceiving 15 to 25 pounds Underweight before conceiving 28 to 40 pounds Carrying twins 35 to 45 pounds
TRACKING WEIGHT GAIN
Your girth is expanding, and you are probably wondering where it is coming from. It may ease your mind to know what contributes to pregnancy weight gain.
Body Part Approximate Weight Gain (lbs) Baby 7 to 8 Placenta 1 to 2 Amniotic Fluid 2 Breasts 1 Uterus 2 Increase in blood volume 3 Body fat 5 or more Increased muscle tissue and fluid 4 to 7 Total: At least 25
When can you expect weight gain to begin? Many women put on between 2 to 4 pounds in the first trimester, which lasts about 13 weeks. Some women may gain little or no weight in the first trimester because they aren't feeling well (morning sickness), while others gain more. Teens should aim for a 4 to 6 pound gain during the first three months of pregnancy.
Once the first trimester is over, weight gain should pick up and become more steady. Aim for an average weight increase of 3/4 to 1 pound a week from the second trimester on. Some months you may gain more, and some months less.
Regardless of beginning weight, pregnancy is not a time to diet or short-change yourself on nutrition. As a midwife, I would prefer to see women gain a little more than the indicated guidelines above, of course using proper nutrition and obtaining sufficient calories, protein, vitamins and minerals in the diet. There is not a need to "eat for two", however it is important to eat enough and eat the right foods. After all, you are building a baby while trying to maintain your own good health.
FOOD CRAVINGS
It is okay to give into food cravings, up to a point... depending upon what you are craving. You will probably feel more hungry starting around your 13th week of pregnancy when estrogen, an appetite stimulant, begins rising in the bloodstream. This is nature's way of getting your body to eat more to support you and your growing baby with enough healthy foods, thus providing the needed nutrition. Usually when a craving is taking place, it is an item that may contain some nutrient that you are lacking or needing more of in your diet. It is generally OK to indulge in your food cravings as long as they don't crowd out more nutritious foods or contribute to excessive weight gain.
Be careful that you do not indulge in non-food items (it is well known that some pregnant women crave things like dirt, newsprint or other potentially dangerous non-food substances. this is called "pica"). Contact your midwife if you have these cravings. These can be potentially dangerous to you and your baby.
COUNTING CALORIES
Calories are the energy in food that your body harnesses to do its work. A full-term pregnancy requires a minimum of about 80,000 calories. That may sound like a lot, but that number is deceiving. Consider that a full term pregnancy is about 280 days (40 weeks). Spread out the total calories required for pregnancy and you need about 300 extra calories per day. Add this to an average energy requirement of 2,200 calories per day for women, and your calorie needs during pregnancy total about 2,500 a day. Of course, some women may need slightly more or less, depending upon their age, activity level, and pre pregnancy weight. For example, pregnant teens require more, as do very active women who may need as many as 2,900 calories daily.
MAKING CALORIES COUNT
Three hundred extra calories a day is not a lot to work with, so make them count. To get a variety of nutrients, choose foods from all 5 food groups, and make a variety of choices within each group. Here are suggestions: 2 cups (16 ounces) of 1% fat milk, and 2 ounces lean meat, poultry, or seafood; 2 slices bread, 2 ounces tuna fish or turkey with 1 teaspoon reduced-fat mayonnaise; 1 cup (8 ounces) of vanilla nonfat yogurt mixed with ½ cup fresh fruit and topped with 1 ounce crunchy cereal; 1 cup (8 ounces) skim or 1% low fat milk, and 1 slice whole wheat toast topped with 1 tablespoon peanut butter and 1 tablespoon raisins.
MEAL FREQUENCY
Women may find that small meals and snacks can help quell the nausea and fatigue experienced during pregnancy. As time goes on, smaller, more frequent meals may become a necessity as a growing baby crowds your stomach and intestines, making it hard to eat large meals. It doesn't matter whether you eat three meals a day, or divide your daily food intake into six or more mini-meals, as long as your servings from each food group total what you need for pregnancy.
NUTRIENTS
CARBOHYDRATES
Most of your foods should come from carbohydrate-containing foods, such as bread, rice, pasta, fruits, and vegetables. Your body uses carbohydrates quickly and efficiently to meet energy requirements. Fat is also used for energy but should not be your predominant calorie source.
If you do not consume enough calories to meet your energy needs, your body turns to protein for energy. Protein is an "expensive" source of energy because breaking down protein to meet energy needs diverts it from its many important functions. Read about protein below.
To get enough carbohydrates in pregnancy, consume at least 9 servings from the Bread, Cereal, Rice, and Pasta Group, at least 3 servings from the Fruit Group, and a minimum of 3 Vegetable Group selections. There are two carbohydrate categories, referred to as simple and complex. With the exception of fiber, all carbohydrates should dominate your diet as the primary energy source. Foods rich in complex carbohydrates are also packed with other nutrients. For example, a baked potato supplies ample amounts of B vitamins, vitamin C, potassium, and fiber, in addition to carbohydrates. Add carbohydrate-packed, fortified breakfast cereals can be a source of many important nutrients, including iron and folate.
Table sugar is just one of several sugars referred to as simple carbohydrates. Table sugar (sucrose) is an added sugar in many different foods whereas the simple carbohydrates in fruit and fruit juices (fructose) and milk (lactose) are naturally occurring. While all provide the body with energy, the main differences between foods containing sucrose, fructose, and lactose are the accompanying nutrients. If you crave sweets, feast on fruit. Minimize intake of cookies, candy, cake, and sodas. Other sweet treats, like frozen yogurt, ice cream, and pudding, provide protein, vitamins and minerals, making them wise choices. Make your calories count.
Avoid or minimize eating foods with artificial sweeteners such as aspartame, saccharin and acesulfame-K. Many people have experienced side effects (some serious) from overuse of these chemicals in their foods. Pregnant women with a rare genetic disorder phenylketonuria (PKU) should not eat foods made with aspartame, because they cannot break down phenylalanine, one of aspartame's components.
FIBER
Fiber is a component of plant foods. Like other complex carbohydrates, fiber keeps good company. It is found in foods typically packed with vitamins and minerals, including grains, vegetables, and fruits. But it is also different from its carbohydrate counterparts in that your body cannot digest it. That's why fiber contributes no calories.
One of fiber's benefits during pregnancy is that it can help alleviate constipation and hemorrhoids that expectant women often experience. Fiber softens and adds bulk to stools, stimulating your intestines to pass them faster and with greater ease. When you strain to move your bowels, hemorrhoids can develop. That's why avoiding constipation is key to warding off hemorrhoids.
Fiber and fluid are essential partners. Fiber absorbs many times its weight in fluid, so sipping at least 8 glasses of non-caffeine fluid daily, including water, milk, and juice, enhances fiber's beneficial effects. Regular physical activity also helps relieve constipation because it increases blood blow to the intestine, helping to keep digestion running smoothly.
Pregnant or not, you need 20 to 35 grams of fiber every day. Fiber is supplied by whole grain foods, fruits, vegetables, legumes, nuts and seeds.
PROTEIN
Pregnant women need protein to make new cells, manufacture enzymes and hormones that regulate life, and control fluid balance. In a pinch, protein can be used as an energy source since it provides four calories per gram. With important responsibilities, it is clear why protein is paramount during a pregnancy.
A pregnant woman needs a minimum of 60-90 grams of protein daily. Ideally, it is better to have between 75 and 100 grams per day. It is important to obtain sufficient protein from your diet. Food supplements, such as prenatal vitamins, do not contain protein, but only other necessary nutrients, such as vitamins and minerals. High protein foods have many necessary nutrients needed for building and maintaining the body for both mother and growing baby. It is also a major preventive measure for the prevention of pre-eclampsia-eclampsia (toxemia of pregnancy).
If you are a vegetarian (lacto, lacto-ovo, or primarily vegan), it is important to obtain enough protein (containing various essential amino acids) from your foods. You may have to combine foods in a specific manner (see Nutritional Guidelines for a Vegetarian Pregnancy Handout) to make sure you obtain enough of the essential amino acids needed for optimal health.
FAT
Fat contains 9 calories per gram so many women will limit their intake of fat. Fat is an essential nutrient, whether pregnant or not. But fat is particularly important when you are pregnant. As the sole provider of essential fatty acids, dietary fat is pivotal in the proper development of baby's brain and central nervous system. Equally important to pregnancy is fat's sole role in transporting the vitamins A, D, E and K - all necessary for healthy babies. Fat is also a concentrated energy source, helping provide the calories you need to foster baby's growth. A certain amount of body fat is expected to form on the mother's body during pregnancy. This is important as an energy source during pregnancy, but also during labor and birth. It is used as a necessary energy reserve that may be essential during a long labor. It is recommended that fat should be limited to about 30% or less of your total nutritional intake.
All types of fats contain more than twice the calories of carbohydrates or proteins. Most fats, such as olive oil, vegetable oil, margarine and butter, contain about 120 calories and 13 grams of fat per tablespoon. Since they all essentially contain the same amount of calories, which type of fat is better than another?
Polyunsaturated and monounsaturated fats are considered the healthiest because of their effect on blood cholesterol level. Even in pregnancy, the bulk of your fat intake should come from these two heart-healthy types, when you are expecting and afterward. Monounsaturated fat is the predominant fat in foods such as olive oil, avocado, peanuts, peanut butter, and other nuts. Cooking oils such as safflower, sunflower, and corn, and tub margarines are rich in polyunsaturated fats, and contain smaller amounts of monounsaturated and saturated fat, too. Seafood supplies a type of polyunsaturated fat known as omega-3 which helps build your baby's brain and eye tissue. Include fish in your diet regularly, especially the fattier varieties, such as salmon and bluefish.
Saturated fat may increase blood cholesterol levels. Animal foods, including full-fat dairy products, fatty meats, poultry skin, chocolate, and butter, are sources of saturated fat. Hydrogenated fat, used in food processing, is another form of saturated fat that you may see on food ingredient labels. When cooking oils are hydrogenated for storage or cooking purposes, their polyunsaturated and monounsaturated fatty acids are converted into more saturated forms. Hydrogenated fats is found in processed foods including margarine, commercially baked goods, fried foods, and snack foods. Try to avoid these as much as possible.
Remember fat is vital to proper growth and development of your growing baby. Fat-modified foods, such as reduced-fat chips and frozen desserts, can help keep fat in control, but many fat-reduced foods contain as many if not more, calories because sugar is often added to make up for the flavor lost with the fat. Some fat replacers are derived from carbohydrates, some are protein-based, while others are made from fats.
VITAMINS
VITAL VITAMINS
Carbohydrate, protein, and fat may be the fuel for pregnancy, but they would not amount to anything without the spark supplied by vitamins. Vitamins regulate the metabolism, digestion, and absorption of the three calorie-containing nutrients and oversee many other bodily functions that keep you healthy and your baby's growth on track.
Vitamins are divided into two classes: fat soluble and water soluble. Vitamins A, D, E, and K travel and dissolve in fat. Fat soluble vitamins from food are stored in your liver and fat tissue and are used as needed. The B vitamins and Vitamin C dissolve in water. Because your body cannot store water-soluble vitamins, it is important that when pregnant you get enough B vitamins and vitamin C on most days.
VITAMIN A
Vitamin A is an all-around nutrient that makes possible the growth and health of cells and tissues throughout the body. The daily requirement for adult women is 5,000 IU daily, whether pregnant or not. You should make sure you get enough, but not too much. While vitamin A is essential, more than is required may be harmful. Unless otherwise recommended by your midwife, the dose of vitamin A should not exceed 10,000 IU. High doses of vitamin A can cause birth defects. Vitamin A is found in both animal and plant foods. Animal products contain the pre-formed form of vitamin A called retinol. Fruits and vegetables contain carotenoids, substances the body converts into vitamin A. Excellent sources of vitamin A include: sweet potatoes, carrots, spinach, milk (fortified with vitamin A), and liver.
VITAMIN D
Vitamin D fosters calcium absorption from food and helps deposit calcium into bones, making them strong and dense. Pregnancy does not increase your need for vitamin D, which is 200 IU per day for women under the age of 50. Vitamin D is one of the few vitamins your body can make. Sunlight sparks the process in your skin, which is finished off in your liver and kidneys. Your body can use vitamin D right away or store it for later. Healthy people who get regular sun exposure can make enough vitamin D to last the whole year. Many women do not get enough sunlight exposure to strong ultraviolet rays that are needed to make vitamin D because they live in northern climates where the sun is strong enough only about half the year. Wearing of sunscreen with a sun protection factor (SPF) of 8 or higher blocks most of the rays that initiate vitamin D production. Women must rely on food for vitamin D. With the exception of foods such as eggs and salmon with bones, few foods naturally contain vitamin D. Fortified foods are: milk, margarine, and breakfast cereals.
B VITAMINS
The B vitamins are a complex of vitamins with closely-related functions. You need more B vitamins when pregnant because these important vitamins are involved in releasing and using energy in food. B vitamins are easy to find in most of the food groups. The only food groups not particularly rich in B vitamins are the Fruit and Vegetable Groups.
B Vitamin Function in Pregnancy Requirement Food Sources Thiamine
(B-1)Releases energy. 1.4 milligrams (mg) Pork, whole grain and enriched grain products; from carbohydrate products, lentils Riboflavin
(B-2)Helps produce energy and helps in protein use. 1.4 mg Dairy products, organ meats, enriched grains Niacin
(B-3)General metabolism, particularly use of carbohydrates and fats. 18 mg Meat, poultry, seafood, nuts, fortified grains Pyridoxine
(B-6)Helps body in making proteins used to make cells. 1.9 mg Poultry, fish, pork, bananas Vitamin
B-12Helps make red blood cells along with folate; helps in using fat and carbohydrates. 2.6 micrograms (mcg) Found mostly in animal foods, with the exception of some nutritional yeast products and fortified soy milk products
FOLATE
Folate is vital for producing new and healthy red blood cells. Over time, too little folate leads to a blood disorder called megaloblastic anemia where underdeveloped blood cells are unable to carry adequate oxygen. Folate deficiency may cause neural tube defects (NTDs), a serious birth defect that occurs early in pregnancy - often before a woman suspects she's pregnant. A woman should get at least 400 mcg minimum, after pregnancy is known then 600 to 800 mcg optimal of folic acid daily from her foods and any prenatal supplements. Any woman capable of getting pregnant should have these levels daily. The only foods that contain folate in the form of folic acid are fortified grain products. Folate can be obtained in these foods: lentils, spinach, chickpeas, orange juice, peas, ready-to-eat cereals, pasta, instant oatmeal, rice, whole grain bread, broccoli, strawberries and oranges.
VITAMIN C
Vitamin C is necessary for a healthy immune system. When it comes to building a healthy baby, vitamin C aids in the production of collagen, a cement-like substance that provides structure to the body by holding together bones and tissues. It keeps blood vessels strong, and it promotes the formation and repair of red blood cells and healthy gums. Vitamin C helps you absorb more iron found in some plant foods, such as grains and vegetables. You should include at least one vitamin C source with each meal. A pregnant woman needs a minimum of 70 mg of vitamin C daily. Foods rich in vitamin C include: Orange juice, red bell pepper, oranges, kiwi, tomatoes, strawberries, and grapefruit.
TIPS ABOUT VITAMINS
- Buy the freshest foods possible, and treat them with care. For the most nutrition, purchase robust-looking fruits and vegetables or their high-quality frozen counterparts.
- Choose milk in opaque containers and refrigerate it immediately after using to better preserve nutrients like riboflavin and vitamin A, which are lessened by light.
- Eat raw vegetables and fruits more often. Even proper cooking will destroy some vitamins, especially heat-sensitive ones like vitamin C and folate.
- If you cook fruits and vegetables, preserve their nutrients by steaming quickly in a covered pot or by microwaving. Cook produce only until crisp, not mushy.
- Eat the skin of fruits and vegetables when possible. Peel away edible skins and you toss nutrients. Wash produce thoroughly and enjoy. There is no need to rinse most grains, such as rice and pasta before cooking. You've just washed away nutrients.
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