Diet and Weight Gain
If you started pregnancy at a normal weight, you only burn about 90 extra Calories per day in the first trimester, 275 extra Calories per day in the second trimester, and 500 extra Calories per day in the third trimester.
Normal weight women (BMI of 18.5-24.9) should gain about 25-35 pounds during their pregnancies. Underweight women (BMI < 18.5) may need to gain more and overweight women less. For obese women (BMI > 30), dieting is safe and beneficial during pregnancy. Most weight gain comes in the second half of pregnancy and often women have gained no weight or even lost weight by their 20th week; this is healthy and okay.
If you’re pregnant with twin (or more!), the expected weight gain will be a little more than. Expected or average weight gain and necessary weight gain aren’t necessarily the same thing. We check your weight at every visit, but please don’t focus on how much you gain. We are usually not worried about you gaining too little weight but instead gaining too much weight. Excess weight gain increases the risks of several pregnancy complications, including the risks of preeclampsia, diabetes, fetal macrosomia (a big baby), and Cesarean delivery.
Many overweight women can gain no weight for the entire pregnancy or even lose some weight if they’re actively dieting. This is not a bad thing. Maternal weight gain, if it is excessive, is associated with a larger fetal size; but that doesn’t mean that gaining too little weight during pregnancy will not make your baby too small if you are overweight at the start of the pregnancy. The goal is to have a healthy baby and a healthy mom. Talk with your doctor or midwife about what your weight journey should look like throughout pregnancy based on your pre-pregnancy weight.
Because of high-levels of mercury, pregnant women should avoid shark, swordfish, king mackerel and tilefish. Smaller fish are usually safe, such as light tuna, salmon, pollock, and catfish. Up to 12 ounces per week of these fish is considered safe.
Foods to Avoid
This is a great question. The truth is, you can eat just about anything you want. Here is the quick and overly cautious answer:
Don’t eat:
- Big fish with high levels of mercury (shark, swordfish, king mackerel, and tilefish)
- Unpasteurized milk and soft cheeses
- Raw or undercooked meats
- Cold cuts (lunch meat, salami, etc.)
Here are the explanations:
Because of high levels of mercury in some big fish, pregnant women should avoid shark, swordfish, king mackerel, and tilefish. Smaller fish are usually safe, such as light tuna, salmon, pollock, and catfish. Up to 12 ounces per week of these fish is considered safe. In fact, regular consumption of fish (and their omega fats) has been associated with lower rates of preterm labor and other complications of pregnancy. Recent evidence suggests that even the recommendation about avoiding the larger fish is likely unnecessary. So don’t stress too much unless you happen to eat these larger fish multiples times per week.
Listeriosis is a rare type of food poisoning that can affect pregnant women and cause stillbirths. To avoid this, you should wash all fruits and vegetables before eating them and avoid eating unpasteurized milk or soft cheeses, raw or undercooked meats, poultry, or shellfish. Ideally, hot dogs and deli meats should be heated thoroughly prior to eating though the absolute risk of acquiring listeria from deli meats is extraordinarily low. Don’t be too freaked out about listeria; most women take a greater chance just by driving to the doctor’s office than by eating high-risk foods. The absolute risk of anything happening from eating any of these foods is incredibly low. So you shouldn’t worry too much, but pregnancy isn’t the time to explore strange and new foods from uncertain sources.
Caffeine
As with most things in life, moderation is the key. Scientific studies have not demonstrated any problems with caffeine consumption during pregnancy until a woman consumes over 700 mg per day. That’s a lot of caffeine! To be safe, and to make sure that a woman never approaches that amount of caffeine consumption, we recommend that women limit themselves to 350 mg of caffeine per day.
In general, you are okay to keep your morning ritual if it consists of an average cup of regular coffee or the average serving of a caffeinated soft drink. But beware, it is possible to overdo it with a large special order from Starbucks. If you drink a lot of caffeine prior to pregnancy, cutting it out altogether can produce daily headaches. All things in moderation, including caffeine.
Most soft drinks have about 40 mg per 12 ounces (Diet Coke has 46 mg). Most coffee has around 75 mg per eight ounces, but this amount varies widely. Most teas have around 40 mg per eight ounces. And energy drinks like Red Bull have about 80 mg per can. Check out this website for the amount of caffeine in your favorite beverage.
What can’t I eat?
Good question. The truth is, you can eat just about anything you want. Click here for a full explanation. The short answer is to not eat:
- Big fish with high levels of mercury (shark, swordfish, king mackerel, and tilefish)
- Unpasteurized milk and soft cheeses
- Raw or undercooked meats
- Cold cuts (lunch meat, salami, etc.)
Finally, make sure you wash your fruits and vegetables well before eating them. The absolute risk of the anything that happening from eating any of these foods is incredibly low. So you shouldn't worry too much; but pregnancy isn't the time to explore strange and new foods from uncertain sources.
How much weight should I gain?
Normal weight women (BMI of 18.5-24.9) should gain about 25-35 pounds during their pregnancies. Underweight women (BMI < 18.5) may need to gain more and overweight women less. For obese women (BMI > 30), dieting is safe and beneficial during pregnancy. Most weight gain comes in the second half of pregnancy and often women have gained no weight or even lost weight by their 20th week; this is healthy and okay.
We check your weight at every visit, but please don’t focus on how much you gain. We are usually not worried about you gaining too little weight but instead gaining too much weight. Excess weight gain increases the risks of several pregnancy complications, including the risks of preeclampsia, diabetes, fetal macrosomia (a big baby), and Cesarean delivery.
Many overweight women can gain no weight for the entire pregnancy or even lose some weight if they’re actively dieting. This is not a bad thing. Maternal weight gain, if it is excessive, is associated with a larger fetal size; but that doesn’t mean that gaining too little weight during pregnancy will not make your baby too small if you are overweight at the start of the pregnancy. The goal is to have a healthy baby and a healthy mom. Talk with your doctor or midwife about what your weight journey should look like throughout pregnancy based on your pre-pregnancy weight.
Can I drink caffeine?
Yes, you can.
As with most things in life, moderation is the key. Scientific studies have not demonstrated any problems with caffeine consumption during pregnancy until a woman consumes over 700 mg per day. That’s a lot of caffeine! To be safe, and to make sure that a woman never approaches that amount of caffeine consumption, we recommend that women limit themselves to 350 mg of caffeine per day.
Click here to find out how much caffeine is in your favorite beverage.
I’m throwing up! Help!
Nausea and vomiting during pregnancy is no one’s idea of a good time. Unfortunately, it affects about two-thirds of pregnant women. The good news is, nausea and vomiting are not associated with risks to the pregnancy; the bad news is, you are nauseated and throwing up.
What can you do?
- Eat several small meals per day and avoid high-fat foods.
- Eat more bland foods and avoid smells that are noxious.
- Increase the protein and liquid content of your food.
- Ginger ale, ginger teas, or ginger capsules can help (three 250 mg capsules a day and one before bed).
- Taking a vitamin B6 supplement (25mg) 2-3 times per day alone or in combination with Unisom SleepTabs (doxylamine) at night may be beneficial.
Your doctor may need to prescribe an anti-nausea medicine for you if these remedies don’t resolve the issue. There are several drugs that are safe in pregnancy to choose from, including ondansetron (Zofran), metoclopramide (Reglan), promethazine, haloperidol, and a few others.
Make sure that your acid reflux and constipation are treated since both of those can contribute to nausea and vomiting as well.
In bad cases, you may need to be hospitalized for IV fluids and other treatments if you are unable to keep anything down and experiencing signs of severe dehydration/malnutrition. Hopefully, you should feel better by the end of the first trimester. If you don’t, or if the above remedies are not working, your doctor may need to investigate other causes of your nausea and vomiting apart from pregnancy. Typically, you shouldn’t be concerned as long as you can maintain your body weight and stay hydrated during the first trimester. If you lose a few pounds from the nausea and vomiting, it isn’t too concerning; but, more significant losses should be investigated further.
Do I need to take anything besides my prenatal vitamin?
In most cases, the answer is no.
There is a whole industry that markets supplements and other products to pregnant women. Even among prenatal vitamins, for most women the only ingredient that is actually required is folate, and folate is only necessary until the baby’s neural tube is closed, which happens early in the first trimester. The truth is, prenatal vitamins are best taken beginning at least two to three months before pregnancy and provide little to no benefit past the first half of the first trimester. In fact, if you are beyond six weeks and prenatal vitamins are making you nauseous or constipated, there’s no reason for you to keep taking them.
Aside from the folate in a prenatal vitamin, the other ingredients often found in these vitamins are not science-based. Don’t get caught up in buying the most expensive prenatal vitamin because the company says it will make your child smarter or reduce the risks of pregnancy; this simply is not true.
In some cases, due to restrictive diets or preexisting anemia or other risk factors, your doctor might ask you to take an additional supplement or medication, most commonly iron.
I have gestational diabetes. Now what?
If you failed your 1-hour glucose screen AND your 3-hour glucose tolerance test, then you have gestational diabetes.
Hopefully, you’ll get a chance to talk to a dietitian. In the meantime, try to cut down (if you can, cut them out completely) the simple sugary items from your diet: sodas, cookies, cakes, candies, and other sources of sugary carbs. Paying attention to portion size is the best thing you can do. Try to make your plate ½ greens, ¼ grains, and ¼ protein for every meal. If you’re not already, add in four to five 20 minute walks or other cardiovascular exercise sessions per week.
You’ll need to check your blood sugar several times per day, at least initially. You should check your blood sugar first thing in the morning (a fasting blood glucose), and then check it two hours after each large meal – breakfast, lunch, and dinner. Your fasting blood sugars should be below 95 and your blood sugars after meals should be below 120. If your blood sugars are running higher than this, you may need to take medicine to help lower your blood sugars.
Is also helpful, in the beginning at least, to track what you are eating. This can help your dietitian and your doctor decide if there are some things you should do differently in your diet. It can also help you understand why your blood sugar might spike – for example, after delicious pizza.
Can I eat fish?
Yes!
Because of high levels of mercury in some big fish, pregnant women should avoid shark, swordfish, king mackerel, and tilefish. Smaller fish are usually safe, such as light tuna, salmon, pollock, and catfish. Up to 12 ounces per week of these fish is considered safe.
In fact, regular consumption of fish (and their omega fats) has been associated with lower rates of preterm labor and other complications of pregnancy. Recent evidence suggests that even the recommendation about avoiding the larger fish is likely unnecessary. So don’t stress too much unless you happen to eat these larger fish multiples times per week.
Do I need to “pump and dump” if I have a drink?
No! Alcohol does pass easily into breastmilk, but it’s also absorbed from milk much like it is from the bloodstream. Basically, if you are sober enough to drive, you’re likely sober enough to breastfeed. A rough average is about two to three hours after one drink. If you breastfeed a little early, it’s unlikely the baby will receive enough to be harmful. Only a very small percentage is actually passed on to the baby in breastmilk. Of course, if you had more than one or two drinks and will need to wait longer than usual between feeds, pumping and dumping may make you more comfortable! Also, bear in mind that current research suggests that “moderate” alcohol use (generally meaning less than one drink per day) is not considered harmful to babies. More than that and you could be putting baby at risk; there is no known “safe” amount of alcohol in breastmilk, and some research suggests frequent alcohol use during breastfeeding may put babies at risk for slowed development and poor weight gain.
