This week I gave a talk at ACAC on prenatal nutrition, and I figured I would share my 10 tips for prenatal nutrition in a blog post as well. Years ago, I wrote a post on Baby KERF on Prenatal Nutrition. While there is some overlap with today’s post (like taking a prenatal), my emphasis this time is more on food choices and less on individual nutrients.
**These are general recommendations and you should always talk to your OB before making any significant changes to your dietary intake**
Take A Prenatal Before, During + After Pregnancy
Look for a whole food-based prenatal that contains folic acid, vitamin D, and iron. Bonus if you can find one with probiotics and omega-3s too. Most prenatals that I’ve seen have a 3-pill-a-day dosage, and it’s best to space those out throughout the day to maximize absorption. New Chapter makes one that has probiotics too, and I liked Garden of Life brand, which I had no trouble with during my morning sickness phase. Note that gummy prenatals often don’t have everything you need. (Although they are yummy!) I prefer the whole food composition more than a capsule, because they are easier to sink and swallow. Lastly, if your prenatal doesn’t have probiotics or omega-3 (200-300 mg), consider supplementing with those. One last extra to consider is vitamin D on top of your prenatal, especially in the winter. Check with your doctor first!
Morning Sickness = Survival Mode
I’ve had horrible morning sickness with each pregnancy that had me dependent on taking Unisom and Vitamin B6 to be able to function. While the first trimester is very important, think big picture. If you’re not able to eat huge kale salads topped with wild salmon (I certainly couldn’t even think about that), do not stress. Focus on eating the healthy foods that do sound good (antioxidant-rich berries, for example). Eat what you can tolerate and talk to your doctor if things get extreme. Pretend you’re a picky two-year-old and blend veggies into smoothies, sauces, or soups so you don’t know they’re there. I could tolerate a blended vegetable tomato sauce ok, but couldn’t think about a raw salad. Any way you can get nutrients in helps. Get creative with recipes – if pancakes sound great but eggs turn your stomach, make a pancake with eggs in it so you’re still getting those egg nutrients.
Second Trimester = Focus on Quality over Quantity
When your appetite is (hopefully) back, focus on making the best choices that you can. Don’t stress out too much about weight gain if you’re focusing on mostly whole foods. When cravings do hit, swap junk food for healthier options like a thick smoothie made with fruit and peanut butter before running out to your nearest milkshake bar. Choose whole grains whenever possible, such as whole grain cereals for those cereal cravings, a grilled cheese made with sprouted bread, or even whole wheat mac and cheese. Make grass-fed burgers at home instead of going through the drive-through. Look for ice creams with a simple ingredient list and lower sugar, such as Breyer’s Vanilla, over loaded candy bar flavors. Olives make a great solution for salty food cravings, and if you’re NEEDING chocolate, choose a pure dark chocolate bar instead of rummaging through the leftover Halloween/Easter candy. Now is the time to go organic on the dirty dozen and buy organic, local, and/or pastured meats and eggs. They cost more, but your goal is to maximizing nutrition and minimize pesticides and toxins during this time.
Hydrate Like An Athlete
When you have to pee every 10 minutes, you might not want to drink a lot of water, but it’s so important to prevent dehydration. I’ve been extra thirsty so drinking more water has come naturally. Of course, plain water is the best way to hydrate. I have a Hydroflask that I love that keeps water super cold even in summer heat and fits a good 32 ounces. Whatever will get you to drink more, do it! Have lemons and limes precut in the fridge, mix a splash of lemonade into plain water (just a little as to not overdo it with sugar), make iced herbal tea like peppermint, or enjoy seltzers. And never leave the house without your water bottle! Watch your caffeine intake – one small cup of coffee under 200 mg is considered fine (checkwithyourdoctor) but be mindful of sodas and black teas that can go down easily in hot weather because the caffeine can add up fast.
Eat + Drink For Insomnia
When people are telling you to “sleep now while you can,” insomnia and uncomfortable restless sleeping can be a drag. I have found insomina to be quite connected to what I eat (or don’t eat) at bedtime. A protein and fat focused snack at bedtime can help fight middle of the night hunger. Some ideas include almonds, Greek yogurt, dark chocolate, trail mix, and nut butters. And if you do wake up and can’t get back to sleep, try a few sips of juice (this is when juice is your friend) or a piece of dried fruit with water. Most of the time this little boost in blood sugar will put me back to sleep.
You Are Not Eating For Two (Sorry)
Mindful eating is just important when your goal is to slowly put on weight. Women need about 300 extra calories in their 2nd and 3rd trimesters. That’s the difference in slightly bigger portion size at your 3 meals and snacks – not adding in extra snacks or treats 10 times throughout your day. Try your best to listen to your hunger cues. If you’re starving during what appears to be a growth spurt week, get those extra calories through satisfying and nourishing foods. Instead of eating easily digested refined carbs, choose protein and fat-focused foods that will help fill you up and provide energy-dense nutrition. If you’re craving sugar nonstop, you might need more satisfying healthy fats, like nuts, whole milk dairy, eggs, or avocados.
Mind The Food Rules
It’s hard to talk about prenatal nutrition without at least mentioning some of the foods you shouldn’t be eating. Deli meat, raw animal products, undercooked foods, unpasteurized cheeses, high-mercury fish, alcohol (ahem) – most women know the list. Kelli wrote an excellent post on food safety a few weeks ago that touches on pregnancy rules as well (she is due the same week as me!) There are ways around most of these things: steam deli meat until it’s at least 165 degrees and then enjoy a turkey and cheese melt, eat your burgers but make sure they’re cooked throughout, look for cheeses that are pasteurized, choose low-mercury fish like sardines and wild salmon, order sushi that is cooked or vegetarian, and get tipsy (the pretend kind) on mocktails. My drink of the summer has been a virgin margarita. I don’t even miss the tequila. (Well, maybe just a little.) Seedlip makes alcohol-free spirits that are wonderful blended into a mocktail with some fresh herbs and seltzer.
Eat More Sardines
DHA + EPA are essential long-chain fatty acids that we have to get from food. You’ll find them mostly in fish and directly from algae, but you can also get them from fortified foods and supplements. Wild salmon and herring top the list of the most omega-3 per three ounces at 1800 mg. Following those are anchoives (1200 mg), rainbow trout (1000 mg), and sardines (800 mg), which also have calcium, vitamin D and iron – all great pregnancy nutrients! Shrimp and canned tuna have about 250 mg of omega-3 each. This site has a great overview of best choices taking into account omega-3s, mercury, and sustainability.
As Stomach Space Shrinks, Turn to Mini Meals with Balanced Macros
Each mini meal should contain protein + carbs + fat to stabilize blood sugar and maximize satiety. Again, if you fill up what little stomach space you have on too many refined carbs, you’ll likely be hungry within the hour. Focusing on more satisfying foods will stretch that time and will lead to more nutrient and energy-dense choices when stomach space is lacking. Some ideas include nut butters, avocado, olives, trail mix, Greek yogurt (2 or whole %), oatmeal, half a sandwich on whole grain bread, hummus with veggies, whole grain crackers with cheese, a glass of milk, or small cup of whole grain cereal with milk. Steer away from snack foods like goldfish, cookies, or chips since they won’t make you full.
Don’t Give Up At The End
This is a reminder to myself as much as to you! I remember with Mazen when I hit 35 weeks I thought: “I’ve made healthy choices this whole pregnancy so I’m going to loosen up a bit and eat whatever I want.” I think I had a little too much ice cream during those dog days of summer! Little did I know I had a whopping six weeks to go until Mazen was born, and I think I put on the most “mommy weight” during that time. Don’t throw nutrition out the window and loosen up on everything just because you’re getting close to the end. Your calcium needs increase for baby’s bone development (2/3 of calcium deposits go to baby in third trimester!) Milk, yogurt, cheese, and all the leafy greens all provide calcium. There is also an increase in magnesium near the end of pregnancy. Take an Epsom Salt bath to absorb it through your skin. Now is a great time to enjoy eggs because your baby needs choline and lutein for his brain and eye development. Continue to follow your hunger and fullness cues and practice eating intuitively. Of course, enjoy some ice cream when you feel like it, but make it a delicious cone of your favorite flavor that you enjoy mindfully.
Charmaine Ng | Architecture & Lifestyle Blog says
I’m not a mother nor am I pregnant (not at that life stage, haha), but it was interesting reading your tips!
Charmaine Ng | Architecture & Lifestyle Blog
http://charmainenyw.com
Amanda says
Thank you for the post today! Loved the part of low blood sugar insomnia. I’ve had experience with this before I got pregnant and it still happens about 4 times a week at 21 weeks pregnant. I never had a good remedy so thank you!
KathEats says
Give it a try! It’s like magic for me.
Claire says
In the UK, we are not advised to avoid deli meat, just unpasturised cheeses and pate etc. The salad at the bottom of the post looks really good!
CM says
I’ve heard folate is better than folic acid. What are your thoughts on that?
KathEats says
I think getting nutrients from real food is always ideal because we don’t know what we don’t know about supplementation, synergy, and interactions between nutrients. That said, I think taking a prenatal with a normal amount of folic acid (aka not a huuuge dose in its own pill) is totally reasonable and recommended.
https://www.ncbi.nlm.nih.gov/pubmed/17284745
https://www.ncbi.nlm.nih.gov/pubmed/25943647
Melanie says
I came here to comment this. With something like an estimated half of the population having the MTHFR gene mutation, it’s becoming increasingly important to focus on foods and supplements with FOLATE and not folic acid. The portion of the population with MTHFR cannot process synthetic folate (folic acid), which can lead to numerous health issues. For pregnant women, that can mean centerline tissue overgrowth. In babies, this often presents as stork bite marks on the back of the neck, lip ties, tongue ties, sugar bug veins on the nose, etc. It’s becoming more and more noticed now that so many kids have ties – this leads to trouble breastfeeding, dental problems, speech delays, I could go on and on! Super interesting topic for me – one of my lactation consultants I worked with after my daughter was born last year taught me more about it.
KathEats says
Very interesting!
Ashley M at neverhomemaker says
I have MTHFR (heterozygous) and my doc thinks it may have been a factor in my three pregnancy losses. I also avoid prenatals (and anything else fortified) with synthetic folic acid. Interestingly, my last doctor had me take extra folic acid with my second child (i think that was an old method of treating MTHFR) and she has a stork bite on her neck! This time my vitamins have folate and I try to just eat folate rich foods.
Shana says
Thank you for mentioning that it’s ok to live in survival mode during the first trimester. I hear so many women berating themselves for not being able to eat salads and worrying about nutrients for the baby. But I truly believe our body knows how to best take care of itself and can fully function even if all you can stomach is waffles and butter. My tip would be to choose nutrient dense foods most of the time BEFORE getting pregnant so your body can stockpile at least some of those nutrients. My other tip would be to be gentle with yourself during pregnancy and trust that your body will follow its own natural rhythm that will eventually rebalance itself over time. This is a great post for all women to read!
KathEats says
Yes and yes 🙂
Robin says
From personal experience, it’s worth mentioning the sodium content of olives, pickles, etc. can impact water retention, especially in hot summer months/3rd trimester. I found it wasn’t worth eating more than 1 or 2 olives or thinly sliced pickles at a time- I would have had to drink gallons of water to try to counter balance the sodium’s impact on my ankles!!!
Liz says
Oh dang it. I love my gummy prenatals! Lol.
Kelli @ Hungry Hobby says
Love this post! My hydroflask and I are BESTIES seriously, that thing keeps water cold even in the 115F heat! I want to get one with a straw to take with me in my hospital bag. Speaking of that would love to hear what you are going to pack! Thanks for sharing my food safety post as well!
KathEats says
I imagine I’m going to pack about the same as last time. I am an overpacker and was so glad I packed everything I did last time! (My own PJs, my own THIN Always pads, etc.) I’ll probably do an update post when the time gets closer 🙂
Kelli @ Hungry Hobby says
Thanks for the link I saved it! 🙂
Megan says
I’m still in my first trimester (11 weeks with my first babe!) and I second all of your tips. I’d also add that I’m trying to stay away from BPA’s in food packaging as much as possible. I’ve been trying to do that for a while, but I’m being extra careful to drink my water from a glass bottle at work and reheat my food in glass prep containers. I know there needs to be more research on this topic, but I figure it’s a good time to start focusing on the more natural material options we can keep our food in!
KathEats says
Congrats! And that’s a good goal to add to the list.
Julie says
What does “sink and swallow” mean when you’re talking about vitamins? I’ve never heard that before….
KathEats says
It’s the difference between trying to swallow something that sinks and something that floats. The floater is harder for me to get down because the capsule has air in it and it floats.
Katie says
I’m the total opposite. Capsules are so much easier for me because they are smoother and less of a taste ime.
Julie says
I’m not sure that’s a thing? ????? Or maybe just not a thing that’s happened to me.
KathEats says
Ha, well maybe you are better at taking pills than me!!
CM says
One more question!
Can you explain the difference between taking a pricey prenatal vitamin and the grocery store brand? Are they different? How do you decide?
KathEats says
The more expensive ones have added ingredients (like probiotics) and are often whole food based and/or made with organic ingredients. I think a prenatal is important enough to get one that has as much punch as you can. Also look for a seal of approval from United States Pharmacopeia (USP), NSF International, or Consumer Lab, which independently verify that what’s supposed to be inside is inside.
LH says
“Watch your caffeine intake – one small cup of coffee under 200 mg is considered fine (checkwithyourdoctor) but be mindful of sodas and black tea”
This doesn’t make sense to me – soda has about 30 mg and black tea has under 50 mg, so you can have four-five of those and still not have as much caffeine as you’d get in a single cup of coffee (especially iced coffee – cold brew has more caffeine).
There are plenty of once/day prenatal vitamins. You made me panic and run to check mine (I have a four month old and never took more than one/day during or after pregnancy) but the label does indeed say you only need to take one. Mine are Nature Made, fwiw.
KathEats says
You’re splitting hairs a little bit, but I mean be mindful of your sodas and black tea if you’ve already had a cup of coffee that day.
I also didn’t say not to take a one-a-day just that if you have a three-a-day dose it’s best to space them out. The three-a-days might be easier on the stomach because there are less nutrients packed into each pill.
Danielle says
Thanks for this post! Can you confirm that your OB was ok with epsom salt baths? The bottle says to check with a doctor if pregnant.
KathEats says
I can’t confirm because I didn’t ask my OB directly. So I guess it’s best to double check with yours. I know you can’t rely on internet information to make decisions (callyourdoctor) but there are many online articles about the benefits of Epsom salt while pregnant. I do know that hot baths are contraindicated – so make sure the water is warm at best.
Sandra says
I’m confused about magnesium being narrated later in pregnancy. Does our body make more? Why do we need to absorb it through our skin? I didn’t realize that it got into our bloodstream when we took a. Epsom salt bath. If it’s increased, seems like we would want to avoid getting more via a bath, right?
Amanda says
The dentist in me gets nervous to hear you recommend a sip of fruit juice for insomnia. Even the smallest sip of juice exposes your teeth to all the juice acid that will then sit there for the rest of the night, starting the demineralization of enamel process and greatly increasing xavity risk (even and especially in someone who has never had much of a cavity problem). If consumed as part of a normal meal or snack, drinking juice is less harmful because chewing other foods in conjunction with drinking the juice, reduces the ph change from the juice. Obviously, sleep and prenatal nutrition are super important! I would just want someone to also think about how those sips of juice can impact their teeth too. Loved your tips though! I’m 11 weeks pregnant with my second and in the throws of pregnancy food aversions so I appreciated the “big picture” reminder about nutrients.
KathEats says
Agree with you – hopefully this is just a once in a while fix. And a quick brush after might solve the problem too.
Congrats to you!!
Emily says
I’ve been reading some of your prenatal posts today– but I just want to add that some prenatals (many of which are marketed as healthy/whole-food/organic) have large amounts of heavy metals in them. I would recommend checking out some independent verifications for prenatal metal contamination (puremarket covers a whole bunch of popular brands) before buying one.