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Nutrition in Pregnancy
Presented by
Dee Anne Domnick, CPM, LM, MH
Throughout Pregnancy & While
Make most of your food choices
healthy ones.
Eating too many foods that are high in
fat during pregnancy leads to too much
weight gain for you without meeting your
increased need for nutrients.
Some nutrient requirements more than
double during pregnancy, while caloric
needs increase only about 15 percent
Why is a healthy diet important
during pregnancy?
For the health of both the pregnant
woman and the developing baby
Healthy foods are the building blocks
of the growing baby since pregnancy
is a complex time of developing new
tissues and organs.
Approximately half of all pregnancies in the
United States result in prenatal or postnatal
death or an otherwise less than healthy baby.
Major developmental defects, such as
neural tube and heart deformities, occur in
approximately 120,000 of the 4 million
infants born here each year.
Exposure to toxic chemicals, both manufactured
and natural, cause about 3 percent of all
developmental defects
At least 25 percent might be the result of a
combination of genetic and environmental
Monitoring of Weight Gain is Important
—Especially of Underweight Women
In addition to the growth of the fetus
associated with maternal weight gain,
pregnant woman store fat to prepare
the mother for lactation.
Weight Gain During Pregnancy
An additional 25-35 pounds is
considered desirable for the
benefit of both the mother and
developing infant
– Recommended by the National Academy of
Sciences /Institute of Medicine
Women who are underweight
when they conceive
should gain about 28-40 pounds
Those who are overweight
should gain no more than
15-25 pounds
Short women (under 62 inches)
should set lower goals for weight
gain, 18-30 pounds
Extremely Obese Women
should gain no more than 15
Young Adolescents
should gain between 28 and 40
pounds, regardless of their prepregnancy weight and height
Women Carrying Twins
should gain 35-45 pounds,
regardless of pre-pregnancy
weight and height
Is it necessary to take a vitamin/mineral
supplement during pregnancy?
Though it’s possible to meet the
requirements for most nutrients
through a balanced diet, most
experts recommend pregnant
women take daily vitamin
supplements, including iron & folic
acid, as a safe guard.
According to the National Academy of Sciences/
Institute of Medicine, supplementation should begin
at the start of the second trimester at the following
Iron.....................30 milligrams (mg)
Folic Acid......400 micrograms (mcg)
Calcium...........………………250 mg
Vitamin C………………...……50 mg
Vitamin B12…….....…………...2 mcg
Vitamin D………..…………….5 mcg
Copper………………………….2 mg
Zinc………………………..…..15 mg
Vitamin B6………………..……..2 mg
Add an additional:
10 mcg of Vitamin D
2 mcg of Vitamin B12
About Folic Acid
Folic acid in a vitamin supplement,
when taken one month before
conception and throughout the first
trimester, has been proven to reduce
the risk for an NTD-affected
pregnancy by 50% to 70%.
Folic acid, a B-vitamin, is necessary
for proper cell growth and
development of the embryo.
Newborn with Spina Bifida
Cleft Lip & Palette
Folic Acid--important in cell development
(a water soluble vitamin)
Recent research suggests that taking folic
acid before and during early pregnancy can
reduce the risk of spina bifida and other
neural tube defects (NTD’s) in infants.
The U.S. Public Health Service
recommends that all women of
childbearing age that are capable of
becoming pregnant should consume 400
micrograms (mcg) of folic acid daily to
reduce their risk of having an NTD-affected
How Can Women Get Enough Folic Acid?
There are three ways women can get enough folic acid to help prevent
spina bifida and anencephaly. They can choose to:
1. Take a vitamin supplement containing 400 micrograms of folic acid
2. Eat a fortified breakfast cereal daily which contains 100% of the
recommended daily amount of folic acid (400 micrograms).
3. Increase consumption of foods fortified with folic acid (e.g.,
“enriched” cereal, bread, rice, pasta, and other grain products) in
addition to consuming food folate from a varied diet (e.g., orange
juice and green vegetables).
Foods rich in folate include:
orange juice from concentrate,
dark-green leafy vegetables:
(spinach, broccoli, asparagus, romaine lettuce)
other vegetables:
(carrots, tomatoes, potatoes)
beans and pulses like black-eyed beans & lentils
whole grains (i.e. brown rice & some cereals)
citrus, bananas, kiwis and strawberries,
Vitamin A supplementation is not
recommended during pregnancy
Excessive levels of Vitamin A can
be toxic to the fetus
Adequate levels of Vitamin A are
available through a balanced diet
Calories--To support the rapid growth of
the fetus, pregnancy demands an additional
300 calories a day over pre-pregnancy needs
This is approximately the same
number of calories as supplied by
2 ½ cups of low-fat milk OR
1 cup of ice cream OR
A bagel with cream cheese OR
A tuna fish sandwich
Both the expectant mother and developing fetus
need increased amounts of protein.
It is recommended that pregnant women
consume 60 grams of protein a day.
This is only 10 grams more than nonpregnant women.
Since most Americans regularly
consume more than they require, most
women will not need to consciously
increase their protein consumption
during pregnancy.
Protein Sources
Beans, legumes
Dairy Products
Lean Meats
Suggestions for Complementing Proteins
(they do not need to be consumed at the same meal as believed)
These are menu ideas for vegetarian dishes:
Stir fried tofu and rice
Tomato, rice and beans
Rice-bean casserole
Wheat-soy bread
Lentil curry on rice
Corn-soy bread
Bean or pea curry on rice
Corn tortillas and beans
Pea soup and toast
Legume soup with bread
Bread made with milk or cheese
Pasta with milk or cheese
Rice and milk pudding
Cereal and milk
Rice-cheese dishes or casseroles
Cheese sandwiches
Yogurt and barley soup
Sesame and milk
Sesame seeds in bean soup
Lentils and rice
Wheat bread with baked beans
The iron requirement doubles
during pregnancy:
30 mg/day during the second
and third trimesters.
•Additional iron is needed as a
result of increased maternal
blood volume.
Also, the fetus stores enough
iron to last through the first few
months of life.
What is anemia?
Anemia is a blood disorder that is defined as:
a level of red blood cells (RBCs) that
is below normal, or
a level of hemoglobin that is below
normal (hemoglobin is the oxygencarrying protein in red blood cells).
There are several forms of anemia, such as:
iron deficiency anemia
hemolytic anemia (destruction of RBCs)
vitamin B-12 deficiency anemia
folic acid deficiency anemia
Vit. E deficiency anemia
Vit. C deficiency anemia
anemias caused by inherited abnormalities of
RBCs (for example, sickle cell anemia and
anemia caused by chronic (ongoing) disease,
such as rheumatoid arthritis.
and more
To Get the Most of Iron from One's Diet:
Eat high-iron meals with vitamin C or foods high in vitamin C.
(Taking 200-500 mg. of Vit. C nearly doubles iron absorption).
Tannic acid, caffeine, and phosphates inhibit iron absorption; avoid them.
Avoid antacids; they neutralize stomach acids, which enhance iron absorption.
Minimize use of laxatives, which decrease the amount of time the body has to
absorb iron.
Minimize consumption of refined carbohydrates; they cause the secretion of
more-alkaline digestive juices, which decrease the acidity of the stomach.
Do not take iron supplements or high-iron meals with dairy products, which
neutralizes stomach acidity.
Niacin, B1, B2, pantothenic acid, choline, B12, folic acid, cobalt, and copper are
involved in the absorption, assimilation, and utilization of iron.
Use leavened whole grains; yeast in the fermentation process makes iron
Do not rely on iron-fortified foods; iron used by manufacturers is often a
phosphate compound not soluble in the human digestive tract.
Large doses of supplemental zinc or calcium interfere with iron absorption.
Cast-iron cookware adds iron to food, especially if the food cooked in it is acidic.
Minimize exposure to cigarette smoke and other air pollutants.
Regular aerobic exercise improves iron absorption because of the body's
greater need for oxygen-carrying capacity.
Choose iron supplements carefully.
You can help reduce your risk of iron
deficiency anemia by eating foods that contain
iron all throughout pregnancy.
These include:
Red meats
Poultry (dark meat)
Fortified breakfast cereals & whole grain breads
(check the container to see if the cereal or bread contains iron)
Blackstrap molasses
Green leafy vegetables
Baked potato, with skin
Cooked beans
Raisins, dates, prunes, figs, apricots
Selected Food Sources of Heme Iron
Milligrams per serving
Chicken liver, pan-fried, 3 ounces
Oysters, canned, 3 ounces
Beef liver, pan-fried, 3 ounces
Beef, chuck, blade roast, lean only, braised, 3 ounces
Turkey, dark meat, roasted, 3 ounces
Beef, ground, 85% lean, patty, broiled, 3 ounces
Beef, top sirloin, steak, lean only, broiled, 3 ounces
Tuna, light, canned in water, 3 ounces
Turkey, light meat, roasted, 3 ounces
Chicken, dark meat, meat only, roasted, 3 ounces
Chicken, light meat, meat only, roasted, 3 ounces
Tuna, fresh, yellowfin, cooked, dry heat, 3 ounces
Crab, Alaskan king, cooked, moist heat, 3 ounces
Pork, loin chop, broiled, 3 ounces
Shrimp, mixed species, cooked, moist heat, 4 large
Halibut, cooked, dry heat, 3 ounces
% DV*
*DV = Daily Value. DVs are reference numbers developed by the Food and Drug Administration (FDA) to
help consumers determine if a food contains a lot or a little of a specific nutrient. The FDA requires all food
labels to include the percent DV (%DV) for iron. The percent DV tells you what percent of the DV is
provided in one serving. The DV for iron is 18 milligrams (mg). A food providing 5% of the DV or less is a
low source while a food that provides 10–19% of the DV is a good source. A food that provides 20% or
more of the DV is high in that nutrient. It is important to remember that foods that provide lower
percentages of the DV also contribute to a healthful diet. For foods not listed in this table, please refer to
the U.S. Department of Agriculture's Nutrient Database Web site.
Selected Food Sources of Non-Heme Iron
Milligrams per serving
Ready-to-eat cereal, 100% iron fortified, ¾ cup
Oatmeal, instant, fortified, prepared with water, 1 packet
Soybeans, mature, boiled, 1 cup
Lentils, boiled, 1 cup
Beans, kidney, mature, boiled, 1 cup
Beans, lima, large, mature, boiled, 1 cup
Ready-to-eat cereal, 25% iron fortified, ¾ cup
Blackeye peas, (cowpeas), mature, boiled, 1 cup
Beans, navy, mature, boiled, 1 cup
Beans, black, mature, boiled, 1 cup
Beans, pinto, mature, boiled, 1 cup
Tofu, raw, firm, ½ cup
Spinach, fresh, boiled, drained, ½ cup
Spinach, canned, drained solids ½ cup
Spinach, frozen, chopped or leaf, boiled ½ cup
Raisins, seedless, packed, ½ cup
Grits, white, enriched, quick, prepared with water, 1 cup
Molasses, 1 tablespoon
Bread, white, commercially prepared, 1 slice
Bread, whole-wheat, commercially prepared, 1 slice
% DV*
Iron tea
Drink daily for iron maintenance. Take with Vit. C & folic acid
supplements for persistent anemia.
Mix equal parts:
Yellow Dock root
Red Raspberry leaf tea
Drink 1 cup daily
the culinary multi-vitamin;
a nutrient powerhouse.
Contains high levels of:
beta carotene
vitamin B12
more vitamin C than citrus
and just about all other
known nutrients.
is just like an immuneenhancing multi-vitamin
and mineral complex in
green plant form. It is one
of the most important herbs
for providing vitamins to
the body. Parsley is made
up of proteins (20 per
cent), flavonoids (maintain
blood cell membranes,
antioxidant helper),
essential oils, iron, calcium,
phosphorus, manganese,
inositol, sulphur, vitamin K,
beta carotene, and
especially vitamin C.
Iron Tincture
(This is an alternative to iron supplements)
Dandelion root
Yellow Dock root
Nettle leaf
Take 1-2 droppers/day
(depending on degree of anemia).
Calcium Rich Foods
Leafy Greens
Sesame seeds
Black strap molasses
Cheese and milk
Sardines and salmon
Hard water
What Is Preeclampsia?
Preeclampsia is a condition that
typically starts after the 20th week
of pregnancy and is related to
increased blood pressure and
protein in the mother's urine (as a
result of kidney problems).
Metabolic Toxemia of Late Pregnancy
is evidenced by symptoms of:
High blood pressure
Sudden weight gain
Spots before the eyes
Elevated liver enzymes
in the most severe cases
eclamptic seizures.
affects the placenta, and it can
affect the mother's kidney, liver,
and brain.
Preeclampsia is also a leading
cause of fetal complications, which
include low birth weight, premature
birth, and stillbirth.
When preeclampsia causes
seizures, the condition is known
as eclampsia--the second
leading cause of maternal death
in the U.S.
The Brewer Diet for Pregnancy
adapted from:
What Every Pregnant Woman Should Know by Tom and Gail Brewer
•4 exchanges of milk (1 cup each): whole milk, low fat, skim, buttermilk. If using
soy milk, 1.5 cups per serving. One serving of cheese is approximately 1.25
•2 calcium replacements for each serving of unfortified soy: almonds, walnuts,
sunflower seeds, brazil nuts, broccoli, molasses, wheat germ*
•2 eggs
•6 exchanges of fish, liver, chicken, lean beef, lamb or pork, any kind of
cheese. Beans, grains, nuts and seeds and vegetables may also be included in
this area, but do not count an item twice. (Average exchange is 1 ounce meat
or hard cheese, 1/4 cup of tuna or soft cheese, 1 cup of milk, 1 egg, 1/2 cup
beans or grains, 2 to 3 ounces of nuts, and about 5 ounces of most
•2 exchanges of fresh, dark green, leafy vegetables: broccoli, brussels sprouts,
spinach, romaine lettuce... (Average exchange is 1/2 to 1 cup)
•5 exchanges of whole grain bread, starchy vegetables and fruits. (An average
exchange is 1 slice bread, 1/2 cup cereal, pasta or rice, and 1/2 piece of fruit.)
•2 exchanges Vitamin C foods. (Average exchange is 1 fruit or 1/2 cup.)
•5 exchanges fats and oils. (1 tablespoon butter, oil or mayonnaise)
•1 exchange Vitamin A food
•Drink to thirst
•Salt foods to taste
•Liver (4 ounces) once a week (Though some people object to eating any
organ meat during pregnancy because of the risk of toxic chemicals supposed
in organ meats.)
Who Is More Likely to Develop Preeclampsia?
Women with chronic hypertension (high
blood pressure before becoming pregnant)
Women who developed high blood
pressure or preeclampsia during a previous
pregnancy, especially if these conditions
occurred early in the pregnancy
Women who are obese prior to pregnancy
Pregnant women under the age of 20 or
over the age of 40
Women who are pregnant with more than
one baby
Women with diabetes, kidney disease,
rheumatoid arthritis, lupus, or scleroderma.
Pregnant women should use caution with
vitamins A, C, and D in higher doses than the
recommended daily allowances.
Synthetic vitamin A in some drugs used for
acne and psoriasis can cause birth defects
in the developing fetus.
The concern with toxicity of vitamin D in
pregnancy is calcification of the placenta
and other soft tissues. The mother is also
more prone to developing kidney stones.
Vitamin C taken in extra large doses is
thought to cause miscarriage in the early
weeks of pregnancy and can cause harm
to the baby after birth.
a rare craving to eat
substances other than
food, such as dirt, clay,
ice, laundry starch or
coal. Speculated to be
psychological, cultural,
or even physiological.
 The craving may indicate a
nutritional deficiency such
as anemia, or may result in
 In some cases interferes
with adequate nutrient
intake or absorption
 Should be discouraged.
Caffeine in Pregnancy
Some studies suggest that drinking more
than 2 to 3 cups of coffee daily increases
the chances of low birth weight.
Watch for hidden caffeine in teas, soft
drinks, & chocolate products.
As with other diuretics, caffeine
consumption should be discussed with
one’s healthcare practitioner
Should sodium intake be restricted
during pregnancy?
Answer: No. In fact, sodium requirements
increase during pregnancy.
The sodium provided by the average diet is
likely to be adequate for expectant mothers.
Use of additional salt is rarely warranted.
Excessive sodium intake does contribute to
high pressure in some people.
Is it safe to have an occasional
cocktail, beer or glass of wine?
Because the effects of occasional alcohol
consumption during pregnancy are unknown,
most health authorities recommend not drinking
alcohol during pregnancy.
Habitual alcohol consumption does affect the
developing infant.
Studies show that pregnant women who drink
1-2 drinks per day tend to have smaller babies.
Alcohol Use in Pregnancy
Women who use alcohol during
pregnancy have a greater risk of
giving birth to babies with fetal
alcohol effects (FAE) or the more
serious fetal alcohol syndrome
Fetal Alcohol Syndrome (FAS)
Characterized by:
Growth retardation
Facial malformations
Heart malformations
Small head size
Mental deficiency
FAS affects about 40 percent of babies
born to women who drink heavily
throughout pregnancy.
Tips for Reading Food Labels
Check out those little stickers on the fresh fruits and vegetables in your market.
A five digit code beginning with a 9 means that produce was
grown organically.
A five digit code beginning with an 8 identifies genetically
engineered produce.
A label with four digits indicates conventionally grown food.
For further details, read "Talking Fruit" at
Packaged food with the USDA ORGANIC symbol must
follow these labeling guidelines:
* 100 Percent Organic = 100%
* Organic = at least 95%
* Made with Organic = at least 70%
To learn more, read "How to Read the New Organic Labels"
Pregnancy presents a good
opportunity for nutrition education.
The basic principles of good
nutrition—balance, variety and
moderation—should be
encouraged during pregnancy
and as lifetime habits.
Clients should be counseled to
enjoy a variety of nutrient-rich
foods for their own good health
and the health of their unborn