Health Society of South Africa

GOOD NUTRITION DURING PREGNANCY
Healthy eating for a healthy baby

You're having a baby. Congratulations! Being pregnant can be wonderful. But it can also be confusing. Don't worry. It's normal to have a lot of questions. You want to know how to give your baby the best start you can. You wonder what to eat and how much weight to gain. Maybe you want to know what to do about morning sickness. This information will help answer these and other questions you may have about healthy eating for you and your baby.

Getting to Know Nutrients
Foods contain nutrients that help you stay healthy and full of energy. The nutrients you need include calcium and protein, as well as carbohydrates, water and some kinds of fats. Your growing baby needs nutrients too. Like you, your baby gets them from the foods you eat. As you read, you'll find out how many servings of each nutrient you need daily. You'll also learn how much of a food (serving size) you need to eat to get enough of a specific nutrient.

Eating for Two ...
Right now you need enough of each nutrient to help your baby grow and to keep your own body healthy. That's why you need to eat healthy foods (those that are rich in nutrients).

When you choose healthy foods, your baby is:
Less likely to be born too early or too small
Less likely to have certain types of birth defect
And you are:
Less likely to feel tired
More likely to have an easier pregnancy

... Doesn't Mean Eating Twice as Much
Although you need more nutrients, you don't need many more calories. In fact, you only need about 300 more calories a day than before you were pregnant.

Calcium: for Great Bones

When you're pregnant, you need extra calcium to help build you baby's bones and teeth. You also need calcium to keep you own bones strong. If you don't eat enough calcium-rich foods, your body will take calcium for the baby from your bones. This means that your bones may become weak later in life.

Dairy Foods: More Than Just Milk
Gram for gram, dairy foods have more calcium than any other food. But they can be high in fat. So try eating low-fat or fat-free forms of:

Hard cheeses (43 g)
Milk (1 cup)
Ricotta (1/2 cup) or cottage cheese (2 cups)
Yoghurt (1 cup)

If You Don't Like Dairy
If you don't like dairy foods, there are still plenty of ways to get enough calcium.
Try these foods:

Broccoli, bok choy, collards, turnip greens (1 1/2 to 2 cups cooked)
Calcium-added : soya cheeses (43 g), soya milk or soya yoghurt (1 cup), tofu (255 g), rice milk or orange juice (3/4 cup)
Canned fish with bones: mackerel (1 cup), salmon (1/2 cup), sardines (5 medium fish)

If dairy is hard to digest
If you have a hard time digesting dairy foods, ask your health care provider about:
Lactose-reduced milk or yoghurt
Lactase enzymes (you can find these in drops or pills in many food stores)

Other calcium options
If your health care provider suggests taking extra calcium, look for calcium carbonate pills. Calcium in this form is easy to absorb.

Protein: Building Your Baby

Think of protein as building blocks. Millions of these protein "blocks" go into making nearly every part of your baby. Without them, your baby can't grow. That's why you need to eat enough protein. If you don't, your body will take protein from you to meet your baby's needs.

High-Quality Proteins: A Cut Above
Your body can easily use the type of protein that comes from animals. Good sources of high-quality protein include:

Chicken, turkey, lean red meat, fish (57 g)
Eggs (57 g)

If You're a Vegetarian
If you eat dairy foods and eggs, you're likely to get all the protein and other nutrients you need. But if you don't eat any animal products, talk to your health care provider. You may need more of certain nutrients. Good protein choices for vegetarians include:

Peanuts or pumpkin or sunflower seeds (1/2 cup), other nuts (2/3 cup)
Soya milk or soya yoghurt (1 cup)
Split peas, lentils, dried beans such as pinto and garbanzo beans (1 cup cooked)
Tofu (170 g) or soya cheeses (57 g)

Pumping Iron
Iron helps make the extra blood you need, as well as all the blood your baby needs. Iron is found in many foods, but some of the best sources are lean red meats, dark greens and enriched grains. Your health care provider may also suggest taking iron pills or prenatal vitamins. If these pills make you nauseous or constipated, tell your health care provider.

Carbohydrates: Vitamins and Energy

Fruit, vegetables, and grains are all carbohydrates (your body's main source of energy). And like other healthy foods, they're rich in many of the vitamins you and your baby need. When you eat fruit and vegetables of many colours each day, you're likely to meet most of your vitamin needs.

Vitamin A: Where to Get It?
Vitamin A helps your baby's cells grow. It also keeps your own skin smooth and clear. It's found in dark yellow, green and red fruit and vegetables such as:

Apricots (3 raw or 1/4 cup dried)
Cantaloupe or mango (1/4 fruit)
Carrots (1 small or 1/2 cup sliced)
Bok choy, collards, dandelion, spinach, mustard greens (1/2 cup cooked or 1 cup raw)
Squash, such as acorn or butternut (1/2 cup)
Sweet potatoes (1/2 cup)
Tomatoes (2 medium) or tomato sauce (1/2 cup)

Vitamin A: Not Too Much of a Good Thing
Both you and your baby need vitamin A to be healthy. But when you're pregnant, food sources of this vitamin are best. Try to eat at least one food that is high in vitamin A each day. Do not take vitamin A pills unless told to by your health care provider. Taking in too much of this vitamin may affect your baby's growth.

Vitamin B: Beyond Pasta
The B vitamins help your body use the food you eat. They also keep your nerves healthy and help make red blood cells. Whole-grain foods are some of the best sources of B vitamins. So reach for whole-grain forms of:

Bagels or English muffins (1/2)
Bread (1 slice)
Pasta or noodles (1/2 cup)
Tortillas (1 small) or pita bread (1/2)
Cereals (3/4 cup) or rice (1/2 cup)

Vitamin C: Not Just Orange Juice Anymore
Vitamin C helps make the tissue that supports your baby's bones and muscles. When you think of vitamin C, you may think of orange juice. You can also get healthy amounts of vitamin C in many types of fruits and vegetables. Here are a few:

Bell peppers - red, green or yellow (1 medium or 1 cup)
Bok choy, broccoli, Brussels sprouts, cabbage, cauliflower (1/2 cup)
Grapefruit or cantaloupe (1/2 fruit)
Kiwi fruit, orange, mango (1)
Papayas or strawberries (1/2 cup)
Tangerines or tomatoes (2 medium)

Folic acid: a Safeguard for You Baby
Folic acid is one of the B vitamins. Getting enough folic acid in the first weeks of pregnancy reduces the risk of certain birth defects. Good food sources include dark leafy greens and black-eyed peas, as well as pinto, kidney and navy beans. But you may need even more folic acid. Talk to your health care provider about taking folic acid pills.

Water: The Nutrient You Drink

Be sure to drink plenty of liquids. Your body will use the water in the liquids to make the extra blood you need and the fluid you baby floats in. Don't worry. Drinking a lot of liquids won't make you feel bloated. In fact, the more you drink, the less puffy you'll feel.

Your Best Choices
When it comes to liquids, water is best. But here are some other good sources of liquid:

Water or selzer water with a slice of lemon or lime (these can help ease a queasy stomach too)
Clear soups that are low in salt
Low-fat or fat-free milk, or soya or rice milk with calcium added
Fruit juices mixed with water
Popsicles or gelatin

Drinks to Avoid or Limit
While you are pregnant, avoid or limit drinking some types of liquids. They contain things that may be harmful to your growing baby. If you have questions, talk with your health care provider. Otherwise:

Avoid alcohol, including beer and wine.
Limit coffee and tea to 2 cups a day, both regular and decaf.
Limit soft drinks, both regular and diet.

If You're Very Active
If you work out, you'll need more liquids. Try to drink an extra cup of water for each 30 minutes of walking or swimming. Drink more water if you bike, jog or do aerobics.

Fats and Sugars: Limit Them

Fats are energy powerhouses. So are simple sugars such as white and brown sugars, honey and syrups. But a little bit of fat or sugar goes a long way. To get just what you need, choose low-fat foods and foods without added sugars.

Fats for Fuel
Fats give you long-lasting energy and help your body use certain vitamins. They also help your baby's brain grow. But fats are high in calories. So limit the amount of fat you add to meals. Also, if you must add fat, use a type that comes from a vegetable source. Here are some better choices:

Avocado (1/8 medium) or olives (5)
Nut butters such as peanut butter or tahini (1 to 2 tsp)
Oils such as olive, canola or corn (1 tbsp per meal)

Sugars: the Highs and Lows
Sugar may taste good and give you a quick lift. But it's high in calories and low in nutrients. Too much added sugar can also affect your moods and energy levels. So when you want something sweet, don't always add sugar or eat candy. Instead, try eating a healthy food that is naturally sweet. Have an orange, a few raisins or a ripe banana.

Artificial Sweeteners
Try not to use artificial sweeteners, like saccharin, or foods sweetened with them. Talk to your health care provider if you have questions.

Hidden Fat and Sugar Calories
Limit these foods. They are high in hidden fats and sugars:

Baked goods
Candy
Dairy desserts
Fast foods
Processed foods
Snack foods

Weighing In

Being a healthy weight is important for both you and your baby. Right now, weight gain is not just extra fat. It's also the weight of your baby and the increased blood and fluid needed to support the baby. During the first 3 months, you may not feel much like eating. That's OK. When you do feel hungry, choose foods that are high in nutrients. This will help you gain a healthy amount.

How Much is Enough?
How much you should gain depends on your weight before you were pregnant:

If your weight was normal, you may want to gain 11 to 16 kilograms.
If you were underweight, your health care provider may suggest gaining 12 to 18 kilograms.
If you were overweight, keeping weight gain to between 7 to 9 kilograms might be best.
If you were very overweight, talk with your health care provider about a weight range that might be best for you.

What if You Gain Too Much?
Gaining too much weight might cause you to feel more tired. You could also have a more difficult pregnancy or birth. If you and your health care provider decide that you're gaining too much too fast:

Limit fats and sugars.
Drink plenty of water between meals.
Eat small meals throughout the day.
Eat fruit, vegetables and whole-grain foods. They have a lot of fibre which helps you feel full.
Get at least 20 minutes of light exercise, such as walking, each day.

What if You Don't Gain Enough?
If you don't gain enough, your baby might be born too early, be too small or have health problems. But don't worry too soon. Women tend to gain most of their weight in the second and third trimesters. In the meantime:

Eat many types of foods. Make sure you get enough calcium, protein and carbohydrates.
Don't skip meals.
Eat healthy snacks.
See a registered dietitian for help.
Talk to your health care provider if you have an eating disorder or problems with food.

Average weight gain:
Extra blood: 1 800 g
Breast changes: 1 400 g
Amniotic fluid: 900 g
Placenta: 1 100 g
Uterus: 1 100 g
Baby's weight (last 3 months): 3 400 g
Body stores (fat and other): 1 800 to 3 600 g
Extra body fluids: 1 100 g

Aim for Health
A slow, steady rate of gain is often best. After the first trimester, you may gain about half a kilogram a week. But keep in mind that every woman gains weight differently. Don't worry too much about kilograms. Aim for feeling healthy, instead.

Don't Diet
Now is not the time to diet. You might not get enough of the nutrients that you and your baby need. Instead, learn how to be a healthy eater. Start by doing it for your baby. Pretty soon, you may do it for yourself.

When Your Body Talks Back

Even if you eat all the right foods, there may still be times when you don't feel as well as you'd like. Being pregnant can have it's ups and downs. But there are ways to make the down times easier. Here are some common problems and tips that might help.

Why Do They Call It "Morning Sickness"
Nausea and vomiting are most common in the morning, but they can last all day. In fact, you might turn green just thinking about food! The good news is that there's nothing wrong. Your own pregnancy hormones are making you feel queasy. It's also likely that you'll feel better after the first 12 weeks. In the meantime, it may help to:

Eat foods that are easy on your stomach. Try cottage cheese, dry toast, crackers or a plain baked potato.
Eat small, frequent meals.
Smell a cut lemon or lemon juice. This can help relieve nausea.
Drink water between meals.

Cravings?
Like many women, you may crave certain foods when you're pregnant. Sometimes these foods are rich in the nutrients that your body needs, such as the iron in a hamburger or the calcium in milk. But at other times, you may crave things that aren't so healthy. If you're concerned about your cravings, talk to your health care provider.

If You Just Can't Go
Constipation is common during pregnancy. That's because your digestion slows down so your body can get more nutrients from your food. To help reduce constipation, try these tips:

Get at least 20 minutes of light exercise daily.
Drink plenty of water.
Eat foods that are high in fibre, such as whole-grain cereals, vegetables and fruit.
Avoid eating too many refined grains, such as white bread, white rice or pasta.
Don't use stool softeners or laxatives without asking your health care provider first.

When Your Heart's on Fire
It's likely to be heartburn. Once again, your hormones may be to blame. They relax your muscles so that food and acids stay in your stomach longer. Sometimes acids back up into the passage between your stomach and throat. Later in pregnancy, heartburn may be caused by pressure from your growing baby. In either case, these tips might help prevent heartburn:

Don't eat spicy or greasy foods. Also, cut down on citrus fruit, tomatoes, black pepper and any foods that bother you.
Limit caffeine. This may mean avoiding coffee, tea, certain soft drinks and chocolate.

Cramping Your Style
Are leg cramps keeping you up at night? If so, here are some tips that may help prevent or reduce cramps:

Eat more foods that are high in calcium. Or ask your health care provider about taking calcium pills.
Drink plenty of liquids.
Stretch your calf muscles.
Sleep with your legs raised on a pillow.

Answering Your Questions

Although we've tried to answer some of the most common questions, you may have questions about things that we haven't mentioned yet. But you are likely to have even more questions as you go through your pregnancy. Be sure to talk to your health care provider or a registered dietitian about your concerns.

Should I Eat More if I Exercise?
You'll need an extra 100 calories for each 30 minutes of mild exercise. You'll need more if you work out longer or harder. Each of the following has about 100 calories:

1 cup fat-free yogurt
1 cup low-fat milk
1/2 bagel with low-fat cream cheese
1/2 turkey sandwich on whole-grain bread
1 banana

What Should I Avoid?
Right now, do not take things into your body that might harm your growing baby. Avoid:

Alcohol, cigarettes and drugs
Unpasteurised dairy foods or juices
Organ meats, such as liver
Raw or undercooked meats, such as sushi and rare hamburgers
Some kinds of fish (ask your health care provider which ones)

What is the Best Way to Take My Supplements?
Help your body get the most from vitamin and mineral pills by doing these things:

Take your pills along with food.
Take iron pills with tomato juice or other vitamin C foods (except orange juice that has added calcium). Vitamin C helps your body absorb iron.
Take calcium and iron pills at different times. Calcium makes it hard for your body to absorb iron.

How Much Should I Eat When I'm Breastfeeding?
Breast milk is the best food for your baby. It contains things that help make your baby stronger and healthier. It can also help you control your weight after the birth. But breastfeeding means you'll need more nutrients. You should try to get:

500 calories a day more than before pregnancy
Plenty of water (10 to 12 cups a day)
As much calcium and protein as when you were pregnant

What If It's Twins?
When you're eating for more than one baby, you need extra protein, vitamins, calcium and iron. Here's what to do:

Talk to a registered dietitian.
Choose foods that are rich in nutrients.
Eat small, frequent meals.
Expect to gain more weight - 2.5 to 5 kilograms more than with one baby.

Eating For Life

When you eat healthy foods, you help give your baby a head start in life. But healthy eating is good for everyone. Now is a great time to help your whole family learn to enjoy foods that are high in nutrients. That way, all the people you love can look forward to healthier lives.