Pregnancy & Breastfeeding

This information has been reviewed and adapted for use in South Carolina by Janis G. Hunter, HGIC Nutrition Specialist, and Katherine L. Cason, Professor, State Program Leader for Food Safety and Nutrition, Clemson University. (New 06/08.)

HGIC 4118

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Nutritional Needs

Pregnant and breastfeeding women and teens have special nutritional needs. Eating well is especially important to help mother and baby stay healthy.

Every pregnant woman should visit a health care provider regularly. That provider can prescribe a safe vitamin and mineral supplement and anything else that ensures the health of mother and baby.

If you are pregnant with twins, triplets or other multiple births, you need higher levels of nutrients and calories than a woman carrying one baby. You should visit your health care provider more often and be monitored more closely, because multiples increase the risk of premature births.

MyPyramid Plan for Moms: Your baby eats what you eat. To have a healthy baby, eat healthful foods from MyPyramid, the food guide pyramid. If you need help choosing the right foods and making better decisions for the health of you and your baby, go to the www.MyPyramid.gov website and click on “MyPyramid Plan for Moms.”

“MyPyramid Plan for Moms,” which contains new interactive tools and information for pregnancy and breastfeeding, was released on May 6, 2008 by USDA (U.S. Department of Agriculture). These tools allow you to create a personalized plan of what and how much to eat from each food group during each trimester of pregnancy or breastfeeding stage. These plans are based on information entered by each individual. For example, if you are pregnant, enter your height, pre-pregnancy weight, physical activity level, and due date.

Enter similar information when breastfeeding, including your baby’s birth date and whether you are feeding your baby breast milk only or supplementing breast milk with formula. If your baby receives no formula, select “breast milk only, no formula,” even if he also eats some solid foods (e.g. cereal or fruit). If you breastfeed at least half the time and sometimes give formula, then select “at least half breast milk, plus some formula.” Breastfeeding only once or twice a day and mostly giving your baby formula means that you should select “some breast milk, mostly formula.”

This website provides a wide variety of additional information, including links to USDA and HHS (U.S. Department of Health and Human Services) websites and other reliable resources.

Foods to Choose Often: On average, an adult needs the following daily amounts of foods from MyPyramid: 6 oz. grains; 2½ cups vegetables; 2 cups fruits; 3 cups milk and calcium-rich foods; and 5½ oz. meat and beans. You should eat the amounts of the foods recommended by your personalized MyPyramid Plan for Moms.

Pregnant and breastfeeding women have a higher need for some vitamins and minerals. Choose the following foods often, because they are the best sources of some nutrients (e.g. vitamins A and E, potassium and iron).

Vegetables: carrots; sweet potatoes; pumpkin; spinach; cooked greens (e.g. kale, collards, turnip green and beet greens); winter squash; tomatoes and tomato sauces, and red sweet pepper.

Fruits: cantaloupe; honeydew melon; mangoes; prunes or prune juice; bananas; apricots; oranges and orange juice; red or pink grapefruit and avocado.

Milk: fat-free milk (skim milk); low-fat milk (1% milk) and fat-free or low-fat yogurt.

Grains: fortified ready-to-eat cereals; fortified cooked cereals and wheat germ. Make half of these whole grains.

Meat & Beans: cooked dry beans and peas (e.g. pinto beans, soybeans, white beans, lentils, kidney beans and chickpeas); nuts and seeds (e.g. almonds, hazelnuts, pine nuts, sunflower seeds, peanuts and peanut butter); lean beef, lamb and pork; shrimp, clams, oysters and crab; halibut, cod, rainbow trout, herring, sardines, rockfish and yellowfin tuna.

It is safe to eat up to 12 ounces (two average meals) of a variety of fish and shellfish weekly. However, do not eat large fish such as shark, swordfish, king mackerel or tilefish, because they contain high levels of mercury. Five of the most commonly eaten fish that are low in mercury include shrimp, salmon, pollock, catfish and canned light tuna, which has less mercury than albacore (“white”) tuna and tuna steaks. Limit consumption of albacore tuna and tuna steaks to 6 ounces or less per week.  For more information on mercury in fish, refer to HGIC 4020, Go Lean With Protein.

Your diet also should include a limited amount of healthful fats and oils. Choose these healthier fats often: olive oil; canola oil; other vegetable oils; tub margarine (preferably trans-fat free) and nut butters (peanut, almond and soy). However, if you have a family history of food allergies, talk to your doctor before eating nuts or nut butters.

Read food labels and choose foods that are low in the “extras,” which are added sugars and solid fats. Look for terms like low-fat, fat-free, unsweetened and no-added-sugars. Avoid items such as soft drinks, desserts, fried foods, cheese, whole milk and fatty meats.

Eat high-fiber foods, such as whole-grain cereals, vegetables, fruits, beans, whole-wheat breads and brown rice. In addition, drink plenty of water and get daily physical activity. This helps prevent constipation, which many women have during pregnancy.

To help prevent heartburn: eat small, frequent meals; eat slowly; avoid spicy, fried and fatty foods (e.g. hot peppers or fried chicken); limit your caffeine consumption; drink beverages between meals instead of with meals, and don’t lie down for at least one hour after eating.

If you have “morning sickness,” your doctor or health care provider can help you cope while keeping your healthy eating habits on track. For example, eat dry whole-wheat toast or whole-grain crackers when you first wake up, even while still in bed. Wait until later in the morning to eat the rest of your breakfast (e.g. fruit, oatmeal, cereal, milk or yogurt).

Fluid Needs: Have you noticed that you are thirstier than you used to be? You need more fluids, especially when you are breastfeeding. Drink enough water and other fluids to quench your thirst, preferably 8-12 cups daily.

Have a glass of water or other beverage every time you breastfeed. Limit your intake of beverages with added sugars, such as soft drinks and fruit drinks.

You can drink a moderate amount (up to two or three cups a day) of coffee or other caffeinated beverages without affecting your baby. Caffeine is in regular coffee, tea and cola drinks, including many yellow soft drinks. Breastfeeding women should not drink alcoholic beverages, because any alcohol in the mother’s bloodstream can pass into breast milk.

Dietary Supplements: A dietary supplement is any product that contains a “dietary ingredient” intended to enhance the diet. Substances that may be “dietary ingredients” include:

  • vitamins.
  • minerals.
  • herbs or other botanicals.
  • amino acids.
  • substances such as enzymes.

In addition to eating a healthy diet according to “MyPyramid Plan for Moms,” talk with your doctor or health care provider about taking a daily vitamin and mineral supplement. They usually recommend a supplement for pregnant women, and they often recommend one for women trying to get pregnant and for some women who are breastfeeding. This ensures that mother and baby get enough important nutrients like folic acid and iron. However, supplements cannot replace a healthy diet, and taking extra amounts of some vitamins and minerals (e.g. vitamin A) can be harmful to the baby.

The FDA (Food and Drug Administration) considers a dietary supplement to be food rather than a drug, so it has to be labeled as a dietary supplement and have a “Supplement Facts” label. However, a supplement ordered by a doctor as a prescription is regulated as a drug, not a food.

Folic Acid: This B vitamin is important for any woman who could become pregnant. It helps prevent neural tube defects, which are serious birth defects of a baby’s brain or spine, including spina bifida. Folic acid also helps prevent birth defects like cleft lip and congenital heart disease, two defects that often happen before a woman knows she is pregnant.

Pregnant women should get at least 600 micrograms of folic acid daily, which is the amount most prenatal supplements contain. For more information about folic acid, refer to HGIC 4068, Folate.

Iron: Extra iron is needed for the increasing amount of blood in a woman’s body during pregnancy. It helps keep the blood healthy and able to carry oxygen to the cells. Iron also is stored in the baby ’s body for use during the first months of life.

Anemia, a condition caused by too little iron, may cause a woman to feel very tired or develop pale skin or paleness under the nails. Doctors and health care providers use blood tests to check for anemia during pregnancy.

Most prenatal supplements contain 27 milligrams of iron, which is the recommended daily amount for pregnant women. Drink plenty of fluids to help prevent constipation when taking an iron supplement. To learn more about iron, see HGIC 4066, Iron.

Other Supplements & Prescription Drugs: Tell your doctor about any supplements you are already taking, including herbals or botanicals. In addition, tell him about any other prescription medicines you are taking to avoid possible interactions between these and the prenatal supplement.

Never take a dietary supplement on your own when you are pregnant or breastfeeding, because you may take too much. Neither should you take herbal or botanical supplements on your own. Possible risks for your baby have not been determined. “Natural” products are not tested or regulated like other drugs and medicines; therefore, they may not be safe.

Fortified Foods: Some foods fortified with vitamins and minerals may help meet nutrient needs while pregnant and breastfeeding.

Vitamin D: Check food labels and choose products with vitamin D added, such as all types of fluid milk, some yogurts, fruit juices and soymilk.

Iodine: Choose iodized salt, because it is fortified with iodine, an essential mineral. However, you should keep the amount of salt and sodium in your diet to a minimum.

Folic Acid: Read labels and select foods fortified with folic acid, including ready-to-eat cereals and enriched bread, flour, pasta, rice and grain products.

Iron: Pregnant women need more iron and should choose ready-to-eat and cooked cereals that are “fortified.”

Avoid Alcoholic Beverages: In addition to not smoking and not using street drugs (e.g. cocaine, crack, marijuana or methamphetamines), pregnant women and women who may become pregnant should not drink alcoholic beverages. This includes beer, wine, liquor, mixed drinks, malt beverages, etc. Good alternatives are apple cider, tomato juice, sparkling water and other nonalcoholic beverages.

Your baby can have behavioral or developmental problems as a result of your drinking even small amounts of alcohol. Heavy drinking can cause your baby to develop serious problems like malformation and mental retardation.

Weight Gain During Pregnancy

If your weight was in the healthy range before pregnancy, then you should gain between 25 and 35 pounds while pregnant. If you were overweight or underweight before becoming pregnant, the advice is different. Let your doctor or health care provider check your weight gain regularly.

The recommended weight gain is divided this way. You should gain a total of two to four pounds during the first three months (first trimester). During the fourth to ninth months (second and third trimesters), the recommended weight gain is three to four pounds a month, or about a pound per week.

To achieve the recommended weight gain of three to four pounds a month during the last six months of pregnancy, a normal-weight woman needs to consume an extra 300 calories a day. The following healthy choices have about 300 calories:

  • 1 cup of fat-free fruit yogurt and a medium apple
  • 1 slice whole-wheat toast spread with 2 tablespoons of peanut butter
  • 1 cup raisin bran cereal with ½ cup fat-free milk and a small banana
  • 3 ounces roasted lean ham or chicken breast and ½ cup sweet potatoes

If you are gaining weight too fast or too slowly during pregnancy, change the amounts you are eating from each food group. To gain weight faster, consume more calories by eating a little more from each MyPyramid food group.

To slow down your weight gain, choose foods from MyPyramid that are unsweetened, low-fat and fat-free. In other words, reduce calories by cutting out the “extras,” or the added sugars and solid fats. “Extras” are found in foods like soft drinks, desserts, fried foods, cheese, whole milk and fatty meats. Alcohol, another “extra, ” should not be consumed during pregnancy or breastfeeding, because it can cause serious problems for the baby.

You probably will return to your pre-pregnancy weight within a few months after the birth of your baby if you gain the recommended amount of weight during pregnancy. However, gaining too much weight makes it hard to get your weight back in the healthy range after your baby is born. On the other hand, not gaining enough weight during pregnancy increases your risks for a premature delivery and a low birth weight baby.

Should you continue to get exercise? Yes, almost all women can and should be physically active during pregnancy. Your doctor or health care provider can suggest a safe level of exercise for you. Generally, the daily recommendation is at least 30 minutes of moderately intense activity, which causes you to breathe harder without overworking or overheating.

Weight Loss While Breastfeeding

Breastfeeding is best for you and your baby for several reasons. It uses up your extra calories and may help you lose those pounds gained during pregnancy, especially if you breastfeed exclusively for more than three months.

Breastfeeding also can help protect your baby against becoming sick, and it develops an emotional closeness between you and your baby. Refer to “Benefits of Breastfeeding” for more information. www.4woman.gov/breastfeeding/index.cfm?page=227

Your doctor or health care provider can keep track of your weight and tell you if you are losing weight as you should. If you are shedding pounds too fast or too slowly, change the amounts you are eating. Eat a little more from each MyPyramid food group if you are losing weight too fast. This adds a few more calories from healthful foods to your diet.

If you are losing weight too slowly or not losing at all, then cut back on calories. Eat foods that are low-fat, fat-free and unsweetened, and avoid “extras” like added sugars and solid fats. This includes items such as soft drinks, desserts, fried foods, cheese, whole milk, fatty meats and alcohol. Consuming alcohol while pregnant or breastfeeding can cause serious problems for your baby.

The amounts of food and calories that you need changes with each stage of breastfeeding to meet changing nutritional needs. You may need a vitamin and mineral supplement to meet increased nutrient needs while breastfeeding. This should be discussed with your doctor or health care provider.

Special Health Needs

Sometimes pregnant and breastfeeding moms have one of more of the following specific health needs and require advice about food choices from a doctor or health care provider.

Medical Condition: Diabetes, celiac disease, renal disease, and phenylketonuria (PKU) are a few of the medical conditions that cause specific health needs during pregnancy and breastfeeding. A baby being breastfed also may have a medical condition, food allergy or food sensitivity that requires its mother to seek advice about her food choices.

Food Allergy: A food allergy is an abnormal reaction to food, even a very small amount. The body’s disease-fighting (immune) system mistakenly thinks the food is harmful and produces antibodies for protection. The most common food allergens that cause allergic reactions are wheat, eggs, soy, milk, tree nuts, peanuts, fish and shellfish.

If you have any allergies (e.g. dust, mold or pollen) or your family has a history of allergies, then you should ask your health care provider for help in avoiding common food allergens (e.g. peanuts) while pregnant or breastfeeding.

To learn more about food allergies, sensitivities and intolerances, refer to HGIC 4158, Food Allergies.

Lactose Intolerance: Do you experience bloating, gas and abdominal pain after consuming milk or milk products? Then your body does not have enough of the enzyme needed to digest milk sugar. This food intolerance is due to faulty metabolism and does not involve the immune system.

There are several ways to get milk’s health benefits, including dietary calcium needed to grow and maintain strong bones. The most reliable way is to select lactose-free milk and milk products. You also can take a lactase pill before eating lactose-rich foods. Another alternative is to add lactase drops to fluid milk and milk products to help digest the lactose before you consume them.

In addition, consume milk and milk products in small amounts. Try eating or drinking up to one cup of milk with a meal, or combine milk with hot or cold cereal. Lactose is “diluted” when combined with a snack or a meal. Consume milk products that are easier to digest, such as yogurt, cheese and buttermilk. Remember to choose milk, yogurt and cheese products that are low-fat or fat-free.

You can get calcium from many foods and beverages, including: calcium-fortified items, such as soy or rice beverages, juices, cereals and breads; canned fish (e.g. sardines, salmon with bones); soybeans, black-eyed peas (cow peas), white beans, and soy products like tofu made with calcium sulfate; and some leafy greens (e.g. collard and turnip greens, kale and bok choy). The amount of absorbable calcium from these foods varies.

Note: A milk allergy is very different from lactose intolerance. People who are allergic to milk usually must avoid all milk products, because the protein components (e.g. casein) cause an allergic reaction.

Food Safety

Food safety is especially important during pregnancy and breastfeeding. A pregnant woman’s ability to fight off infection is lower than usual, and her unborn baby’s immune system is not fully developed. Therefore, mom and baby have a greater chance of getting a “foodborne illness,” or becoming sick from eating unsafe food.

The effects of a foodborne illness may be worse during pregnancy, possibly causing a miscarriage, premature delivery or death of the newborn baby. The baby also may have serious health problems after birth.

In addition to avoiding alcohol, you should not consume raw fish, fish high in mercury, soft cheeses, and anything you crave that is not food (e.g. clay or laundry starch).

For more food safety advice during pregnancy and breastfeeding, go to the www.MyPyramid.gov website and click on “MyPyramid for Pregnancy & Breastfeeding.” Select Food Safety from the menu of topics, and you can learn more about: avoiding cross-contamination; maintaining safe food temperatures; eating fish safely; and bacteria and infections (e.g. listeria and toxoplasmosis).

HGIC 3640, Food Safety for Pregnant Women & Their Babies and HGIC 3639, Listeriosis & Pregnancy: A Food Safety Concern contain additional information to keep you and your baby safe.

Other Resources

For more information on pregnancy and breastfeeding, check these websites:

  • U.S. Department of Health and Human Services. National Institutes of Health. Fit for Two: Tips for Pregnancy . http://win.niddk.nih.gov/publications/two.htm. This booklet contains ideas and tips to improve your eating plan and become more physically active before, during, and after your pregnancy.
  • www.healthierus.gov/dietaryguidelines. This website includes the 2005 Dietary Guidelines for Americans and information about food groups and nutrition values.
  • U.S. Department of Health & Human Services. http://www.hhs.gov/children/index.html#pregnancy. Refer to the section on pregnancy, which includes tips on a variety of topics from prenatal care to postpartum depression.
  • The National Women’s Health Information Center. U.S. Department of HHS. Office on Women’s Health. www.4woman.gov.This website provides resources about each trimester of pregnancy, family planning, preparing for the new baby, childbirth, postnatal and postpartum care, and financial assistance.
  • National Institute of Child Health and Human Development. www.nichd.nih.gov. Several publications on healthy pregnancy are available at this site.

MyPyramid.gov contains other links to reliable information at: www.mypyramid.gov/mypyramidmoms/more_info.html

Source:
MyPyramid for Pregnancy and Breastfeeding. www.MyPyramid.gov

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