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 Nutritional Medicine: Nutritional Programs for Pregnancy 
  • Nutrient Program for Pregnancy (Range - RDA to Optimum)

    Nutrition during pregnancy is probably the most important aspect of this magical creation of life. Good nutrition before and during pregnancy can make the difference between health and sickness and support the general constitution of your child for life. The key word for pregnancy is EAT—and that means to eat well, not overeat or eat junky, high-calorie, empty nutrient, or high-fat or salty foods, but highly nourishing foods. The woman’s body needs more of everything—calories, protein, calcium, iron, zinc, B vitamins, and most other vitamins and minerals.

    A very important factor in a healthy pregnancy is the woman’s pre-pregnancy condition. The risk of nutrient depletions is greatly enhanced during pregnancy and lactation. To enter this demanding period with illness, bad habits, or any nutritional deficiency, such as anemia, may mean a troublesome pregnancy and years of recovery. So if you are thinking about having children, even vaguely considering the possibility, begin early to care for yourself. This applies to men as well. Nutritionally healthy men will provide healthier, more functional sperm and probably healthier children. My advice to people planning a pregnancy is to prepare themselves by having a complete evaluation—physical, general biochemistry, diet and nutrient analyses—and then get on a good diet and supplement program. Changing health-damaging habits such as smoking, regular alcohol or caffeine use, and other drug use is definitely a wise move.

    In Nutrition in Health and Disease, Myron Winick, M.D., calculates that it takes an estimated 75,000 calories to make a baby, or about 300–400 extra calories per day. The average woman will need 2,400–2,600 calories per day during pregnancy, and even more in the last trimester. This means about 15–20 percent more calories than usual. An extra few hundred calories can be consumed pretty easily, but if they come from sweets or other empty-calorie foods, they will not provide the extra nourishment needed. Wholesome foods are a necessity, and concentrated or nutrient-dense foods are crucial if a mother-to-be wants to get much of her requirements from food. Women need a higher nutrient/calorie ratio in pregnancy.

    Protein. Besides more food and more calories, pregnant women need nearly twice as much protein as the 45 grams usually required; 75–85 (even up to 100) grams of protein are needed daily during pregnancy. Some preliminary research, however, points out that too much protein intake during pregnancy can lead to some problems, such as larger babies and thus, more difficult birthings, and postmature babies. This area needs further study. During pregnancy, women need adequate good quality protein within a balanced diet. This protein supports the tissue growth of both the fetus and the new tissues made by the mother. Common protein foods are meat, fish and poultry, eggs, and dairy foods. Nuts, seeds, grains, and legumes are also important. The lacto-ovo-vegetarian will need sufficient grains, legumes, seeds, nuts, eggs, and dairy foods. I do not suggest strict veganism during pregnancy. Although it can be done, it does not have the same degree of safety as eating a wider range of protein foods, let alone the added calcium and iron needed. Even though vitamin B12 may be absorbed better by vegetarians than by meat-eaters because of their needs, it is not found in many vegetable foods. Traces may be found in foods such as peanuts, sunflower seeds, sprouts, kelp and other seaweeds, and soybean products, particularly tempeh, miso, and soy sauce. Seafood, however, has much higher levels of vitamin B12.

    Calcium is also very important. Calcium needs in general are more than 50 percent greater during pregnancy, particularly the second half. If the mother is not obtaining sufficient calcium, her body will pull it from her bones to nourish the growing fetus. At least 1,200 mg. of calcium are needed daily, and this is difficult to obtain from the diet alone unless more dairy products and fish are eaten. Calcium helps form the baby’s bones and teeth and aids muscle and heart function, blood clotting, and nerve transmission. Besides fish and milk products, calcium foods include whole grains, nuts and seeds, leafy greens, sea vegetables, and other vegetables. Meats contain some calcium, but their high phosphorus level may interfere with calcium utilization.

    Iron is another crucial nutrient, needed to help build blood cells in the mother and fetus. Iron also aids in disease resistance and elimination. The iron needs more than double, to at least 30–60 mg. per day and likely more. Estimates suggest that women need somewhere between 15–20 mg. absorbed, and absorption is only about 10–20 percent of that ingested, thus pregnant women need an intake likely over 100 mg. daily (and if anemic, probably more). It is difficult to get that high an iron intake from the diet alone unless we live on liver, molasses, wheat germ, and eggs, and most of us would not enjoy that much. If the mother-to-be does not obtain enough iron from her diet, she will deplete her iron stores. With these reduced, her demands to make more blood cells will not be met, and anemia will occur, usually accompanied by fatigue and poor endurance. Thus, almost all pregnant women take an iron supplement with their vitamin program. Since iron is not absorbed efficiently, more is needed to increase its availability; taking it two or three times daily also improves the chances of obtaining enough. Some women have trouble handling iron supplements; certain formulas may be handled more easily than others (again, see the Iron discussion in Chapter 6, on Minerals). Good animal sources of iron include beef liver, red meats (beef, lamb, and pork), eggs, chicken, and salmon. Vegetable sources are: seaweed, brewer’s yeast, molasses, millet, prunes, raisins, mushrooms, chard, spinach, and most nuts, seeds, and legumes.

    Zinc is another important mineral that can be deficient in pregnancy and is needed to aid normal development of the immune system in the fetus. Zinc is found in the same foods in which iron is found, with additional amounts in shellfish, especially oysters.

    Folic acid is another crucial nutrient during pregnancy. It is needed to help form red blood cells, to aid the growth and reproduction of other cells, and to support the development of the nervous system in the fetus. Folic acid also helps stimulate the mother’s appetite. Needs are doubled during pregnancy, to 800 mcg. daily. Folic acid is found in leafy green vegetables, whole grains, yeast, fish, dairy foods, and organ meats.

    Other nutrients are also needed at increased levels. The needs for vitamins A, C, E, and B6 all go up. I do not suggest megadoses of vitamin C during pregnancy because the effects of this have not been clearly determined. However, regular intake of 50–100 mg. several times daily will help utilize iron, calcium and magnesium, folic acid, zinc, and vitamin A. Other minerals, such as iodine, magnesium, and sodium, are also needed in increased amounts. For years, obstetricians were advising pregnant women to avoid sodium, but now they are suggesting that they use it as usual. For most women, some added salt is fine, and they can eat foods that naturally contain sodium, such as celery, beets, red meats, cheese, eggs, and scallops. The craving that some women have for pickles, olives, or sauerkraut may be related to a need for sodium. While more salt is needed to build the blood volume, there are limits, and very salty foods, such as potato chips and pretzels, should be avoided. Excessive salt intake can lead to problems of water retention, elevated blood pressure, and further risks to the mother and baby.

    Another change that has been suggested in the field of obstetrics involves the healthy level of weight gain during pregnancy. Even 20 years ago, doctors suggested that women limit their weight gain to 20 pounds, and even a limit of 10–15 pounds might be suggested. Now the goal is more like 20–25 pounds, or about 20 percent of ideal weight, and it has recently been shown that women who gain even 30–40 pounds, especially from good food, deliver larger and very healthy babies. The average weight gain is around 25 pounds, but 25–35 is fine. Most of the weight (10–13 pounds) is gained in the last trimester, about 8–12 pounds during the mid trimester, and only 3–4 pounds during the first three months.

    As emphasized, the mother needs more of everything during pregnancy because she has to make a new being. And Mother Nature has provided the inner baby with the mechanisms to get what it needs from the mother whether she has extra or not. As I have stated, the baby can pull minerals, vitamins, and protein from the mother’s bones, organs, tissues, and other storage areas. This can leave the mother depleted, which can take a long time, even years, to correct. Besides making a new baby, these nutrients are needed to form the placenta, to increase the size of the uterus and breast tissue, and to create amniotic fluid. Mother’s blood volume increases by 25–50 percent, and more fluids, iron, B12, folic acid, zinc and copper, calcium, magnesium, and proteins are needed to support this new blood. Storage levels of most nutrients must be obtained from the diet as well.

    So what is the best diet for our mother-to-be? First, she should eat a well-balanced diet containing all the food nutrients, with an increased amount of calories, usually about 300–400 more per day than usual. Weight-reduction programs during pregnancy are definitely taboo except for the obese and under careful supervision. (Weight Watcher’s actually has a program for pregnant and nursing women.) There is much less worry about weight gain and sodium use now than there was years ago, as both these factors may contribute to a healthy pregnancy and child. It is really the quality of the weight gain that is important—that is, the building of the necessary tissues rather than just adding fat.

    A wholesome diet is crucial to avoid wasted calories from junk foods and sugary snacks and to provide plenty of nutrient-rich foods to satisfy the increased needs for most of the vitamins, minerals, and protein. More dairy products, animal meats, whole grains, and vegetables will help a lot. Nutrient-rich foods for pregnancy that will help guard against dietary deficiencies include eggs, fish, poultry, organ meats, milk products, red meats, whole grains, wheat germ, nuts and seeds, yeast, molasses, seaweeds, and leafy green vegetables. Some of these should be eaten daily.

    Nutrient-Rich Foods that Will Help Guard Against
    Dietary Deficiencies During Pregnancy

    eggswhole grains
    fishwheat germ
    organ meats*molasses
    milk productsseaweeds
    red meatsleafy green vegetables
    nuts and seeds

    *only from organically raised animals; these foods are really more like medicines

    A high-fiber diet with whole grains, fruits, and vegetables is also important for good bowel function to avoid constipation, a common problem of pregnancy. At least six to eight glasses of good drinking water should be consumed daily besides some milk and herb teas. The top herbal choice is raspberry leaf tea, which is thought to tone up the uterus. Herbal folklore claims that a cup of raspberry leaf tea drunk daily during pregnancy will assure a healthy labor.

  • (Excerpted from Staying Healthy with Nutrition ISBN: 1587611791)
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     About The Author
    Elson Haas MDElson M. Haas, MD is founder & Director of the Preventive Medical Center of Marin (since 1984), an Integrated Health Care Facility in San Rafael, CA and author of many books on Health and Nutrition, including ...more
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