General Pregnancy Information

Pregnancy is the most nutritionally demanding time of a woman's life. Your body needs enough nutrients every day to support the growth of your baby. The Food Guide Pyramid for Pregnant Women helps you choose foods for both your needs.
A pregnant woman needs about 300 calories a day more than she did pre-pregnancy to support the rapid growth of the fetus and her changing body. (Pre-pregnancy needs are about 2,200 calories daily for most active women and teenage girls and about 1,600 calories for sedentary women.)

Weight gain during pregnancy should be gradual with the most weight being gained in the last trimester. According to the ACOG, you should gain about 2 to 4 pounds during the first three months of pregnancy and then 3 to 4 pounds per month for the rest of your pregnancy. Total weight gain should be about 25 to 30 pounds. This will decrease the risk of delivering a low-birth-weight baby. The Institute of Medicine recommends that women who have a low Body Mass Index (BMI) - the ration of weight to height - should gain 28 to 40 pounds during pregnancy and women who have a higher BMI should gain 15 to 25 pounds.

Food Group	Recommended Servings	What Counts as a Serving?
Breads, Cereal, Rice, and Pasta Group - especially whole grain and refined (enriched)	6 - 11 servings	1 slice bread 1/2 hamburger bun or English muffin 3 - 4 small or 2 large crackers 1/2 cup cooked cereal, pasta, or rice About 2 cup ready-to-eat cereal
Fruit	2 - 4 servings	3/4 cup juice 1 medium apple, banana, orange, pear 1/2 cup chopped, cooked or canned fruit
Vegetable (Eat dark-green, leafy, yellow or orange vegetables, and cooked dry beans and peas often.)	3 - 5 servings	1 cup raw leafy vegetables 3/4 cup other vegetables - cooked or raw 3/4 cup vegetable juice
Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts - preferably lean or low fat	3- 4 servings	2 -3 ounces cooked lean meat, poultry, fish 1/2 cup cooked, dry beans** or 1/2 cup tofu counts as 1 ounce lean meat 2 tablespoons peanut butter or ⅓ cup nuts counts as 1 ounce meat
Milk, Yogurt, and Cheese - preferably fat free or low fat	3 - 4 servings*	1 cup milk 1 cup buttermilk 8 ounces yogurt 1 1/2 ounces natural cheese 2 ounces processed cheese 1 cup calcium-fortified soy milk
Fats and Sweets	Use sparingly	Limit fats and sweets
Alcohol	Avoid	Avoid alcoholic beverages altogether
* During pregnancy and lactation, the recommended number of milk group servings is the same for non pregnant women. A soy-based beverage with added calcium is an option for those who prefer a non-dairy source of calcium.
**Dry beans, peas, and lentils can be counted as servings in either the meat and beans group or the vegetable group. As a vegetable, 1/2 cup cooked, dry beans counts as 1 serving. As a meat substitute, 1 cup cooked, dry beans counts as 1 serving (2 ounces meat).
Adapted from Eating for Two, 2002, March of Dimes and the Dietary Guidelines for Americans, Fifth Edition, 2000, U.S. Department of Agriculture and the U.S. Department of Health and Human Services.

Read juice labels. Many drinks that seem to be fruit juices are really drinks that have littler no fruit juice. Since fruit-type drinks are mostly sugar, they do not count as a serving. Remember, fresh fruits and dried fruits have more fiber than fruit juice, so they are better choices.

The following is a chart that outlines the RDAs for by age group as well as the RDAs for pregnant women:

Prenatal Vitamins:
Prenatal vitamins are fortified with Folate and are available over-the-counter (OTC) or by prescription. If you have severe nausea or are unable to take the vitamins, you can purchase 400 mcg of folic acid by itself. There is no data that after the first trimester prenatal vitamins are beneficial.

Folic Acid or Folate:
Folate is a "B" vitamin that may lower the incidence of neural tube defects in your growing baby. You need 400 mcg of Folate daily. Over the counter prenatal vitamins contain 400 - 800 mcg of folic acid while prescription vitamins contain 1000 mcg. of Folate. Foods rich in folic acid include beans, lentils, peanuts, sunflower seeds, walnuts, almonds, orange juice, pineapple, cantaloupe, bananas, avocados, broccoli, asparagus, spinach, dark green lettuce and okra. Many cereals and breads may be fortified with Folate. The nutrition label on the foods should list any supplements.

Iron Metabolism:
For good health, it is important that you eat a balanced and varied diet. If you think that you are not getting enough iron in your diet or you become anemic, you should take an iron supplement. Iron is found in the diet in two forms - heme iron, which is well absorbed, and non-heme iron, which is poorly absorbed. The best dietary source of absorbable (heme) iron is lean red meat. Chicken, turkey, and fish are also sources of iron, but they contain less than red meat. Cereals, beans, and some vegetables contain poorly absorbed (nonheme) iron. Foods rich in vitamin C (e.g., citrus fruits and fresh vegetables), eaten with small amounts of heme iron-containing foods, such as meat, may increase the amount of nonheme iron absorbed from cereals, beans, and other vegetables. Some foods (e.g., milk, eggs, spinach, fiber-containing, coffee, tea) may decrease the amount of nonheme iron absorbed from foods. Additional iron may be added to food from cooking in iron pots.

Preparation                           Iron compound                      Percent (%)                           Elemental Iron
                                                   (mg) per tablet                      of iron                                    per tablet
Ferrous fumarate                     200                               33                                   66 *best absorption
Ferrous gluconate                    300                                 12                                   36
Ferrous sulfate                        300                                 20                                   60 *least expensive

Iron Supplements:
A blood count will be drawn during your pregnancy at the first visit and again in the third trimester to determine whether you have an iron deficiency anemia. To prevent deficiency, adult pregnant women should ingest 30mg iron per day. Breast-feeding women should ingest 15 mg per day. To treat a deficiency, take the amount prescribed by your physician or on the manufacturer's package directions. Iron is best absorbed when taken on an empty stomach, with water or fruit juice about 1 hour before or 2 hours after meals. However, to lessen the possibility of stomach upset, iron may be taken with food or immediately after meals.

Do not take iron supplements and antacids or calcium supplements at the same time. Iron supplements can be purchased without a prescription. The different preparations may be ferrous sulfate, ferrous gluconate or ferrous fumerate. Your body will absorb only a small amount each day so any of these preparations is adequate for iron supplementation. Some iron preparations contain vitamin C, which increases iron absorption or a stool softener if you have problems with constipation. If you are anemic and taking more than one iron tablet per day, separate the times that you take it. Please see the http://ods.od.nih.gov/factsheets/iron.asp#h8 for more information on iron sources in your diet and supplementation.

Ferrous sulfate is the least expensive iron with the most side effects. Many people complain of constipation while on iron supplementation. Of each 300 mg tablet of ferrous sulfate, only 60 mg of iron is available for absorption. Ferrous gluconate contains only 36 mg of iron so it is less likely to cause stomach upset. The best iron is ferrous fumarate which contains 66 mg of iron per 200 mg tablet with the most bio-available iron for absorption. Ferrous Fumarate is more expensive but is milder in terms of side effects.

Calcium:
The recommended daily allowance during pregnancy is 1000 mg daily. Supplements can be purchased without a prescription at your pharmacy. Calcium carbonate gives you the largest percentage of usable calcium and should be taken with meals. Calcium citrate should be taken between meals for best absorption. There is no difference between most generic calcium supplements. TUMS or Viactiv Chews are both excellent methods of supplementation.

Dietary Sources of Calcium
Pregnant and lactating women need 1000 mg/day of calcium. Most of the calcium in the body is found in the bodys bones and teeth. One percent circulates in the blood to enhance nerve conduction, muscle contraction and blood clotting. If nutritional calcium intake is not adequate, calcium is taken from the bone to maintain blood calcium levels and osteoporosis may occur.

Calcium Supplements:
Calcium carbonate gives you the largest percentage of usable calcium. Calcium carbonate should be taken with meals or snacks to increase absorption. Calcium absorption is dependent on an adequate level of vitamin D. Supplementation is not usually necessary because vitamin D is added to fortified milk and occurs in fish and eggs. It also occurs naturally in the skin by sunlight exposure 10 minutes/day. If you have a history of kidney stones or if calcium carbonate causes gas or constipation, try calcium citrate. Calcium citrate should be taken between meals for best absorption. Please download a list of calcium sources and supplements.

Other food sources of calcium are fortified breads and cereals. High fat dairy products should be avoided. Foods are the best source of usable calcium. Recent evidence indicates that calcium from supplements interferes with manganese, iron and thyroid medication absorption. Calcium from foods does not have that detrimental effect. Take calcium supplements under the supervision of your physician or a registered dietitian. If you are unable to obtain all the necessary calcium from foods, a combination of foods and a moderate amount of supplement may be the best therapy.

Hot tubs and Saunas:
Studies have shown that there is an increased incidence of miscarriage if a sauna is used during the first three months of pregnancy. We recommend against using the sauna during the entire pregnancy and not using a hot tub during the first three months of pregnancy. After the first three months of pregnancy, limit the hot tub to 100 degrees temperature. The danger to the fetus appears to be from raising the mother's core body temperature. Warm baths and showers are safe throughout pregnancy.

Caffeine:
Caffeine should be limited to less than 300 mg/day.

Herbal supplements:
We do not recommend any herbal supplements during the pregnancy. Most have not been studied so no safety record is available. If you are taking a supplement, please bring it to your appointment and discuss its use with your physician.

Exercise:
We encourage you to continue your normal exercise routine. There is no longer a recommendation regarding maximum heart rate or pulse while exercising. If you can speak normally, you have an acceptable heart rate. We advise 30 minutes of moderate exercise on most, if not all, days. Be careful to not injure yourself during the later part of pregnancy when your balance changes and your ligaments loosen. DO NOT EXERCISE if you have bleeding, cramping, abnormal pain or other high risk factors relating to the pregnancy. Soccer, ice hockey, skiing, horseback riding and water skiing are strongly discouraged due to risk of falling. Scuba diving is not safe at any time during pregnancy. You can download the ACOG bulletin on exercise during pregnancy. http://www.acog.org/publications/patient_education/bp119.cfm

Alcohol:
Fetal Alcohol Syndrome (FAS) is the leading known cause of mental retardation. It is preventable. Please DO NOT drink during your pregnancy or use any illicit drugs such as amphetamines, cocaine, marijuana, or hallucinogenic drugs.

Smoking:
Smoking while pregnant increases the incidence of low birth weight babies, placental abruption, miscarriage, and pre-term labor. It also increases your baby's risk for future ear infections, frequent colds and SIDS. Please do not smoke during your pregnancy.

Dental Work:
Local anesthesia injections are safe. Use a lead apron if X-rays are necessary. Pain medications and most antibiotics are safe (your dentist will prescribe correctly). Ampicillin and Lidocaine are safe.