NUTRITION

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Studies show that the better a pregnant woman's nutrition, the more likely she is to deliver a healthy baby. Eating too little (or too little of the needed foods) increases the risk of giving birth to a baby who may be born too soon or too small, have birth defects, or have breathing and blood chemistry problems at birth. Poor prenatal nutrition increases the risk of problems ranging from stillbirth to developmental delay, as well as increasing your chances of morning sickness, constipation and fatigue, heartburn and muscle cramps, and obstetrical complications, such as anemia, toxemia, a more difficult delivery, and a greater chance of needing a cesarean section.

Think of your pregnancy as a baby-building process. You yourself need energy � calories to do the building. This energy comes from fats and carbohydrates. Then you need the right mix of materials for a solid structure -- proteins, vitamins, iron, other minerals, and water. If, in building your baby you don't have enough energy the work doesn't get done. If you don't use the right mix of materials, the building isn't constructed well. All you have to do is provide enough energy and make the right materials available.

2. Body cravings change but you must match all cravings with your knowledge of good nutrition.

3. Portion sizes change. You are likely to want to eat lighter, smaller portions more slowly, and more frequently. There will be days when you graze like a toddler, snacking all day long. Sometimes you'll satisfy the "always hungry" feeling by eating all the time.

4. Your calorie needs change. You will need to eat an extra 300-500 calories per day to ensure adequate nutrition for both of you.

5. Your pregnant body needs specific nutrients: proteins, carbohydrates, fats, vitamins, minerals (mainly calcium and iron), and water. "Balancing" your nutrition during pregnancy means trying to get the right mix of these nutrients: 15% of your calories from proteins, 50-60% from carbohydrates, and 20-30% from fats, plus the recommended daily allowance (RDA) of vitamins and minerals.

6. Your need for fats changes. The pregnant body needs fats. Besides being a valuable source of energy, certain fats (called essential fatty acids) are necessary building blocks of vital tissues, especially the brain and nervous system. However, all fats are not created equal. Best nutrition is found in the fats of fish, nuts, avocados, and all vegetable oils. Less healthy, but still necessary, fats are found in dairy products. Least healthy and least necessary fats are those that come from meat.

7. Your need for cholesterol changes. Your pregnant body and your developing baby need extra cholesterol. Growing little brains need cholesterol. Cholesterol is also a building block for pregnancy hormones. Pregnancy hormones make and metabolize cholesterol anyway, so it's natural for cholesterol levels to increase during pregnancy.

8. Your protein needs change. Proteins are the structural element of your body and the body of your growing baby. Your baby's tissues and organs grow by piling up millions of proteins on top of each other until each organ has reached full growth. Try these food combinations to get complete proteins:

9. Your carbohydrate needs change. Best sources of complex carbohydrates are: pasta, potatoes, grains, legumes, nut butters, and seeds. The time-released complex carbohydrates along with fructose and lactose provide slow, steady energy and give the feeling of fullness longer, resulting in steadier blood sugar levels and a greater overall feeling of well being.

10. Your iron needs change. Iron is necessary to make the extra blood you need to nourish your baby and to make the billions of red blood cells the baby needs. Insufficient iron (anemia) or "tired blood" makes for a tired mom. Most women need to double the amount of iron in their diet when they're pregnant, taking in at least 60 milligrams of elemental iron each day, more if anemic or carrying multiples. It is nearly impossible to consume enough dietary iron while pregnant without eating excess calories. If iron upsets your already upset stomach, ask your doctor if you can safely delay taking iron supplements until after your morning sickness subsides, since the greatest demand for iron is in the second half of your pregnancy.

1. Eat iron-boosting foods. Foods high in vitamin C (citrus fruit, strawberries, green pepper, kiwi), when eaten along with iron-containing foods, increase iron absorption. Milk, tea, coffee, and antacids inhibit the absorption of iron.

2. Consider the myths about iron. Remember when your mother made you eat your spinach? Yes, spinach is rich in iron, but most of it cannot be absorbed through human intestines. There are other foods like this, ones that contain a lot of iron that is not absorbable. The figures look good on paper, but that's all it is -- "paper iron." The iron found in vegetables and egg yolk, for example, is not well absorbed.

3. Read labels. The amount of "iron" listed on a food label may be misleading. More nutritionally important is "elemental iron," which means the amount of iron that is available for absorption.

4. Choose from iron-rich foods including liver, beef, oysters, sardines, tuna, clams, shrimp, apricots, figs, peaches, raisins, bread, cereals (iron-fortified), bagel, pasta, nuts, lentils, artichoke, peas, potato, with skin and Brewer's yeast.

Your calcium needs double during pregnancy, so that your body can build healthy baby bones and maintain mommy's healthy frame. Baby's teeth and bones begin to form in the second month, and double their growth by the sixth. If the calcium in your diet is insufficient, baby will pull calcium from your bones, making them more brittle -- a condition called osteoporosis. You and your baby together need an average of 1,600 milligrams of daily calcium, 800 milligrams more than before you were pregnant. Be sure your calcium reserves are adequate when your baby begins to need large amounts, which is primarily during the third trimester. Unless you must avoid dairy products it's not too difficult to ingest this amount. New studies show that pregnant women who took 1,500 to 2,000 milligrams of daily calcium supplements can reduce their chances of developing high blood pressure and pre-eclampsia by 60-70 percent. One quart of milk contains your total daily calcium requirement. The calcium champion, the food that packs the most calcium into the least calories and agrees with most women is yogurt. If you dislike milk, an equivalent amount of yogurt is higher in calcium and generally more nutritious than milk anyway. Treat yourself to a daily yogurt shake. Three 8-ounce cups of yogurt will meet the total daily calcium needs of most pregnant women. Cheese is also a concentrated source of calcium that is an alternative to drinking milk. If you have trouble digesting regular milk, try acidophilus milk. If you have a lactose intolerance, try calcium-enriched soy or rice milk or take the enzyme lactase (lact-aid), available in tablet form, along with your milk. If it's the fat or the calories in dairy products that you're not fond of, try low-fat or non-fat dairy products, which may contain slightly higher amounts of calcium. Best sources of calcium include yogurt, milk, salmon (if the salmon is canned include the softened bones as they hold a lot of calcium), tuna, sardines, cheese, tofu, cottage cheese, blackstrap molasses, kale, and refried beans.

Unless advised by your healthcare provider, you should not restrict your salt while pregnant. Salt causes your body to retain fluid, which you need more of during pregnancy. Your fluid requirements while pregnant will nearly double to support the 40 percent increase in your blood volume and the constant replenishing of the amniotic fluid surrounding baby. Be sure to use iodized salt (not sea salt), as your body needs the extra iodine to prevent thyroid deficiency while pregnant. Salt your food to taste.

Vitamins are found in nearly all foods, so as long as you are eating a reasonably healthy and balanced diet it is unlikely that you or your baby will suffer vitamin deficiency.

The need for folic acid doubles while you're pregnant. Since your body does not store this vitamin, and as the kidneys excrete much more of this vitamin during pregnancy, you need a daily source of 400-800 micrograms. Deficiency in folic acid has been linked to congenital malformations of the baby's central nervous system, primarily spinabifida. Recent studies showed that pregnant women who took between 100 and 4,000 micrograms of folic acid during the first 6 to 12 weeks of pregnancy had a much lower risk of delivering babies with spinal column defects. Since there is no way to tell if you are one of these women, all women should take folic acid supplements, as early in pregnancy as possible since these malformations occur in the first few weeks. Folic acid is plentiful in common foods, such as raw, leafy vegetables, legumes, kidneys, nuts, liver, dark yellow fruits and vegetables, dried beans and peas, and broccoli.

Don't megadose on vitamins while pregnant unless your doctor orders. Excesses of vitamin A, D, and E have been linked to birth defects or health problems in the mother. Even though the body usually protects against overdosing of most nutrients (especially water-soluble vitamins), excess vitamins A, D, and E are not automatically eliminated from the body because they are fat-soluble and therefore stored in body fat. Large doses of vitamins A, C, and B-complex used to be considered harmless because these vitamins are water-soluble and therefore the excess is easily excreted through the urine. Yet newborns of mothers who take megadoses of vitamin C can enter the world dependent on these high doses and actually develop signs of vitamin deficiency after birth. Some infants of mothers who took large doses of vitamin B6 during pregnancy may be more likely to develop seizures. The bottom line on this new research is that it's safest to stick with the dosage of vitamins recommended by your healthcare provider, no more, no less.

Extra fluids are not only necessary to increase your blood volume by 40 percent and to keep refilling the pool of amniotic fluid; they are also necessary for your overall well-being during pregnancy. Drinking lots of water and other fluids helps keep your skin soft and smooth. More fluids in your diet put more fluids in your bowels, lessening constipation. Keeping your body primed with extra fluids helps move along and dilute the body's waste products and causes you to urinate more frequently, lessening the risk of urinary tract infections. You will need eight 8-ounce glasses of fluid a day to keep your body and your baby well hydrated. Avoid caffeine and alcohol, since these substances have a diuretic effect, robbing your body of fluids.

1. Maximize iron absorption by combining plant sources of iron with foods high in vitamin C.

2. Be sure to tell your healthcare provider you're a vegan, and have your hemoglobin checked at least every other month. Because you can still feel anemic with a normal hemoglobin level, your doctor may want to do an iron profile, which is a more accurate measure of iron-sufficiency in your blood than is measuring your hemoglobin. (Research whether the increased fluid volume artificially dilutes the hemoglobin, giving a falsely low value.)

3. If your practitioner recommends that you take iron supplements, protect yourself from discomfort by taking smaller doses with meals, for example, 100 milligrams of ferrous sulfate tablets three times a day. To increase the amount of iron absorbed from these pills, down a 100-milligram vitamin C tablet at the same time.

4. Lean on sunlight as a valuable source of vitamin D. Since vitamin D is not stored in the body, you may need to take a supplement daily. Excess vitamin D is not readily excreted, so be sure you take only the required amount, which is 400 IU daily.

5. You will need vitamin B12 supplements, since animal foods are the primary sources of this vitamin. Consult your healthcare provider. Some Vitamin B12 is found in yeast, wheat germ, whole grains, eggs, and milk.

6. If you are a lacto-ova vegetarian (eat eggs and dairy, but no meat or fish), you can get adequate vitamin D and additional protein from these sources, yet iron and B12 may still be insufficient.

7. If you are unwilling to take commercial supplements but are willing to compromise, eating four ounces of fish (fish liver oils, salmon, sardines, tuna) daily will provide enough of the otherwise missing nutrients for you to safely continue being "almost" a vegetarian while pregnant.

8. If you're a strict vegetarian (a vegan -- no eggs, dairy, meat, or fish), you will need to monitor your diet most carefully. Consult a nutritionist to work out alternative sources of marginal nutrients.

1. Grains: bread, cereal, rice, and pasta. 6-11 servings (one serving = 1 slice of bread, 2 cup of rice, pasta, or cooked cereal, 2 cup of potatoes or beans, or 1 oz. of ready-to-eat cereal). Use whole grains whenever possible.

2. Vegetables. 3-5 servings (one serving = 1 cup of raw, 2 cup of cooked, or 3/4 cup of vegetable juice). Use fresh whenever possible, organic is best.

3. Fruits. 2-4 servings (one serving = 1 medium-sized orange, apple, or banana; 2 cup of canned fruit, 3/4 cup of juice.) Use fresh whenever possible, organic is best.

4. Dairy products. 2-3 servings (milk, yogurt, and cheese; one serving = 1 cup of milk or yogurt, 2 cup of cottage cheese, 1-2 ounces of cheese, 2 cups of ice cream).

5. Meat, poultry, fish, eggs, and legumes (beans, seeds, and nuts). 2- 3 servings (one serving = 3 ounces of meat, fish, or poultry, 2 eggs, 2 tablespoons of nut butter, 1 cup of cooked legumes).

Note: The above pyramid food groups and recommended servings apply to all healthy eaters, whether pregnant or not. The range of servings accounts for levels of exercise. Very active persons would consume the higher number of servings. Pregnant women would also consume the higher number of servings and perhaps add an extra serving to groups four and five.