Another guest post from Susan Macfarlane, a Registered Dietitian Nutritionist running a busy private practice in Canada’s capital of Ottawa, Ontario, detailing using Cronometer.com (https://cronometer.com) to help in building a healthy baby.
Included at the end are links to Susan’s previous article’s.
Pregnancy is a time of incredible excitement and joy in the lives of parents-to-be. However, ensuring that you are meeting all essential nutrients and supplementing with the proper vitamins and minerals can feel overwhelming. Below is my essential guide for building a healthy baby and having a nourishing pregnancy.
Weight Gain Targets
In the past, women were often encouraged to “eat for two” and not worry about over-indulging on calorie-dense foods. And while pregnancy is certainly not a time to follow a restrictive diet, we now know that gaining too much weight in pregnancy can increase a women’s risk for pregnancy-related complications. The chart below highlights weight gain guidelines, according to Health Canada and the Institute of Medicine (1):
|Pre-pregnancy BMI||Recommended weight gain during pregnancy||Recommended weekly rate of weight gain (2nd and 3rd trimester)|
|< 18.5||12.5-18||28-40||0.5 kg (1.1 lb)|
|18.5-24.9||11.5-16||25-35||0.4 kg (0.9 lb)|
|25.0-29.9||7-11.5||15-25||0.3 kg (0.6 lb)|
|> 30||5-9||11-20||0.2 kg (0.5 lb)|
If your rate of weight gain is quicker or slower than the rate recommended above, it’s important to make an appointment with your physician and dietitian.
Energy Needs in Pregnancy
If you don’t need to eat for two, then how much do you need to eat during pregnancy?
The answer to this question depends on what your pre-pregnancy weight is and what trimester you are in. Women with a BMI between 18.5-24.9 should consume an extra 350 calories in the 2nd trimester (think large snack) and 450 calories in the 3rd trimester (think mini meal). If your BMI is lower than this range, you will need more food. If your BMI is higher than this range, you will need less food.
|350 Calorie Snacks||1 cup plant milk
¼ cup almonds
|¼ cup hummus
whole grain pita
|1 slice whole grain toast
1 tbsp peanut butter
1 cup plant milk
|450 Calorie Snacks||1 cup whole grain cereal
1 cup plant milk
1 cup berries
¼ cup pumpkin seeds
|1 cup plant milk
· 2 whole grain toast
· ½ avocado
· 2 T nutritional yeast
· 1 cup plant milk
· 2 T peanut butter
· 1 T flaxseed
Protein-rich foods provide essential nutrients and are needed by baby to grow muscle and other tissues. Requirements for women at a pre-pregnancy BMI between 18.5 and 24.9 are 1.1 g of protein per kg (or ~0.5 g of protein per pound).
Meeting protein requirements is not difficult, provided you are eating enough calories and including a source of protein with every meal and at 50% of your snacks. Include plenty of plant-based sources of protein, such as lentils and beans, to help alleviate constipation.
During pregnancy, iron requirements are significantly higher because of an increase in mom’s blood volume. In addition, baby’s iron stores are being built up through mom’s diet for his or her first ~6 months of life. In Canada, a prenatal multivitamin containing 16-20 mg of iron is recommended for all pregnant women to help them meet iron needs. This amount, combined with a balanced diet that includes adequate protein, should meet the iron needs of most women. Additional iron may be needed in situations where anemia develops.
Calcium is an essential nutrient used to build your baby’s bones and teeth. Requirements for calcium are not different in pregnancy since your body absorbs calcium better when you are pregnant. To ensure you are meeting your calcium needs of 1000 mg per day, include at least 1-2 cups of milk or plant milk per day, outside of meals (since calcium can interfere with absorption of iron).
This essential nutrient is produced in our skin following exposure to UV light. However, in countries/states that fall above 37 degrees north, such as Canada, making vitamin D year-round is not possible. In addition, cloud coverage, skin pigmentation, smog, and sunscreen can reduce the amount of vitamin D our bodies produce. As such, it is wise to ensure that your prenatal supplement includes at least 600-1000 IU of vitamin D.
Folate is a B vitamin that is needed to deve lop a baby’s spine, brain, and skull, especially during the first four weeks of pregnancy. A folate deficiency in pregnancy can increase the risk of developing neural tube defects, which is a deformation of the brain or spinal cord. Since folate is so important in early pregnancy, it is recommended that all women consume a folate-rich diet and take a folic acid supplement providing 400 mcg folic acid 2-3 months before conception (2).
Foods rich in folate include: edamame, cooked spinach, cooked asparagus, Brussels sprouts, legumes, and sunflower seeds.
Iodine is an essential mineral that helps to regulate function of the thyroid hormone. In pregnancy, it is needed to support healthy brain development in the fetus. Needs during pregnancy are 220 mcg and should not exceed 1100 mcg. Few foods provide a good source of iodine, which is why iodine (in Canada) is added to table salt (1/2 tsp = 190 mcg iodine). To ensure you are meeting your iodine needs, only use salt that has iodine added and ensure that your supplement contains at least 150 mcg of iodine per tablet.
DHA and EPA are long-chain omega 3 fats critical for a baby’s neurodevelopment during pregnancy. Although there is currently no consensus on how much omega 3 from EPA/DHA women should consume during pregnancy, the American Academy of Nutrition and Dietitians and Dietitians of Canada advise healthy adults to consume 500 mg of EPA/DHA per day (3). Fatty fish, such as herring, salmon, and sardines, are rich in EPA/DHA, but may contain low levels of mercury and other pollutants, such as dioxins. If you choose to avoid fish during pregnancy, it is important to supplement with a source of DHA. Fish oil supplements contain little to no mercury, while algae supplements contain no mercury and are a good choice for vegans and vegetarians. Before supplementing with DHA, talk to your doctor to ensure there are no risks of supplementing your diet with omega 3, such as intrauterine bleeding.
Building Vegan Babies
Many women are misled to believe that they can’t have a healthy pregnancy following a plant-based diet. According to the American Academy of Nutrition and Dietetics/Dietitians of Canada, “appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes” (4).
That said, it’s important to understand what appropriately planned vegan diets are. The nutrition guidelines for pregnancy outlined above apply equally to vegans, with the following considerations:
It’s important to plan your meals and snacks around plant-based sources of protein, such as seitan, tofu, tempeh, beans, lentils, nuts, and seeds. Doing so will not only ensure that you meet your protein requirements (which are ~10% higher than omnivore diets), but will help you to get sufficient amounts of iron, zinc, folic acid, and magnesium.
Iron needs for vegans may be 80% higher than non-vegans. As such, it’s important to ensure you that you are including iron in both supplemental and dietary forms. Quality sources of plant-based iron are found in protein-rich foods listed above. You can also enhance your body’s ability to absorb iron by including a source of vitamin C with meals and separating foods high in iron from those containing caffeine and calcium.
All vegans should supplement with vitamin B12 since there are no good, reliable sources of the nutrient. In pregnancy, supplementation is even more important since deficiency in the developing fetus can result in cognitive changes that can be permanent. B12 requirements in pregnancy are 2.6 mcg and can easily be met by most prenatal supplements.
Zinc is an important nutrient with many roles in the body that promotes normal growth and development in children. Like iron, needs may be slightly higher (by ~50%) in vegans and are further increased by the demands of pregnancy. Zinc can be found in protein-rich plants, and is especially concentrated in wheat germ.
Are there any foods to avoid in pregnancy?
The following foods and ingredients should be limited or completely avoided in pregnancy due to a potential risk of harm to the fetus.
Total caffeine intake should not exceed 300 mg per day, the equivalent of 1-2 250 mL cups of brewed coffee per day. Levels above this can increase the risk of miscarriage and low birth weight (5).
Most artificial sweeteners have been found to be safe in pregnancy when consumed in small, infrequent amounts. Artificial sweeteners containing cyclemates (Sugar Twin®, Sweet N’ Low®) should be avoided.
No amount of alcohol has been shown to be safe in pregnancy. Consuming alcohol when pregnant can lead to a low birth weight, developmental and neurological birth defects, and having a baby with fetal alcohol spectrum disorder (FASD).
Despite their natural origins, many herbal teas can put your baby at risk. Below is summary of teas that should be avoided during pregnancy (6).
|Teas that are NOT safe in pregnancy||Teas that MAY NOT be safe in pregnancy|
red bush tea (Rooibos tea)
evening primrose oil
St. John’s Wort
tea tree oil
Foods that increase the risk of foodborne illness
During pregnancy, a women’s immune system is slightly compromised, putting her at a higher risk of disease or illness. It’s therefore important to avoid consuming foods that are more likely to contain bacteria that could make you (and your baby) sick:
- Raw fish, seafood, and animal products
- Unpasteurized products (apple cider vinegar, orange juice, or milk products)
- Soft cheeses
- Ready-to-eat meats, unless they are cooked to steaming
- Raw sprouts
Using Cronometer in Pregnancy
Cronometer is a useful tool to help pregnant (and breastfeeding) women ensure they are meeting their nutrient needs. The first step to using Cronometer when pregnant is to set your account to “pregnant” or “breastfeeding”, as shown below:
Selecting this option will automatically adjust your targets for calories, protein, vitamins, and minerals to be consistent with the recommendations outlined in the Institute of Medicine’s Dietary Reference Intakes.
Another useful feature of Cronometer that can help you have a healthy pregnancy is the “Oracle”. If you notice that you are low in a nutrient, the Oracle can suggest foods to help you meet your nutrient needs.
As you can see from the example below, my diet was lacking in vitamin B5. The Oracle suggested that I add mushrooms to my diet in order to meet 100% of the DRI for this vitamin. (Note that vitamin D is still low in my diet since this nutrient is not commonly found in foods.)
- Food and Nutrition Board, Institute of Medicine; Board on Children, Youth and Families. Weight gain during pregnancy: reexamining the guidelines [Online]. 2009. Available from: http://books.nap.edu/catalog.php?record_id=12584#orgs
- Practice-based Evidence in Nutrition. Pregnancy: Practice guidance toolkit [knowledge pathway online]. 2017 May. Available from: http://www.pennutrition.com . Access only by subscription
- Kris-Etherton PM, Innis S, for the American Dietetic Association, Dietitians of Canada. Position of the American Dietetic Association and Dietitians of Canada: dietary fatty acids. J Am Diet Assoc. 2007;107:1599–1611. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/17936958
- Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: vegetarian diets. J Acad Nutr Diet. 2016 Dec;116(12):1970-1980. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/27886704
- Dietitians of Canada. What is the impact of caffeine intake in pregnancy and lactation? In: Practice-based Evidence in Nutrition [knowledge pathway online]. 2009 Apr. Available from: http://www.pennutrition.com. Access only by subscription
Alberta Health Services. Nutrition Guideline: Pregnancy [Online]. 2013 Mar. Available from: https://www.albertahealthservices.ca/assets/Infofor/hp/if-hp-ed-cdm-ns-4-1-1-pregnancy.pdf
Links to Susan’s previous articles for cronometer.com :