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[font=verdana,arial,sans-serif]by [/font][font=verdana,arial,sans-serif]Marjorie Greenfield, M.D.[/font][font=verdana,arial,sans-serif]reviewed and revised [/font][font=verdana,arial,sans-serif]by [/font][font=verdana,arial,sans-serif]Marjorie Greenfield, M.D.[/font]
[font=arial, helvetica, sans-serif]If you start off with a relatively healthy well-balanced diet, generally following the food pyramid guidelines (found at www.USDA.gov/...), you will need to make only minor modifications in pregnancy.First TrimesterIf you find yourself having a hard time even coming close to eating a balanced diet in your first trimester, rest assured that you are not alone! Because of queasiness, some women eat all the time and gain a lot of weight. Others are hardly able to get anything down, and subsequently lose weight. And for many women, only a limited number of foods seem tolerable.Getting folate and preventing malnutrition and dehydration are the most important considerations in the first trimester. If a perfect balanced diet were that important, we wouldn't have evolved to feel so nauseated. For more information on first trimester, see the article on morning sickness.CaloriesYou need about 300 calories more than usual each day when you are pregnant. The best way to get this is to listen to your body and eat when you are hungry. Your hunger "thermostat" tells you how many calories you need. Try to eat mostly healthy foods from the bottom of the food pyramid.If you are gaining weight too slowly, eat more frequently (adding extra, small meals or healthy snacks) and consider slightly increasing the fat in your diet. If you are gaining weight too quickly, it isn't bad for the baby, but can be upsetting to you. You still need to eat when you are hungry, but can try to decrease your portion size, eat more slowly, and substitute lower fat foods for higher (like skim milk instead of 2% and frozen yogurt instead of ice cream.)CalciumBy second trimester, you need 1500 milligrams of calcium per day for your bones and the baby's. That represents more than a quart of milk. Calcium is missing from even relatively healthy diets. In addition to milk, good sources of calcium include all dairy products, calcium fortified juices, and calcium supplements. Tums-EX® has 350 milligrams per tablet.FiberFiber helps to prevent constipation, a common problem in pregnancy. North American diets tend to be low in fiber. Fiber is found in whole grains, fruits and vegetables. Fiber supplements (also called fiber laxatives) like Metamucil® or Citrucel®, are safe in pregnancy.ProteinUnless you are a strict vegetarian, protein intake is not usually a problem for pregnant women who eat a healthy diet.IronMany women start off pregnancy a bit iron deficient. This is most likely to be true for women with closely spaced pregnancies or those who have very heavy menstrual periods. You will be checked for anemia (the manifestation of iron deficiency) early in your pregnancy, and again in the third trimester.Dark leafy green vegetables and meats are good sources of iron. Iron supplements (like prenatal vitamins and ferrous sulfate tablets) can cause intestinal symptoms such as constipation, cramps and diarrhea. If you are having difficulty getting enough iron, discuss the options with your practitioner.VitaminsFor most healthy North American women, a diet that is adequate in calories and protein is adequate in vitamins, with the possible exception of folate (folic acid).Folate is found in dark leafy green vegetables and in fortified cereals. Because of the known association of folate deficiency and spina bifida (a problem of spine development) in the fetus, a 400 microgram folate supplement is recommended starting before conception. This amount of folate is found in over-the-counter folate pills and in prenatal vitamins.Since you get the other vitamins that you need in your diet, you may want to discuss with your practitioner whether prenatal vitamins are necessary, especially if you are having difficulty taking them. Folate alone, or in combination with a regular daily adult vitamin may be acceptable for you.[/font]
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