Pregnancy Nutrition: Managing Nausea

As moms, we all know how exciting of a time it is to be pregnant. But this time can bring on some challenges related to the surge of hormonal changes going on throughout the gestation period. Some fair these changes with little difficulty while others have problems. With my second child, I struggled much more than my first with both food aversions and nausea. I had cravings for processed foods, especially processed meats – hot dogs, deli meat, and fried chicken – which are fairly unusual for me. We went to the Texas State Fair the year I was pregnant and I had an extreme craving for their world famous corny dogs. I told my husband about my primal anticipation, and he looked at me very strangely and said, “Who are you and what did you do with my wife?” But the funniest part of the story was that when I finally got a hold of the corny dog, I began scarfing it down like I hadn’t eaten in a month. I was half way finished with it when my love for the dog turned to hate. How could a food taste so incredible one minute and then taste like rot the next? Yuck! I had to get it away as fast as possible. The smell, the flavor – everything about it was hideous. So I know firsthand that yes, hormones are a crazy thing in pregnancy!

The term "morning sickness" does not give nausea
in pregnancy justice because it can certainly strike
anytime.  Take basic steps so you are well prepared.

It is very common to have food aversions and nausea in pregnancy, particularly in the first trimester. But in the most extreme cases, hormonal illness in pregnancy can cause continuous vomiting and the inability to keep food down. It can get so bad that intravenous feeding is necessary. Of course that is an extreme and rare situation, but it can happen. Here is a quick reference chart that can help you deal with your nausea in pregnancy.

CONSUME

Bland foods. [During extreme nausea and recovering from vomiting] These include white breads and pastas, applesauce, bananas, eggs and lean meats with minimal seasonings. They are easy to digest, soothe your stomach while providing much needed calories and nutrition.

Focus on nourishing foods. [Light to no nausea] Foods that nourish the body the best are the ones that contain the most nutrients. Lean meats, fish, beans, low-fat dairy, fruits, vegetables and healthy fats all supply the vitamins and minerals moms and babies need.

Peppermint or ginger. Both are safe in pregnancy and have been shown to decrease and treat pregnancy nausea. Make sure that you get real peppermint and real ginger foods and drinks. Things like commercial ginger ale do not contain the real thing.   Make your own fresh ginger tea by mincing some ginger with 4 cups of water in a tea pot.  Bring to a boil and then pour it over a 2 inch piece of fresh ginger in a coffee cup.  Add some honey and lemon for a nice, refreshing taste.  Allow the tea to cool until it is lukewarm for the most soothing effect.

Salty crackers. You read it everywhere and it’s true. They really help. And normally I would say go for the whole grain ones, but in the case of pregnancy nausea, it’s probably best to go for the old saltine-type crackers that get into your system faster.

Food with medication and vitamins. Both increase stomach acid in general, so make sure you take them with food unless instructed otherwise. Do not take any medication, vitamins or herbal supplements without telling your doctor first. Strong smells. As you are probably aware, your senses are heightened during pregnancy and that includes your sense of smell.

Enjoy decadent food cravings in moderation. We still need to exhibit self-control in pregnancy because the reality is that we are not eating for an equivalent of 2 people. More than ever, women are exceeding the weight gain goals for pregnancy and that its implications on both mom and baby. But allowing yourself to eat some of your decadent food cravings will make you feel more satisfied during pregnancy. Most decadent foods may fall into the “avoid” category, so consume only if they do not contribute to feeling ill.

AVOID

Strong smells. As you are probably aware, your senses are heightened during pregnancy and that includes your sense of smell.  An intense smelling food can trigger nausea in the blink of the eye, so be congnicent to those most offending aroma.

Skipping meals. Just as a stomach that is too full can cause nausea, the same is true with an empty stomach. The best way to eat during pregnancy is small, frequent meals.  Keep snacks in your purse and in your car so you can put something in your stomach when hunger strikes without any lapse in time.

Foods that cause reflux. Acidic foods, high fat foods, chocolate and large meals tend to produce more stomach acid. This can exacerbate nausea and also contribute to reflux (reflux also increases as the belly gets bigger due to anatomical pressure).

Drinks with meals. If you really need something to wash your food down, sip on water that is room temperature. Drinking warm, cold or too much fluid can expand your stomach to the point of causing nausea and exacerbating reflux.

Strong smells. As you are probably aware, your senses are heightened during pregnancy and that includes your sense of smell.

All personal food aversions. Each of our pregnancy experiences vary and that is also the case when it comes to the foods that we crave and dislike. Listen to those cues of aversions to avoid an unnecessary illness. If that aversion is high in nutritive value, try a similar alternative, or seek advice from a Registered Dietitian.

If you cannot keep food and/or liquid down without vomiting, contact your doctor. He may prescribe some medication that will assist you during this period. Know the signs and symptoms of dehydration which include dizziness, weakness, decreased urination, dry eyes, headache and dry mouth or eyes. Discuss your weight gain with your doctor. If either you or your doctor do not think you are gaining weight or are not getting the food variety suggested in pregnancy (see Pregnancy Nutrition: The Basics), it is best to turn to a Registered Dietitian in your area. They can work with you on an individual basis to maximize your nutrition status – for you and your baby’s sake. One day, like me, you can share giggles with others about your food issues during pregnancy. Know that this is a phase – and this phase will certainly pass!

Pregnancy Nutrition: Foods to Avoid

As dietitians, we generally do not like to say “don’t eat this” or “don’t eat that.” We believe that most foods fit into a healthy diet. However, pregnancy is a little different. It is important that you stay away from foods that might cause undue illness or even have bad effects on your developing baby. So, err on the safe side and avoid these risky foods and drinks.

Don't let grocery shopping be intimidating during
pregnancy.  Follow these basic guidelines so you
can shop stress-free.

Foods Fostering Excessive Bacteria. Since our bodies are hyper focused on growing a human body (or more with multiples), pregnancy is a time when a woman is more vulnerable to illness. So when you are thinking about consumption of foods, you want to think bacteria minimization. I am not suggesting that you become obsessive, but I am recommending some caution. Any foods that might have more opportunities for bacterial growth are best to be avoided. These include undercooked meats and seafood; underpasteurized milks, juices and cheeses; and sprouted raw vegetables (radishes, bean sprouts, alfalfa).

Alcohol. It is unknown how much alcohol causes fetal alcohol syndrome. Most experts agree that it is recommended to abstain from all alcohol in pregnancy.

Oversupplementation. While a basic prenatal vitamin is recommended to ensure adequacy of vital nutrients, oversupplementation can have equally dangerous effects. Do not believe more is better in pregnancy. Avoid any megadosing on vitamins, herbal supplementation or any other alternative supplements unless you first get approval from your physician or dietitian.

Seafood High in Mercury. The FDA says that it is safe for pregnant women to consume up to 12 ounces of low mercury fish each week.  Shark, tilefish, king mackerel and swordfish generally have higher amounts of mercury while wild salmon, shrimp, canned white tuna, catfish and tilapia have lower amounts. Fish actually contain great amounts of protein and omega-3 fats that may assist in cognitive and brain development for your baby.  There has been so much discussion about mercury intake in pregnancy that I wonder how many pregnant women are avoiding fish altogether.  I encourage pregnant women to eat fish regularly during pregnancy, staying within the FDA guidelines.

Caffeine. Caffeine levels over 200mg per day have been shown to increase a woman’s risk for miscarriage – particularly in the first trimester. A typical 8-ounce cup of home brewed coffee contains anywhere from 95-200mg. Dark caffeinated colas contain 25-44mg per 12-ounce can. The best rule of thumb is to minimize caffeine during pregnancy for optimal outcome. If you are currently drinking large quantities of caffeine, wean off slowly to avoid uncomfortable withdrawal symptoms.

Allergy Foods. Foods that are highly allergenic should only be avoided if you have a family history of a certain allergy. There is some evidence that shows avoidance during pregnancy can help lower your baby’s chances of having that allergy. High allergenic foods include peanuts, shellfish and eggs to name a few. If there is no history, allergenic foods do not need to be avoided.

Stay tuned for the last blog post on pregnancy nutrition where we discuss nausea and illness associated with hormonal changes.  I have a pretty funny story of my own that I look forward to sharing with you!

Pregnancy Nutrition: The Basics

I was honored to have written a 3-part series on pregnancy nutrition for a great product for expectant moms.  The product is called Ritmo™ which is a sound system belt that transmits songs and stories to your baby.  I wanted to share these articles with Mommy Dietitian readers, and with the posting here, you get a bonus healthy weight gain section.  Feel free to pass them along to anyone you know that is pregnant or even thinking about becoming pregnant.

Pregnancy Nutrition: THE BASICS

Congratulations on your pregnancy! Whether it is your first child or you have been pregnant before, it is thrilling news to find out you are having a baby. As a mother of a 3 year old and a 6 year old, I can attest to the road you are on this very minute. I remember the excitement and joy, but also remember the fear of the unknown. Relax! Any new adventure naturally comes with it some fear. It is very normal. The great news is that your body knows exactly what to do in order to grow this baby. My advice is follow some basic guidelines in nutrition so you can provide the fuel required to start this baby’s life off on the right foot.

Pregnancy is certainly a great motivator to eat smart. Balanced nutrition will yield a healthy body weight and will also help you achieve the vital nutrients you and your baby need during this incredible time of growth. It amazes me to know that the blood volume in our bodies increase 45-50% in pregnancy! This increase is needed for extra blood flow to the uterus, higher metabolic needs of the fetus, and increased perfusion of other organs, especially your kidneys. All of this requires proper nutrition. We will touch on the basics of pregnancy nutrition in this article so you can hit the ground running in the right direction.

Proper Weight Gain. Studies show that gaining the right amount of weight really helps your baby in being born a normal weight. Low weight gains, especially in underweight women, are associated with increased risk of perinatal mortality and low birth weights. High weight gains, particularly in obese women, are associated with increased risk of birth weight , longer labor times, complicated deliveries and birth traumas. The first thing you want to do is figure out what your body mass index (BMI) was before getting pregnant. Once you get that BMI number, look at the table below to establish what the weight gain recommendations are for you. Your obstetrician will weigh you periodically to make sure you are on the right track.

Step 1: Figure Out Your Pre-Pregnancy Body Mass Index (BMI)
http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.pdf

Step 2: Follow Recommendations for Total and Rate of Weight Gain During Pregnancy, by Prepregnancy BMI















5 Key Nutrients during Pregnancy. Nutrition needs increase during pregnancy due to rapid fetal growth, and there are some key nutrients that you should focus on while you are pregnant.

Folic Acid. Folic acid, folate or less known as vitamin B9, is critical in pregnancy nutrition. Folic acid supports reactions required for rapid cell division, carbon transfers and maintenance of red blood cells during the fetal growth process. Normal female needs are 400mcg, but daily pregnancy needs are 600mcg. Due to the critical nature of this nutrient during pregnancy, it is recommended that all pregnant women take 400mcg of a folic acid supplement to ensure adequacy (if taking a prenatal vitamin, the folic acid requirements should be included). However, foods that are high in folic acid include fruits and vegetables (especially leafy greens), whole grains and fortified cereals.

Iron. Due to the increase in blood volume as mentioned above, iron needs increase during pregnancy from 18mg to 27mg for most pregnant women.* As you progress in your pregnancy, you are at higher risk of becoming anemic due to the increased growth of the baby. Your doctor will do hematocrit finger pricks to check iron status. It is good to be mindful of foods that are naturally high in iron – such as beans, lentils, cooked spinach, fish, nuts, dried fruits, beef and other meats. There is an increase in high iron foods such as tofu of which ½ cup provides 13.2mg. Non-animal sources contain a type of iron that requires Vitamin C for absorption. Iron and calcium fight for absorption so as able, separate high iron foods from foods that are high in calcium.

Zinc. Zinc plays a vital role in protein synthesis, cell division, hormone metabolism and immune function. These bodily functions are highly utilized during pregnancy. Therefore, needs go up from 8mg to 11mg per day.* Vegetarians, depending how restrictive, may need to consider supplementation. Foods high in zinc that are recommended for pregnant women are red meat, poultry, eggs, pork, nuts, pumpkin seeds, summer squash, asparagus, chard, collard greens and broccoli.

Calcium & Vitamin D. Although needs do not increase during pregnancy, calcium (1000mg per day) and vitamin D (200-400mg per day, but amounts currently under review) are essential to bone mineralization and metabolism. Unfortunately, many women do not get adequate levels so purposeful intake is advised. Foods high in calcium are dairy foods, spinach, collard greens, soy, rhubarb and fortified cereals. Vitamin D is mostly found in dairy foods, fatty fish such as salmon and tuna; fortified foods, mushrooms and animal fat such as butter. Sunshine is an excellent source of vitamin D, so consider 15-20 minutes of daily sunshine to help achieve minimum levels.

Making a pregnancy meal plan. In general, a typical pattern should include 3 meals and 2-3 snacks each day to keep your body running well. The amounts of each type of food really depend based on your individual calorie and nutrient needs. If you are feeling nauseous, try and focus on foods that have more mild smells, spices and flavors. With my daughter, all I felt was a little nausea in the first trimester. With my son, I was very sensitive to smells and even remember changing my mind about foods mid-meal. Yuck! No worries, just make some adjustments if this happens to you. Plan around your aversions as much as you can. Overall, it is good to think this way for each meal and snack:

Breakfast: Dairy, protein, fruit, grain, healthy fat
Lunch & Dinner: Protein, vegetable, fruit, grains, dairy, healthy fat
Snacks (2-3): Protein, grains, fruit or vegetable, healthy fat

Balanced nutrition in pregnancy allows moms to
enjoy decadent treats. Here I am, pregnant with my son,
Evan, pretty excited about my baby shower cake.

Although the MyPyramid website is dynamic, a great way to get a plan that is perfect for you is to consult with a local Registered Dietitian (RD) that specializes in pregnancy nutrition. This is especially important if you have pre-existing health conditions, are having trouble getting nutrients in due to hormonal illness or have special dietary needs.

With a little proper planning and considering, you and your baby will be off on a healthy, exciting adventure. Be sure to cherish these days, write thoughts and feelings down – and above all, enjoy and appreciate this great miracle that is occurring inside your body right now. Blessings of good health to you and baby!

Linked Resources:
*Complete list of the Dietary Reference Intakes (DRIs) in Pregnancy

MyPyramid Plan for Moms

Expect the Best with Elizabeth Ward, MS, RD