A guide to nutrition during pregnancy

You are here, pregnant and hopefully feeling very happy about it. We all have different journeys to getting pregnant. For some, it will be a long journey that might involve several attempts, investigations with a doctor and perhaps IVF. For others, it might be a surprise and perhaps involve spending many weeks not having a clue that your sudden aversion to various foods is your body’s way of saying "Hey, you need to start looking after yourself so that is why that glass of wine or sushi won’t be very appealing right now". Your body is very clever in guiding you at this time.

So, if this is the case and you find yourself in this situation, feeling anxious because maybe you haven’t prepared yourself nutritionally or mentally, don't worry. Embrace the magic of your body and know that it’s never too late to start nourishing yourself and your baby. Nutrition can make all the difference to pregnancy and beyond.

Eating during pregnancy and key nutrients

Eating for two or not?

First up, we have all heard of the saying "eating for two" when we are pregnant. Well, it doesn’t quite work like that and, in fact, we need more food once the baby is born and we are breastfeeding. While it’s critical to eat enough food during pregnancy to nourish your growing baby, keep in mind that in the first trimester, the "two" you are eating for is a tiny fetus – just pea-sized or smaller.

However, the issue often is that women don’t eat enough food, pregnant or not, as it is. So once you are pregnant, you want to make sure you eat regular meals including lots of healthy food throughout the day. That means a protein-rich breakfast, lunch with plenty of protein, vegetables and whole grains, an afternoon snack and a lighter dinner always including protein. This is not the time to diet.

In the last trimester, it’s advised that a pregnant woman should eat about 200 calories more than she usually does. Examples of snacks that are around 200 calories could be: 

• A piece of wholemeal toast with some organic peanut butter and a sliced banana.
• 1 cup of plain Greek full-fat yoghurt with a handful of blueberries.
• ½ cup of full-fat cup of cottage cheese, a sliced tomato in a wholemeal pitta bread.

The importance of protein

Aiming to eat at least 80-120 g of protein daily ensures proper fetal growth and development, as well as supporting the mother’s overall health. Choose between animal proteins such as meat, dairy, and eggs. Good vegetarian sources are things like tofu and if you eat legumes (i.e. beans and lentils). Combine these with a grain to get a complete protein. Eating adequate protein also helps to avoid that dreaded morning sickness. If you are vegan or vegetarian, you might want to make sure you check your iron levels as that can be harder to get if you don’t eat animal foods.

Calcium

Calcium is particularly important in the latter stages of pregnancy and during lactation. ‘The skeleton of full-term infants has 20–30g of calcium, most of which is accrued during the last trimester of pregnancy.’ Not only is dairy a good source of vitamin A but calcium is so important to maintain strong bones and teeth in the mother. If the mother has inadequate calcium, then this will affect the baby and the mother as the body will provide the baby with calcium at every cost.

Dairy products such as milk and cheese are a great source of calcium but if you are lactose intolerant you can also get it from plant sources such as dark leafy green vegetables, broccoli and blackstrap molasses. Also, legumes such as tofu, tempeh, chickpeas and lentils. Nuts and seeds like almonds, Brazil nuts, sesame seeds, tahini and canned oily fish with soft bones (such as canned sardines or pilchards) are also good sources.

When buying dairy make sure you get very high quality – ideally organic. Avoid unpasteurised cheese as this may contain listeria that can harm your baby. “Milk is one of the most important and cheapest sources we have available for high biological value proteins.” Dr Tom Brewer – Metabolic Toxaemia of Late Pregnancy.

Enjoy having dairy by making fruit milkshakes, omelettes with extra egg yolks, custards and cheesecakes. Making a vegetable soup including the leafy green vegetables and broccoli and serving this with some hummus on the side would be a good plant-based, high-calcium meal.

Folic acid

Having an adequate intake of folic acid before and during pregnancy can lower the chance of certain types of birth defects of the brain and spinal cord known as a neural tube defect. You may have an increased risk if there is a family history of neural tube defects, or if you have diabetes. 

This is particularly important in the first trimester as in these initial months the brain and the spinal cord start to take shape. Eat foods like dark leafy greens, avocado, broccoli, squash, nuts and citrus fruit, especially in the first three months. The leafy greens can be added to a smoothie which could be easier to sip on throughout the day especially since those early days can make you feel a bit sick. You can also supplement, see below.

Vitamin D

Vitamin D is very important for the growth and development of your baby’s bones and teeth and helps to maintain your bones too. Unfortunately, in the UK we only get vitamin D from the sun in the summer months – late March/April to the end of September. Many prenatal supplements contain vitamin D but if they don’t, supplementing with 400 IU / daily is a good idea. Having your vitamin D with a meal that contains good fats such as butter, avocado, full-fat dairy and eggs helps to significantly increase vitamin D absorption.

Sea salt

Salt is not only essential for helping to restore blood volume but also for retaining magnesium and regulating blood sugar. Studies show that salt restriction in pregnancy contributes to hypertension and the development of preeclampsia as well as decreased uterine blood flow which means less oxygen and nutrients for the fetus. So women who lose extra salt or burn extra calories because of intense exercise, for example, and don’t make allowances for this are more likely to develop rising blood pressure, preeclampsia and swollen ankles and legs.

Avoid processed foods that are very high in hydrogenated fats and salt of the wrong kind and choose instead a good quality, non-iodised, sea salt like Maldon. If you are eating enough protein and using a good, non-iodised salt this should help to pull the extra fluids out of your tissues and back into circulation.

Hyperemesis gravidarum (nausea in pregnancy)

Morning sickness is generally linked to oestrogen dominance due to an inability to detoxify oestrogen in the liver which is compounded by progesterone deficiency. If you have a hormonal imbalance before pregnancy, this may be amplified when pregnant.

“X-ray studies have demonstrated that there are spasms of the small intestine (near the bile duct) associated with oestrogen-induced nausea.” – Ray Peat PhD.

Avoid nausea by eating smaller, regular meals that include protein. The liver needs good amounts of protein to do its job. You might even find that having several very small snacks/bites throughout the day instead of larger meals helps to stave off nausea and keep your blood sugar level. Have your taste buds guide you if you really feel like you can’t keep food down.

One way to support your gut and your liver is keeping your bowel movements regular and eating a raw carrot daily is a simple tool for keeping your bowels clear and reducing any elevated estrogen. Including plenty of fibre like cooked vegetables, grains and avocado should also be on the menu.

Supplementing in pregnancy

If we all ate a good, varied diet that consisted of 90-120g of good protein, whole grains and a rainbow of vegetables and fruit, we shouldn’t have to worry about supplementing. But for many, opting for a high-quality pregnancy supplement can feel safe and protective. Make sure the supplement contains methylated folate.

A special mention about cell salts in pregnancy, they are both safe and effective. They are a homeopathic remedy that works very well to supply both mother and baby with mineral salts in the different stages of pregnancy.

One thing to remember when it comes to supplementing in pregnancy is that balance is everything which is why I like a good quality pregnancy supplement instead of supplementing with single minerals or nutrients, the exception being vitamin D.

Don’t go too extreme with anything. Eat plenty of healthy foods, lower your stress, and take time out to enjoy the journey, if only momentarily closing your eyes for a moment to check in with yourself when you are perhaps eating your lunch in a busy office. Think of every bite that you eat supports you and your baby now and beyond and remember that pregnancy is only the beginning of the journey.