There are a lot of misconceptions surrounding eating during pregnancy.  Eating for two is the most common one, but there are others including that having cravings is normal.  So, what should you know about eating during pregnancy?

While you are indeed eating for another human being, that human being will weigh around 8 lbs, so you certainly don't need to eat double the calories you normally eat.  You should focus on eating nutrient dense foods because the need for nutrients in pregnancy is significantly higher than when you are not pregnant.  Not only does your baby need nutrients as organ systems develop and mature, but your body has increased nutrient needs to sustain pregnancy.  

Cravings can be a sign your body needs more of a particular nutrient or nutrients.  Pickles are considered a common craving during pregnancy.  Pickles are salty, and the body needs salt to hold onto the fluid required to expand blood volume so that may be why it seems to be common craving.  Craving ice can be your body teling you it needs more iron.  Sometimes cravings can be for non food items (known as pica) and indicate extreme nutrient deficiencies

Salt your food to taste.  As I mentioned, your body is expanding blood volume in pregnancy, by 50 percent!  It needs salt to hold onto the fluids necessary to expand your blood volume, and let's face it; salt makes food tasty.  There is some thought that you should restrict salt in your diet to prevent swelling, high blood pressure and pre eclampsia but the evidence doesn't support these ideas.

Focus on eating whole foods that are not processed. If you are eating a wide variety of whole foods such as fruits, veggies, nuts, whole grains, meat and so on, you are providing a wide variety of nutrients and vitamins for your baby and your baby.  Be mindful that you are not eating more calories than you and your baby need. Calorie recommendations vary depending on what your BMI was before pregnancy. 

As part of my prenatal care for clients, we talk a lot about nutrition.  If a client is having cravings, usually a dietary tweak can resolve those.  I like to see a food log at least twice during pregnancy.  While I don't track client's weight, I do discuss caloric needs and encourage clients to exercise to have a healthy weight gain.  I encourage clients to eat in a way that they enjoy, and is sustainable while providing plenty of nutrients.

How much weight will I gain in pregnancy?  How much weight should I gain in pregnancy?  What can I do to keep weight gain down during pregnancy?  What if I gain too much weight while I'm pregnant?  Should I lose weight while I'm pregnant because I started pregnancy overweight? These are all questions I have been asked in my midwifery practice.

We know some of the weight gain that comes with pregnancy will go away with birth. Expanding blood volume is 3-4 pounds, amniotic fluid is about 2 pounds, the placenta is about 1 1/2 pounds, 2 lbs as breast tissues preps for breastfeeding, and your baby may weigh 7-8 pounds.  So, with birth you will drop around 12 pounds or more as soon as birth happens, and lose a few more pounds as your blood volume returns to normal levels. 

ACOG has guidelines on weight gain that are tied to what BMI was before pregnancy. The guideline for someone carrying one baby who starts pregnancy at a healthy weight is 25-35 pounds. If pregnancy starts out underweight, then the guidelines allow for higher weight gain, and the guidelines are lower for a pregnancy that starts out overweight.

Gaining too little weight has risks including that baby will have a low birthweight, and it is tied to premature labor. Babies who are smaller seem to have a harder time thriving after birth, requiring more frequent feedings than a baby who is born at a healthy weight. Gaining too much weight also is associated with risks such as gestational diabetes, preeclampsia, postpartum hemorrhage, and baby's blood sugar may drop too much after birth.

I want my clients to gain weight. I don't have "rules" about how much should be gained during pregnancy or when weight should be gained. I don't have a scale in my office to weigh clients. I figure we all have enough stress about our weight without the need to stand on a scale at appointments. 

I want clients to eat enough nutrient dense food to support their body and pregnancy. I rely on non-scale ways to ascertain if a client's diet is supporting pregnancy well. I use assessments like how fundal height is increasing, and how baby feels when I palpate. I also observe how clients look, if they feel well, and if they are having any issues such as swelling as pregnancy progresses. I like to see a food log at the start of prenatal care, and I like to see one again around 30 weeks. Some of my clients find it really helpful to keep a food log as a way to help keep the focus on eating nutrient dense foods.

I understand the desire not to gain more weight than needed for a healthy pregnancy. I work with clients to encourage them to eat nutrient dense foods, and recommend foods they may want to add or focus on if they experience cravings. If a client is eating primarily nutrient rich foods during pregnancy and engages in regular exercise, I believe she will gain the amount of weight her body needs to sustain that pregnancy. 

While encouraging clients to eat nutrient dense foods, we focus on ways to make that sustainable and enjoyable. After all, if you don't like it, you won't keep doing it. We are all individuals and while there are recommendations about weight gain, they may or may not be appropriate for the client. I do not believe in a one size fits all approach to maternity care, and I certainly do not believe a one size fits all approach is appropriate for pregnancy weight gain.

I am always looking for solid resources that help me stay up to date with the latest evidence and recommendations so when I read Real Food For Pregnancy by Lily Nichols, RDN  I was blown away. I learned so much from her book that I incorporated some changes into my practice regarding labs, and my nutritional recommendations for clients. 

It used to be assumed that protein needs during pregnancy stayed the same throughout, but a recent study shows that as the pregnancy progresses, the amount of protein needed also increases. A 2011 study has shown that outcomes are improved when mothers supplement with higher levels of Vitamin D than the 600 IU/day that is currently recommended. The mothers body is amazing, if the diet doesn't provide everything baby needs, then the body will start pulling nutrients from the mother's body. This can impact the mother years after pregnancy, so eating to support both Mom and baby in pregnancy is important not just for pregnancy.

If you are curious to learn about prenatal nutrition more in depth, and learn what the latest evidence shows, I highly recommend reading Lily's book. It's easy to read, the information is easy to understand and her recommendations are easy to implement. She even has a small section with recipes to try. Knowledge is power, and in this case knowledge is vital. We are what we eat, and babies during pregnancy get the building blocks they need to grow organ systems, and be ready for life outside the womb from what Mom eats.  Eating in a way that supports the pregnancy appropriately will make a world of difference for baby, and for how Mom feels during pregnancy, as well as Mom's health in the years after pregnancy.

What is Hemoglobin?
Hemoglobin is found in your red blood cells.  It is a protein your body makes from iron, and is what holds oxygen to transport it around your body to cells and organs.

How do I get the iron my body needs to make hemoglobin?
Food is the best source of the iron your body needs to make hemoglobin.  Remember being told as a kid you should eat liver?  Well, pregnancy is the time to take that advice.  For those who just can't handle liver (including me), red meat such as beef, buffalo, venison etc are the next best source.  Dark chocolate is a good source too.  The darker the chocolate, the higher the iron content.  Lots of foods have iron, so read labels and do some research online.  Be mindful that calcium will block iron absorption, so if you are needing to increase your hemoglobin, think twice about adding cheese to your hamburger.  On the other hand, Vitamin C will increase iron absorption so you can feel good about enjoying some dark chocolate covered strawberries.  Make sure you have are getting folate since iron needs this as well as Vitamin C to do its job.  If your iron has dropped at around 30 weeks gestation, good job expanding your blood volume!  You have time to get your hemoblogin back up to a healthy level before birth. 

What should my hemoglobin level be?
In the first prat of pregnancy, hemoglobin levels should be 12-15 g/dL.  As your blood volume expands, this number drops, usually by 2 g/dL.  This drop is due to your iron being diluted by the increased amount of blood in your body.  I prefer my clients have a hemoglobin level of at least 11 g/dL before the baby is born.  This will help Mom handle blood loss from birth well and lets baby build iron stores.  Iron transport accross the placenta to your baby is highest in the last 4 weeks of pregnancy.

How will I know if my hemoglobin levels are low? 
You may notice fatigue, brittle nails, pale skin, dizziness, shortness of breath and heart palpitaiton or rapid pulse.  I like to check hemoblogin at around 30 weeks gestation so we can see how much of a change there is, and so there is time to get it back into a healthy range.  

What should I do if my hemoglobin levels are low?
I recommend my clients focus on iron rich food while being mindful that sources of calcium will block absorption and vitamin C will increase absorption.  Depending on what lab work indicates, I sometimes recommend supplemental forms of iron and sometimes Folate to help raise levels.  It takes about 2 weeks before any increases will shop up in labwork, although often clients will notice an increase in energy, or a lower heartbeat after just a few days  of working to raise iron levels.  Depending on how much the level has dropped and how a client is feeling after working to raise levels,  I may check it again around 36-37 weeks gestation.

​Hemoglobin is critical for your baby, and for your body.  I expect hemoglobin to drop in pregnancy, and I actually find it more concerning when the level doesn't drop. Monitored through your pregnancy,  hemoglobin levels are very easy to address with simple changes in diet.
 
               



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It seems everywhere I turn, there's another article or "expert" recommending the newest supplement, superfood or diet that everyone should be taking or doing. I am amazed at how quickly the next thing comes out!  If you are thinking about adding in some supplements to your daily nutrition, there are some things to consider.

Why do you want to take this?  What benefit do you hope to get?  Sometimes you may read someting online or in a magazine that makes you think you would benefit from adding a supplement.  Perhaps your midwife has suggested you add a supplement.  You should understand the reasons for taking any supplement and what the benefits are so you can monitor to see if you are actually getting the expected benefit from a supplement.

Are there reasons not to take the supplement? What are the potential risks? There may be reasons not to take a supplement.  For instance, if you have a sea food allergy, Spirulina is something you should avoid.  Another reason may be that a supplement may have a serious interaction with a medication you are already taking.  Adding a baby aspirin to your daily nutirtion regimin may not be wise if you are already taking garlic since they both have blood thinning properties.

What supplement dose is appropriate for you?  Flouride can be beneficial in small doeses, but high doses of floride can cause several issues including heart arhythmias.  Selenium is another supplement you can take too much of, causing hair loss among other effects.  Be aware of the proper dosing and remember, too much of a good thing can have damaging effects.

Have you discussed using the supplement with a health care provider?  It is important to talk with your health care provider about your supplements.  Some over the counter supplements can interact with prescription medicines.  For instance if you are taking Levothyroxine, there can be risks to taking an over the counter decongestant.  In pregnancy, some supplements may not be wise to use, or only used in the last trimester.

Can you get the supplement benefit through nutrition changes or tweaks? The best source for nutrients is from whole food sources.  If you are experiencing low iron levels, you may want to try eating liver, spinach or more red meats before adding a supplement.  Selenium can be found in Brazil nuts.  Broccoli has more calcium per serving than milk.  Consider if dietary changes or tweaks will provide the nutirients you want to add through a supplement.

How will you know if you are getting the benefits you are looking for from the supplement?  If you are supplementing for something measurable such as taking iron to raise hemoglobin levels, having labs drawn is one of the more accurate ways to know if you are getting the benefits.  Keeping a journal of how you are feeling, and what changes you are observing is another way to determine if you are benefiting from a supplement.

Supplements can be great, or they can be detrimental so do your research before adding in something new.