Pregnancy Nutrition

Pregnancy nutrition what you need to know about eating to grow a healthy baby

Chances are that you are reading this article because you are either pregnant (congratulations!) or are planning pregnancy and want to know how to optimise your diet and lifestyle for a healthy pregnancy journey.

Pregnancy certainly is miraculous. The fact that your body knows how to create an entire new human is almost beyond comprehension, yet women are giving birth around the world every minute. While miraculous, the idea that your body will take care of everything can leave us with a sense of disempowerment when it comes to your risk of complications and birth experience.

I completed my PhD in pregnancy nutrition because I wanted more women to be empowered with nutrition and lifestyle knowledge to support a healthy pregnancy. For many women, a diagnosis with gestational diabetes, excess weight gain, or blood pressure complications come as a stock that seriously impacts their pregnancy experience. The more risk factors that develop during pregnancy, the more dangerous labour and delivery can also become, leading to a high risk of birth trauma and an increasing sense of disempowerment. This is not what bringing a child into the world should be, however, rates of metabolic complications such as gestational diabetes and preeclampsia are increasing.

Pregnancy shouldn’t be all doom and gloom, and I’m not here to scare you about these issues. This article aims to provide you with the essential information to know how to support your body for a healthy pregnancy.

Keep reading and you will learn about:

Needs for all nutrients needs increase during pregnancy

Pregnancy is a time of massive physiological changes for the mother. Literally, building another human being requires a lot of the mother’s nutrition. All the enzyme processes involved in replicating DNA, building blood vessels in the placenta, developing organs, and expanding maternal tissues require various micronutrients to allow these processes to go smoothly.

Energy and metabolism

Let’s first look at how energy needs (aka calories) change during pregnancy. Changes in energy metabolism during pregnancy can be thought of in three phases for each trimester.

In the first trimester of pregnancy, there is no significant change in energy needs. It is a common misconception that as soon as you are pregnant, you need to start eating more to grow a tiny human. For the first 14 weeks of pregnancy, this isn’t the case.

Women will often experience changes in their appetite that come with the changes in hormone levels. While cravings for salty, carby, and fatty food are common at this time, you want to make conscious choices to avoid excess weight gain in the first trimester. Unless you were underweight entering pregnancy, you are not required to eat significantly more.

Expected weight gain in the first trimester is typically only 3 kg; most of this weight is attributed to changes in fluid distribution. Excess weight gain in the first trimester is associated with a high risk of metabolic complications such as gestational diabetes because it points to a higher baseline level of insulin resistance before pregnancy.

From around 8 weeks’ gestation is when placental hormones start to rise and ignite major changes in maternal metabolism. From this point onwards, the first half of pregnancy, or most of the second trimester, maternal metabolism is “anabolic”. This means hormones and metabolic changes all drive building and growth as the maternal body is sequestering nutrients for her developing foetus. This is the time when body fat stores are supported to expand so that mum has the energy from body fat to fuel rapid growth in the last trimester, delivery, and lactation. In the second trimester, women need roughly an additional 340 calories per day, which is the equivalent of about three eggs and half an avocado, which might make a good addition to 2 pieces of sourdough toast for breakfast or as a mid-morning snack.

Trimester One

Major hormone and metabolic shifts start around 8-10 weeks’ as the placenta forms

No significant energy increase

Remember to hydrate, as fluid needs go up

Trimester Two

More “anabolic” = Storing body fat and nutrients for later

+340 kcal

3 large eggs and 1/2 avocado

Trimester Three

More “catabolic”
= Mobilising body fat and nutrients for rapid foetal growth

+450 kcal

1 banana, 100 g plain Greek-style yoghurt, and 50 g mixed nuts or grain-free granola

The third trimester of pregnancy is the “catabolic” phase. The foetus has formed all their organs and is now ready for rapid growth and fat storage. Maternal metabolism is catabolic because mum breaks down body fat and delivers plenty of nutrients to the developing foetus to fuel their growth. This period of rapid growth means that typically a woman needs an additional ~450 calories per day, which is the equivalent of a banana with ½ a cup of Greek yoghurt and 2-3 tbsp of mixed nuts of grain-free granola that can be enjoyed as a desert.

The best way to eat for metabolic health

Problems related to blood sugar control (gestational diabetes) and insulin resistance are the most common pregnancy complications. Factors contributing to a woman’s risk for gestational diabetes, preeclampsia, or gestational hypertension all occur well before pregnancy. It is the changes in metabolism brought on by pregnancy that can then draw these complications out. However, this doesn’t mean your outcomes are totally out of your control. There is very good evidence that diet and lifestyle choices from early on in pregnancy can dramatically reduce the risk of complications associated with these metabolic conditions.

A crucial way to optimise your metabolic health during pregnancy is by eating to balance your blood sugar and insulin levels across the day. Issues with blood sugar and insulin are not only linked to gestational diabetes. This metabolic dysfunction underpins many complications in pregnancy, including excess gestational weight gain, gestational diabetes, preeclampsia, foetal overgrowth, and blood pressure problems.

The key principles of eating for blood sugar stability are:

Combine protein, fat, and slow-release carbs in every meal
Eat protein in the morning. Protein is often overlooked at breakfast because it’s not always convenient to prepare. Include foods like eggs, fish, high-protein Greek-style yoghurt, or protein powder in your first meal of the day.
Choose your amount of carbs based on your insulin sensitivity and activity levels. Some people need a decent portion of starch, such as rice or potatoes in every meal. Other people are better off choosing mostly non-starchy vegetables and fruit for their carbohydrates
Avoid refined carbohydrates and sugars. Sweet and processed starchy foods such as biscuits, chips, crackers, cereal, and muesli bars can send your blood sugar levels soaring. When we have these types of foods alone as a snack, they don’t tend to keep us feeling full, and further sweet cravings and energy crashes later in the day.
Don’t eat naked carbs. Always combine starchy or sweet foods with a source of protein and/or fat to keep you feeling full. Examples include crackers with cheese and fruit with nuts and yoghurt.

Don’t forget about protein

Protein is especially important during pregnancy. Protein is essential for life and growth; therefore, during a process of massive growth, a woman’s needs for protein increase dramatically. If there’s only one thing you consider about your diet while pregnant, it should be to think about including plenty of protein-rich foods.

Protein also offers a huge benefit to blood sugar stability. This means that protein rich-meals and snacks do a better job at keeping you feeling full and reducing carb or sugar cravings.

The first study to directly estimate protein requirements during pregnancy was published in 2015. Authors found that estimated protein requirements were nearly double the current EAR (estimated average requirement from the US dietary allowance). This means that current guidelines may seriously underestimate protein needs during pregnancy – and there’s plenty of room to eat more without overdoing it.

As a guide, you want to aim for at least 1.6 g/kg of protein per day, based on your pre‑pregnancy weight. From mid-to-late gestation, aim for closer to 1.8-2.0 g/kg. For a 65 kg woman, this means to aim for between 105-130 g of protein per day.

Here are some examples of high-protein foods, each providing 25-30 g of protein:

Micronutrients

While needs for all micronutrients go up during pregnancy, a few deserve a special mention as they may be more challenging to obtain in adequate amounts if you’re not specifically eating the right foods or supplementing. We’re going to cover these nutrients and the foods to include in your diet to make sure that you’re getting enough.

Folate (Vitamin B9)

Folate is always one of the first nutrients we think of for pregnancy because it’s the one women are recommended to supplement from the time they start trying to conceive.

Folate is the name for the natural form of Vitamin B9. Folic acid is a synthetic product only found in supplements. Folate is what we want to meet our vitamin B9 needs. Since the metabolism of folic acid is quite different to the natural form, there are increasing concerns to suggest this isn’t the best way to meet our vitamin B9 needs.

Folate forms an essential coenzyme in the cellular process of one-carbon metabolism. This is an essential part of cellular metabolism used for making DNA (hello, for the formation of DNA in a developing embryo and foetus) as well as many other cellular processes. Folate is especially important during the very early stages of pregnancy when an embryo is undergoing rapid cell division and DNA is becoming imprinted (or programmed) to determine the developmental trajectory of the foetus.

Folate is found in foliage. This means predominantly dark green leafy vegetables such as spinach and broccoli are the best sources of natural folate. Folate is also found in very high levels in liver, making this an excellent superfood to include in small amounts during pregnancy.

Vitamin B12

Vitamin B12 serves essential functions working alongside folate in various cellular processes; they work together to regulate gene expression in the early development stages. High-dose folate supplementation can mask symptoms of vitamin B12 deficiency, which is why it is important to consider vitamin B12 levels with a blood test before pregnancy.

Vitamin B12 is only found in animal products – meat, fish, chicken, eggs, and dairy. A vegetarian or vegan diet before conception seriously increases the risk of inadequacy. Additionally, Vitamin B12 absorption can be a common issue in people with digestive problems, making it important to get this nutrient tested with a blood test.

Choline

Choline is folate and vitamin B12’s underappreciated cousin that also serves as a coenzyme in cellular metabolism. Getting enough choline during pregnancy and breastfeeding is essential to support baby’s neurological development and brain function. Many women don’t get enough. The main food sources of choline as egg yolks and liver, with small amounts found in legumes, soy, and nuts. On top of that, many prenatal nutrients either exclude choline entirely or provide insignificant amounts to meet optimal choline needs. Choline is the primary reason why I seriously encourage women to eat eggs regularly during pregnancy. If you really can’t stand eggs, find ways to include them in foods like these two-ingredient banana egg pancakes.

Iron

During pregnancy, iron is used in massive amounts for the development of the foetal brain and the formation of their vascular system. Iron deficiency during pregnancy is very common, however, often, it’s not picked up until symptoms such as breathlessness, fatigue, and dizziness start to present.

Changes in maternal blood volume and inflammation make blood tests for iron status unreliable during pregnancy. Checking your iron status at the beginning of pregnancy is a good way to determine whether you could end up with iron deficiency later on.

To reduce the risk of iron deficiency, aim to include plenty of iron-rich food from day one. The best food sources of iron include red meat, liver, and eggs. White meats also provide iron.

It’s is a common misconception that spinach can be used to treat or prevent iron deficiency. While spinach is one vegetable with the highest amounts of iron, the amounts are incomparable to red meat. Furthermore, iron from plants is not as bioavailable as iron from animal sources, meaning you need to eat more to get the same outcomes.

Glycine

Glycine is used for the formation of collagen, which is essentially the glue that holds our bodies together. Glycine is an amino acid that becomes “conditionally essential” during pregnancy. This means that usually, our body’s can make enough, but the increased demands of pregnancy mean that more is required through the diet.

Where do we get glycine from in our diets? Glycine is found in collagen, making gelatine, collagen powder, bone broth and slow-cooked meats excellent sources of this protein component.

Eating liver safely during pregnancy

Mainstream pregnancy nutrition advice had traditionally advised women away from eating liver during pregnancy. This guidance sparked from concerns that excess levels of vitamin A can have potential negative effects on foetal development and result in birth defects. Largely, these adverse consequences can arise from vitamin A supplementation in mega doses, for example, when used to treat acne conditions and for vitamin A deficiency seen in developing nations. However, liver may carry similar risks if consumed in excess amounts. Vitamin A isn’t all bad news! It is an essential nutrient that is also commonly lacking in the diets of people who avoid animal products, have problems absorbing fat, or have problems converting beta-carotene (the plant-source of vitamin A) into active retinol.

The safe vitamin A intake during pregnancy recommended by the World Health Organisation is a maximum dose of up to 10,000 IU (3000 μg) daily or 25,000 IU weekly after the first 60 days of gestation. This 10,000 IU is also the upper limit for dietary intake that is regarded as safe from the New Zealand Ministry of Health. The UK National Institute for Health and Clinical Excellence guidelines for the prenatal period recommend avoiding vitamin supplements containing more than 5000 IU (1500 µg).

To avoid reaching the upper level linked to vitamin A excess, liver intake should be moderated to no more than 100 g per week. One helpful thing about eating liver is that it has a very rich flavour and is quite self-limiting when it comes to quantities. When you have liver for one meal, you’re typically satisfied and not looking to have it again for several days.

Consuming 50-60 g of organic liver per week is safe to consume during pregnancy and will provide a terrific source of essential vitamins A, B12, folate, iron, and choline. Liver really is a pregnancy superfood.

One great way to include this superfood in your diet is to grate or chop liver into beef mince and prepare the “super mince” as you usually would. In this way, liver can be incorporated into meatballs, meatloaf, and bolognese sauce.

Managing nausea and other early pregnancy symptoms

While some appetite changes during pregnancy can be quite hilarious, nausea, vomiting, and malaise is not a fun time.

There’s no real consensus to explain why some women are more worse off with nausea and vomiting than others. The most typical form first arises around the fourth week of pregnancy and then disappears by week 16. The severe form, hyperemesis gravidarum happens in about 1 in 200 women.

There are plenty of herbal remedies and homoeopathic solutions that claim to help symptoms, but few are backed by good evidence. A systematic review from 2016 concluded that ginger, pyridoxine (vitamin B6), antihistamines, and metoclopramide could be beneficial for mild nausea and vomiting during pregnancy. These strategies may take the edge off, but if you are struggling to get food down, it is really about making the most of when you feel best and having little and often.

Strategies for managing nausea and vomiting during pregnancy include:

Eat little and often; aim to eat something every hour. Plain salted crackers or popcorn are good options to have on hand.
Have plain salted crackers at your bedside to have before getting up in the morning.
Have a meal or a plan for what you’re going to eat ready for when you feel your best.
Ask someone else to do the cooking. Often strong smells can set off symptoms and put you off your food. Ask someone to cook the meat on a barbeque outside while you make vegetables or salad inside.
Ginger:

Remember, it’s expected that typical nausea and vomiting during pregnancy stops around week 16. If you experience prolonged nausea and vomiting, you should seek help from your primary care provider to avoid dehydration or weight loss that can occur.

Managing nausea and other early pregnancy symptoms

While some appetite changes during pregnancy can be quite hilarious, nausea, vomiting, and malaise is not a fun time.

There’s no real consensus to explain why some women are more worse off with nausea and vomiting than others. The most typical form first arises around the fourth week of pregnancy and then disappears by week 16. The severe form, hyperemesis gravidarum happens in about 1 in 200 women.

There are plenty of herbal remedies and homoeopathic solutions that claim to help symptoms, but few are backed by good evidence. A systematic review from 2016 concluded that ginger, pyridoxine (vitamin B6), antihistamines, and metoclopramide could be beneficial for mild nausea and vomiting during pregnancy. These strategies may take the edge off, but if you are struggling to get food down, it is really about making the most of when you feel best and having little and often.

Strategies for managing nausea and vomiting during pregnancy include:

Eat little and often; aim to eat something every hour. Plain salted crackers or popcorn are good options to have on hand.
Have plain salted crackers at your bedside to have before getting up in the morning.
Have a meal or a plan for what you’re going to eat ready for when you feel your best.
Ask someone else to do the cooking. Often strong smells can set off symptoms and put you off your food. Ask someone to cook the meat on a barbeque outside while you make vegetables or salad inside.
Ginger:

Food safety

Another fascinating phenomenon during pregnancy is the changes a woman experiences in her immune system. The immune system becomes more “tolerant” of other microbial species. This tolerance allows the placenta and foetus with different DNA to develop in a woman’s body without the immune system kicking up a fuss. In the gut, this suppression of the immune system also means the intestines harbour higher volumes of bacteria than any other time. Food safety during pregnancy is about reducing the risk of food poising, predominantly caused by the Listeria monocytogenes bacteria. Pregnant women are at higher risk of poisoning with listeria in pregnancy due to their suppressed immunity. The consequences can be devastating, including miscarriage or premature labour.

The New Zealand Ministry for Primary Industries provides a comprehensive list of the foods to be conscious of during pregnancy on their website: https://www.mpi.govt.nz/food-safety-home/food-pregnancy/list-safe-food-pregnancy/

For the most part, the recommendations apply common sense. It’s about aiming to eat freshly prepared food that is cooked and stored appropriately.

Some tricky everyday food safety situations that can catch women out include:

Smoothies with frozen berries. Berries need to be cooked or washed. Opt for mango, kiwi, or banana smoothies unless using fresh washed berries.
Cheese platters and grazing boards. Items such as cheese and cold meats left out for several hours at an event are particularly high risk. In these situations, choose nuts, crackers, dried fruit, and hot appetisers.
Unpasteurised juice and fermented beverages such as kombucha.
Preprepared cold foods such as salad, sandwiches, or poke bowls.

Nutritional supplements during pregnancy

My view is that it can be challenging to obtain adequate levels of the various micronutrients needed during pregnancy through diet alone. Many things can get in the way of women achieving 100% of their micronutrient needs during pregnancy. These include:

Changes in appetite, aversions, nausea, and vomiting can make it physically very difficult to eat the food you “want” to eat.
Life is busy, and many people struggle to find time to cook well-balanced meals 100% of the time.
Many women may enter pregnancy unexpectantly without having a six-to-twelve month lead-up to optimise their nutrition status with diet.
A variety of choices for fresh produce is not always available or safe to eat.
Produce is less nutrient dense than it was 100 years ago due to industrial agriculture and the decimation of soil life.

These are the go-to supplements that I recommend for most women during pregnancy.

Pre-pregnancy and in the first eight weeks of pregnancy:

Throughout pregnancy:

If you would like to get in touch with me to chat about personalised nutrition and lifestyle guidance for fertility or pregnancy, you can get in touch via my contact page to book a free 15-minute call.