We know you want to do what you can to have a healthy pregnancy and a healthy baby! Eating right is one piece we have some control over in the process. I recently sat down with Judy Simon, MS, RDN, CD, CHES, FAND to talk about nutrition in pregnancy and how what we eat can influence things like gestational diabetes, pregnancy induced hypertension and pre-eclampsia. Judy counsels people working to get pregnant and throughout pregnancy on nutrition and diet, as well as presenting on such topics professionally. She has lots of good, common sense answers for us to get and stay healthy.
Melinda: “People get a LOT of advice about nutrition in pregnancy. What are your top three pieces of information you feel people should know?”
Judy: “I come from the fertility side and go back to pre-conception. About half of pregnancies are unplanned— so go back to thinking about early prenatal visits to get nutrition info. For those planning for pregnancy— be as healthy as possible at least 3 months prior to conception— consider taking folic acid, talk to your provider regarding immunizations or other health issues to address— particularly diabetes or chronic diseases, and medications you are taking. Make sure you are eating in a way that will help grow a healthy baby, it’s good to start early. You might be nauseous in early pregnancy, and if you’ve been eating healthy prior to getting pregnant you’ve got some buffer there.
A) Focus on foods that help your health and grow a healthy baby— nutrient dense whole foods rather than prepared foods.
B) There’s no need for additional energy that first trimester— focus on nutrient dense foods, this may mean eating less food even. If you are starting out underweight, or possibly if having multiples you may still need to eat more in the first trimester.
C) Be a mindful eater. Be attuned to your hunger and fullness. Respect what’s going on in your body in the moment.”
Melinda: “Are there some pregnancy complications that can be influenced by diet?”
Judy: “For hyperemesis (excessive nausea and vomiting) there’s not much to do to proactively prevent it. When it occurs in pregnancy— try to keep well hydrated, try breaking up meals into small little snacks, and avoid fatty, greasy foods as these are harder to digest. Keeping fluids separate from dry foods may help. Eating or smelling ginger (crystallized or fresh), mint or citrus may help with the nausea. What’s most important is to not get dehydrated.
For gestational diabetes- a person is at higher risk if they are older, have PCOS, or a family history of diabetes, and some larger individuals. Focusing on nutrient dense foods such as lentils, beans, whole grains, and other low glycemic foods can help. Being active also helps, so get out for a walk, take a yoga class, etc.. This helps reduce insulin resistance. Do what you can to keep within recommended weight gain.
Hypertension- If you come in to pregnancy with high blood pressure consider trying the DASH Diet- “dietary approaches to stop hypertension”. It’s similar to a Mediterranean diet, and can help to manage hypertension prior to pregnancy. Do your best to eat less processed foods and more plant based foods and fish. Again, getting good exercise can be helpful too.
Pre-eclampsia- Some studies have shown adequate nutrition (DASH diet) can be helpful but also preventing excessive weight gain in pregnancy can be helpful. As above, focus on the quality and quantity of meals, be sure to get enough protein, and not excessive sodium. Dr. Brewer’s nutrition plan recommends a higher protein intake, focus on whole foods and focuses on quality of diet vs calories for better pregnancy outcomes. I agree with his suggestion that people should not restrict sodium to prevent pregnancy induced hypertension.
Melinda: “Caffeine in pregnancy- how much is ok? My clients are craving their cup of coffee!”
Judy: “Nobody really knows what is a safe level of caffeine. I tell folks to try to do without it, but if not, limit coffee to a cup a day. If you are too tired without caffeine, maybe work with sleep and exercise to resolve this if you can.”
Melinda: “Is it ok if someone had an alcoholic drink before they knew they were pregnant?”
Judy: “In many cultures people drink throughout their pregnancy. We don’t really know the safe level, so have as little as possible. If you had a drink socially prior to realizing you were pregnant- don’t feel guilty about this.”
Melinda: “Why are some foods banned in pregnancy, like sandwich meat, and unpasteurized cheeses - if it's so dangerous, how come it's ok to eat when you're not pregnant?”
Judy: “The big concern is listeria, this is a food borne illness. It can live in cold food. A pregnant person is more prone to be negatively impacted by this, but it doesn’t happen a lot. Pregnant people are more susceptible to listeria. Your chances of getting this illness are pretty low, but food borne illnesses seem to be on the rise. Just keep your radar higher when pregnant.”
Melinda: “What can you tell me about the keto diet and pregnancy?”
Judy: “It’s not recommended for pregnancy, we don’t have any evidence that it’s safe. The keto diet is well below the recommended carb level, which is needed for neurodevelopment. In pregnancy, a person can be on a moderate carb diet, but may be missing some nutrients.”
Melinda: “I know you also work with people following a strict vegan diet in pregnancy. What sorts of things do these folks need to be aware of?”
Judy: “The main concern is around getting good sources of calcium because a supplement may only provide for about 25% of the need. Calcium can be found in greens, nuts, and seeds. Plant based milks are often fortified with Calcium as well. Seaweed can be a way to get the recommended amount of Iodine (150-200 micorgrams). Choline, though, is almost impossible to get enough of through a vegan diet, so I recommend a supplement for this. Lastly, Iron can be challenging as well and the odds of becoming anemic on a vegan diet go up. Eating plenty of dark leafy greens, cooked in an iron pot can help, but also be sure to add vitamin C to the diet as this helps with the absorption of Iron. Overall, I suggest that people following a vegan diet in pregnancy meet with a dietician to help keep them on track.”
Melinda: “What are some of your favorite sources of information on nutrition in pregnancy?”
Judy: “Healthy, Happy Pregnancy Cookbook: Over 125 Delicious Recipes to Satisfy You, Nourish Baby, and Combat Common Pregnancy Discomforts Paperback – September 27, 2016
Eating Expectantly: Practical Advice for Healthy Eating Before, During and After Pregnancy 4th Edition
Many thanks to Judy Simon for sharing her time and knowledge! You can learn more about her on her website. We hope you will share this information with those who are pregnant or trying to get pregnant as quality information they can trust on eating healthy in pregnancy.