Don't Let a Nutritious Pregnancy Diet Force You into March Madness

By Sharon Voyer Lavigne, MS, CPEIS Teratogen Information Specialist

We have all heard this before from our mothers and grandmothers before them, but here it is again, what we put into our bodies really affects our health and well being. What better time to delve into that saying than during the month of March - National Nutrition Month. For women, proper nutrition becomes especially important during our childbearing years.  When planning a pregnancy, newly pregnant or breastfeeding, good nutrition is key to healthy outcomes.So how does a woman go about getting "nutritionally" healthy?

First, we need to look at our diet.  Yes the dreaded four-lettered word D-I-E-T. Let's first focus on the version of this word that is positive, instead of it's negative connotation that makes us think of deprivation and cravings.  What kind of food do you consume? Fruits, vegetables, proteins, grains and fats should all be on the list. During pregnancy and breastfeeding, vegetarians and vegans need to be more creative at getting in enough protein and healthy fats, but it is doable.  A consultation with a dietician or nutritionist may help you round out your intake properly. Women with medical conditions like Crohn's disease or ulcerative colitis (See fact sheet- http://www.otispregnancy.org/files/IBD.pdf) may also benefit from consulting an expert to cater to their needs. These conditions may limit what you can eat or effect how you absorb nutrients.  In some cases, supplements are helpful. For example, Vitamin K (the clotting vitamin) may be deficient in someone with inflammatory bowel disease.Another group that needs to be aware of their diet is those individuals with diabetes.

Diabetics need to eat the right balance of carbohydrates in order to keep their blood sugar level in a healthy range (See fact sheet: http://www.otispregnancy.org/files/diabetes.pdf). This is especially true prior to conceiving, since elevated blood sugar levels can cause birth defects and pregnancy complications.  A diabetic's glycosulated hemoglobin levels (HbA1c) should be as close to normal (below 6 ug/ml) as possible prior to and during pregnancy. Some women who had been previously able to control their diabetes with diet and exercise alone may need insulin during pregnancy. In many cases, using insulin makes it easier for a woman to be in control of her blood sugar levels.Now lets look at supplements. Vitamins and minerals can be supplemented to round out our nutritional intake. In the perfect world, prenatal vitamins would be started prior to conception. However, since 50% of pregnancies are unplanned, vitamin and mineral intake often starts after conception. Vitamin and minerals typically have a predetermined Recommended Daily Allowance (RDA) for pregnancy and for breastfeeding. Women should stick to these guidelines unless their health care provider has determined that they are deficient in something specific. Then an additional amount of what vitamin or mineral is lacking can be supplemented. More is not always better, so heeding the guidelines of the RDA is safest.One vitamin that most women have heard about is folic acid or folate. This B vitamin has been shown to reduce risks for certain birth defects, so all women planning to conceive or who are already pregnancy should be taking at least 600mcg of folic acid. Women who have taken medications recently or need to continue to take medication that decrease folic acid will need more- 4-5 mg per day. This is not a typical dose in a prenatal vitamin, so a separate supplement of folic acid will be necessary.

Any supplement that also contains herbal products should be avoided.  Natural herbs are not always safe to use during pregnancy. While the majority may not cause birth defects, very little data exists on their safety in pregnancy and breastfeeding. Some herbs interfere with hormones, which may affect fertility. Some herbs may cause uterine contractions and cause pregnancy loss. A supplement without additional herbal ingredients is best.Okay, now what about omega 3 fatty acids, fish and methyl mercury? Yes, fish is found in a healthy diet. Fish does contain omega 3s, which are important for your health and the growth and development of your baby. Some prenatal vitamins contain omega 3 fatty acids now.  Fish can also contain methyl mercury, a toxic form of mercury that may affect your baby's developing brain. Avoiding types of fish that may contain high level of methyl mercury is best. These include shark, swordfish, King mackerel and tilefish (See fact sheet: http://www.otispregnancy.org/files/methylmercury.pdf).

The FDA suggests consuming no more than 12 ounces of fish per week of most types of cooked fish. If you prefer to eat fresh water fish from local waters, the Environmental Protection Agency or your state or local health department should be able to advise you on what fish are currently safe to eat. Finally, we cannot ignore the negative connotation of the word D-I-E-T. Trying to get down to a healthier weight is a good idea prior to pregnancy. However, once you conceive, you should strive for the healthy balance we have discussed so far. Weight loss during pregnancy may put you at greater risk for having a child with birth defects or pregnancy complications. Leave those thoughts and plans of weight loss until after you have had your baby.Good 'ol grandma was right "You are what you eat! So, eat right, monitor your health, and you'll be rewarded when a healthy, bouncing baby's toothless smile is gleaming up at you!

Sharon Voyer Lavigne is a Teratogen Information Specialist and coordinator of the Connecticut Pregnancy Exposure Information Service (CPEIS), a non-profit based at the University of Connecticut Health Center that aims to educate women about exposures during pregnancy and breastfeeding. She's also been a genetic counselor for the past 20 years. CPEIS is an affiliate of the Organization of Teratology Information Specialists (OTIS), a non-profit with affiliates across North America. Connecticut women with questions or concerns about pregnancy or breastfeeding exposures can be directed to (800) 325-5391. Outside of Connecticut, please call OTIS counselors at (866) 626-OTIS (6847).

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