Monday, March 30, 2009

Prenatal Nutrition

I've been thinking I wanted to write a post like this, and then last week Jenn at BabyMakinMachine wrote a post full of questions about prenatal vitamins, so I figured I should get this thing finished up and published asap.

Prenatal vitamins are typically recommended during pregnancy and breastfeeding, as well as for women who might become pregnant (or are trying to become pregnant) and really for any woman of fertile age. I think one main reason for this is that prenatal vitamins have extra iron in them, and that is beneficial for a woman who is losing iron to menstruation every month.

As I said in my post on vitamins, the human body needs certain nutrients to live, and needs extra of some things when growing a second little human body. For centuries women just ate whole foods straight from their gardens and had perfectly healthy children. Unfortunately, in our modern world most of us eat comparatively lousy diets, so we rely on prenatal multivitamins. But as I pointed out in the vitamin post, multivitamins are a very poor substitute for real food.
SO, do you need a prenatal multivitamin? Probably not. But you do need certain nutrients, and while whole foods are the ideal source, it's nice to know that if you have severe morning sickness and throw up everything you eat, then an appropriate prenatal vitamin can be a saving grace.

If you do choose (or need) to take prenatal vitamins, here is something to remember: not all prenatal vitamins are created equal. Next time you're at the store (or if you have a bottle of inexpensive vitamins on your shelf), pull out the bottle and read the ingredients. Does it sound like a list of chemicals to you? That's because it is. In fact, it's highly processed forms of all those vitamins, and since it's not in it's natural form, your body is going to have a hard time figuring out what to do with it. The majority of it is going to get routed straight back out of your system. Yep, you got it, the average multivitamin is little more than expensive urine.
The one form of prenatal multivitamin that seems to really be good is a whole foods based one, such as Rainbow Light or Nature's Plus. On the one hand, they can be quite pricy, on the other hand, the ingredients are nice pretty things like "spinach" and "pineapple." I can pronounce those words! And my body knows what do do with those foods! As I said before though, if you are able to eat the actual foods, that is always better than even the best vitamin.

SO, assuming that I've convinced you to forgo the prenatal multivitamin, what do you need, why do you need it, and how can you get it?! (ahh, this is my favorite part!)
(see end for source info/links)

Folate aka Folic Acid aka "B-9"
This may be one of the most important nutrients to worry about, at least in the first couple of months. A lack of folate can lead to problems with brain stem and spinal cord development (problems such as spina bifida), and because that development occurs in the first month after conception (including those two weeks before you even take a pregnancy test) it's important to have a good source of folate in your diet when you are trying to conceive.
**The recommended daily dose for pregnancy is 600-800mcg of folate, however daily consumption of over 266mcg of folic acid (the synthetic form) can cause problems with metabolizing all forms of folate in the future (possibly for years)
**Some good food sources of folate are: asparagus, okra, spinach, avacado, liver, chickpeas, beans, lentils, broccoli, yeast, wheat germ, strawberries, and orange juice (see source links for details on the benefits and sources of folate: link, link, link)

A pregnant woman should be drinking at least a half gallon of water a day. The guideline I have heard most often is to take your body weight in pounds, divide in half, then that is how many ounces of water you should drink in a day. So, if I weigh 140 lbs, then half of that is 70, so ideally I should be drinking 70 oz of water per day. (A half-gallon is 64 oz, in case you forgot, so I should have 6 12oz glasses, or 9 8oz glasses of water every day.) I know that probably sounds like a lot if you're not used to drinking water--it used to sound overwhelming to me too. But proper hydration is extremely important for health, especially in pregnancy. (Here is a post with tips for drinking more water)

During pregnancy a woman's blood volume will increase by 50%, so nutrients that build blood are vital, and protein is one of those nutrients. In my own experience, eating protein keeps morning sickness at bay better than anything else.
**Some practitioners advise trying to get 100grams of protein a day, but that can be very difficult. A more moderate recommendation is 60-100grams.
**Good sources of protein are: beef, chicken (which actually has more protein per oz than beef), milk, yogurt, cottage cheese, eggs peanut butter, wheat germ, and beans.

Iron is another nutrient that contributes to blood-building (iron deficiency is called "anemia" and is a common concern following miscarriages or other situations involving blood-loss). Trust me that anemia is not something you want to deal with, so make sure you get your iron!
**The daily recommended intake for iron 30-60mg, although this is partly due to its poor absorption rate (as low as 10%), so if you are getting it from good food sources you can probably get by with the lower end of the range. Most of the sites I've visited point out that there are two forms of iron--heme and non-heme, with the former coming from meat sources and the latter coming from all other sources. All the sites seem to agree that the heme is better absorbed, and that for full benefit of the non-heme forms, it's best to consume them either with a heme iron; or with a vitamin-C-rich food (like citrus fruits); or at least cooked in an iron pan.
**Some especially Iron-rich foods include: artichokes, blackstrap molasses, nuts, lean red meat, salmon, clams & oysters, beans, lentils, currants,egg (yolks), chicken (especially the liver), quinoa, pumpkin seeds, spinach, tofu, wheat germ, sesamie seeds, seaweed (hijiki is best), and foods cooked in a cast-iron pan. (source links with additional info on iron: link, link, link, link)

This is another nutrient that contributes to building blood volume in pregnancy--as with our other bodily fluids, both blood and amniotic fluid contain sodium. Sodium also helps maintain balanced fluid levels in your cells, as well as the health of the nervous, muscular, blood, and lymph systems. A diet low in sodium can lead to a decrease in blood volume as well as elevated blood pressure and swelling. Sodium deficiency can also cause impaired kidney function, decreased urine volume, and other signs of toxemia. (I am aware that a lot of doctors feel that restricting salt is the solution for toxemia, but based on my own experiences, plus those of my midwife who gave me the advice in the first place, I think that advice stems from fear of and misinformation about salt rather than from really understanding how sodium works.)
**While there is no daily recommended intake for salt, pregnant women should not hesitate to salt food to taste. If you crave salty foods (such as potato chips or french fries) then get yourself some healthy salt-containing foods, such as celery, dairy products, seaweed, or other seafoods.

Pregnancy is not the time to be afraid of fats. Your baby's developing cells (especially brain and nervous system) need a certain of fat in order to grow properly. Vitamins A, D, E, and K are all fat-soluable, meaning that you must have fat in order to digest (or use) them. Essential fatty acids are most readily available via fats. Cholesterol is necessary for the formation of sex and adrenal hormones, among other things.
**Now obviously not all fats are created equal, and balance is important (that is a whole other post). You do NOT need any form of trans-fats (partially hydrogenated oils), but you should seek a balance of saturated, mono-unsaturated, and poly-unsaturated fats, because each supplies your body with different essential things. Also a balance of omega 3s, omega 6s, and omega 9s. (Like I said, there will have to be another post about that all soon!) You should feel comfortable with around 60grams of fat per day.
**High quality sources of fats include: nuts, seeds, unrefined, cold-pressed vegetable oils (refined ones tend to be partially-hydrogenated aka trans-fats), butter, dairy products, and the fats in meat. Essential fatty acids are found in salmon, mackerel, herring, cod liver oil, and the oils from evening primrose, black currant, flax seed, walnut, and borage. (link, link, link, link)

In the near future I'm hoping to put up a post with a list of some pregnancy keep an eye out for that. ☺

There are other vitamins and nutrients that are important, and I'm sure I'll get a chance to talk about them...potassium is good for tight muscles (I often get muscle spasms or cramps when pregnant), magnesium and calcium contribute to good bone development...but the ones mentioned above are the key ones to focus on. Most veggies contain many vitamins (as you can see from the repetition on the lists above), so if you are getting a good diet you can feel pretty safe that you are getting what you need.

In case you didn't know (although I hope you did!) pregnancy is not the time to be thinking about your waistline, but it also is not the time to just eat twice as much. Remember that even though you are "eating for two," that second being is pretty little, and does not need adult portions! Eat when you are hungry, stop when you are full. Focus on eating healthy foods. Don't be distressed if you gain 40lbs...and don't be distressed if you gain only 20. Don't be distressed if this pregnancy is totally different weight-wise than the last one was. Don't worry if you lose a few pounds due to morning sickness (though more than 10 is cause for concern), and don't worry if you don't gain a pound until 22 weeks along (I didn't last time). So long as you and the baby are both healthy, pounds on the chart are just one more thing that doesn't really matter.



Emily said...

A word about protein and salt: studies are now showing that diets deficient in salt and protein are *causing* pre-ecclampsia and toxemia. If you have a history of pre-e or are concerned about getting it, you must be sure to get enough proteins and salt in your diet.

The Happy Housewife said...

Great post, I am always careful about what vitamins I buy. I have also found that each pregnancy is so different. I have gained the least with this pregnancy, and I think it is due to being on bed rest and not being very hungry. When I do eat I try to make sure it is super healthy because my appetite is so little!

Future Mama said...

Wow!! This is so helpful! Thanks I'm going to bookmark this for sure!! And guess what?! Hubby is coming around!!! Woohoo!

I'm looking at my prenatals right now and trying to compare. Hmm... May want to get some new ones! Thanks again!

Becky N. said...

You always put together such informative posts! You put a lot of good detail in here. But you either had a typo or got a number wrong: There are 128 ounces in a gallon (4 32oz quarts), so 64 ounces in a HALF gallon.

Pregnant ladies need so much water! My midwife encouraged me to drink a full gallon if I could, but the best I could ever manage was about 96oz.

Mommy Bee said...

Good call Becky. I will blame it on preggy brain, but really I just had 64 stuck in my brain someplace and didn't bother to actually do the math. OOPS!!
I fixed it in the post.

4MySales said...

Great post. As a professional in the vitamin industry, I agree that there is a lot of snake oil out there and you do get what you pay for. When looking for a prenatal, or any vitamin for that matter, don't buy the cheapest thing on the shelf. If it is dollars less than the other products, it likely won't meet the potency claimed on the label.

B. Nielson

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