OB Complete? Nutrition Pregnancy-related Q&As
By Rebecca Scritchfield, MA, RDN1, EP-C
It’s no secret that eating healthy is important, but, now that you’re doing it for two, it’s essential.
The primary foods to avoid during pregnancy are those that may impact your baby’s health. These are typically foods that carry an increased risk of toxins or food-borne illnesses, as these can cross the placenta to your baby.
- Unpasteurized soft cheeses and milk
- Raw eggs
- Unpasteurized juice
Note: Most commercially available products in the United States are pasteurized. However, an increasing number of specialty stores, farmers markets, farms and artisan juice bars and restaurants are using these ingredients, so be sure to clarify prior to consumption.
- Raw, unwashed fruits and vegetables. Ensure fresh, uncooked fruits and vegetables are thoroughly washed with vinegar or a vegetable wash to avoid toxoplasmosis (a parasitic disease) that can affect produce.
- Raw sprouts. Watch out for these in salads or on sandwiches. Bacteria can get into sprout seeds through cracks in the shell before the sprouts are grown. Once this occurs, these bacteria are nearly impossible to wash out. If pathogenic bacteria are present in or on the seed, they can grow to high levels during sprouting.
- Raw fish including shellfish. This includes most sushi, unless you can verify that the sushi is vegetarian or only contains fully-cooked, low-mercury fish, such as shrimp.
- Fish that contains high levels of mercury (e.g. shark, tilefish, swordfish, bigeye tuna)
- Fish exposed to industrial pollutants. Avoid fish from contaminated lakes and rivers that may be exposed to high levels of polychlorinated biphenyls. This primarily applies to those who fish in local lakes and streams and these fish typically include bluefish, striped bass, salmon, pike, trout, and walleye. This warning is regarding fish caught in local waters and usually not those from your local grocery store.
Note: Keeping track of which kinds of fish are pregnancy-safe can be challenging. Thankfully, the FDA released an easy-to-read infographic that gives serving recommendations for a safe and healthy pregnancy.
- Raw (e.g. carpaccio, tartare, etc.) or undercooked meat of any type
- Deli lunchmeat that has not been preheated to 165 degrees or served steaming hot
- Cooked meats served cold from behind a deli counter (e.g. chicken salad) due to concerns of cross-contamination
- Refrigerated meats (e.g. smoked salmon and pâté); canned varieties are typically fine to eat
- Caffeine; it is best to avoid this in the first trimester to reduce the risk of miscarriage, later, in the second and third trimesters avoid consuming more than 200 mg or the equivalent of one 12 oz. cup of coffee per day from all sources (e.g. coffee, tea, dark chocolate, etc.)
Pregnant women are about ten times more susceptible to contracting listeriosis than other healthy adults and an estimated 1 in 6 cases occur in pregnant women. Listeriosis carries with it an increased risk of miscarriage, premature labor, low-birth weight, and infant death. Fetuses who have a late infection may develop a wide range of health problems, including intellectual disability, paralysis, seizures, blindness, or impairments of the brain, heart, or kidney. So, keep your fridge clean and at the proper temperature, check expiration dates, and follow the recommendations above as they relate to lunch and refrigerated meats, soft cheeses, unpasteurized and prepared foods.
There are many healthy foods you can and should enjoy during pregnancy to help you and your baby obtain essential nutrients. Fruits, vegetables, beans and legumes, cooked fish (with a priority on high DHA omega-3, low-mercury fish like salmon), and whole grains (e.g. brown rice, oatmeal, whole wheat bread, pasta, and crackers) are particularly nutritious and can be prepared rather quickly and easily.
OB Complete® meal plans and nutrition videos offer more ideas for obtaining the best nutrition for you and your baby.
Food cravings and aversions are normal during pregnancy and can be managed with mindful eating; no one knows for sure why cravings occur and/or whether a particular craving is actually indicating a nutrient deficiency. Managing pregnancy cravings is best achieved by taking a few deep breaths to consider why you’re having a craving. Don’t judge or overanalyze it, just take a moment to acknowledge it. Emotional distress, fatigue, and anxiety can all trigger a desire to self-soothe with food. Take a moment to consider whether you’re hungry. If you recently ate, try drinking a cup of water or caffeine-free tea to see if the craving passes.
When you’re hungry, give yourself permission to enjoy your food. First, think about how much food you think you’ll need to satisfy the craving – the answer is not always more. With mindful eating as an ultimate goal, consider what you can do to add to the nutritional value of the food you’re craving. For example, if you have a carbohydrate craving and want a bagel, adding an egg or cheese for protein and fat along with vegetables or a side of fruit will help deliver the balanced nutrients your body needs.
Eating out is a normal and fun part of life, but relying too much on “comfort foods” prepared outside the home can compromise the quality and balance of your meals. When dining out, pair your selections with any nutrient-rich, green vegetables or fruit to ensure a more nutritional meal for you and baby. There are many restaurant-worthy recipes you can try at home that easily transform some of life’s favorite indulgences into healthy, satisfying meals.
OB Complete® offers snack suggestions you may enjoy when you’re having a particular craving, such as smoothies and fruit dipped in dark chocolate.
The stimulant effects of caffeine can feel particularly necessary when pregnancy-induced fatigue begins to set in. Unfortunately enough, caffeine crosses the placenta meaning that when you consume it, so does baby. And so, the less caffeine you consume during pregnancy, the better. Most experts agree that you should avoid caffeine during the first trimester of pregnancy to reduce the risk of miscarriage. Beyond the first trimester, the recommended upper limit of caffeine, from all combined sources (e.g. coffee, chocolate, soda, tea, etc.) is 200 mg per day, or the equivalent of one 12 oz. cup of coffee. Caffeine is a diuretic meaning it increases the need for urination and thus causes excess fluid to leave the body. To combat this, add an extra glass of water after consuming caffeine to rehydrate.
Unsweetened decaf lattes or café au lait are great options to keep caffeine intake low while satisfying your coffee craving. Alternatively, opt for “half-caf” beverages, or coffee drinks with a 50/50 blend of caffeinated and decaf coffee. Generally speaking, decaf tea and most commercial herbal teas, such as raspberry leaf, chamomile, ginger, peppermint, and the like can be consumed throughout pregnancy and lactation.6 Remember to read all labels carefully and avoid caffeine/energy pills, energy drinks and dietary supplements or teas containing caffeine (note that most weight-loss supplements or those promising improved mental focus contain some caffeine). If you’re unsure about a particular drink or supplement, it’s best to avoid it until you can visit with your health care provider to solicit a pregnancy-safe recommendation.
Although we often use the term, “morning sickness,” pregnancy-related nausea or vomiting can occur at any time of day. Cold foods may be better tolerated because they have less of an aroma, which often plays a role in nausea. Avoid any smells that bother you. Generally speaking, bland foods are preferred over spicy foods.
If the thought of sitting down to a meal sounds too challenging in the moment due to nausea, take a deep breath and repeat a simple and kind affirmation to yourself, such as: “It’s okay, my baby is getting nourishment even though I’m struggling to eat in this moment.”
Below are a few snack ideas to keep nausea at bay:
- Saltine crackers with nut or seed butter (e.g. peanut butter, sunflower butter, or almond butter) for protein
- Broth-based soup (e.g. chicken and rice, lentil, minestrone, or bone broth)
- Fruit and vegetable smoothie. Try the Baby Bump Breakfast Smoothie (OB Complete® 7-Day Meal Plan, Day 1 Breakfast) recipe for a healthy treat.
- Frozen fruit (e.g. bananas or grapes)
- Popsicles or Jell-O
- Ginger tea or ginger ale
Follow these simple anti-nausea tips:
- Eat small, frequent meals 4–6 times per day instead of larger ones to avoid overloading the digestive system.
- Take a quick walk following meals to get some fresh air and stimulate digestion.
- Drink liquids separately from your meals. Ideally, avoid drinking for at least 30 minutes before and after eating.
- Avoid caffeine and spicy and/or fatty foods.
Watch this video on “First trimester tips” for more information on managing morning sickness.
If nausea and vomiting become unmanageable and you cannot keep food down, seek the advice of your health care provider. Some women also find relief from nausea with alternative therapies, such as acupuncture, morning sickness bands, or hypnosis. Talk to your health care provider about the best options for you.
The list of foods you should eat during pregnancy is long and varied. With just a bit of reading, eating healthy for you and baby can satisfy your individual preferences and pregnancy cravings. OB Complete® Meal Plans & Snack Recommendations offer seven full days of meal and snack ideas throughout pregnancy and lactation.
Focus food choices on minimally processed, wholesome foods, such as:
- Fruits and vegetables; a variety of colorful fruits (e.g. avocado – a good source of monosaturated fat, melon, antioxidant-rich berries) and leafy (e.g. spinach, broccoli) and starchy (e.g. potatoes, corn, and peas) vegetables
- Seeds and nuts
- Whole grains (e.g. 100% whole wheat bread, pasta, crackers, brown rice, quinoa, buckwheat)
- Meat, poultry, low-mercury fish* (especially salmon with omega-3 DHA to promote your baby’s brain development), and plant-based, protein-rich foods (e.g. tempeh, tofu, lentils, beans) for adequate protein and iron.** Also note that dark, leafy greens (e.g. spinach, swiss chard, and collard greens) contain iron. Consume plant sources of iron with vitamin C and without calcium to enhance absorption.
*Note on fish: According to the American Pregnancy Association, many Americans do not eat adequate amounts of fish. However, the Food and Drug Administration (FDA) recommends up to 12 ounces of fish low in mercury (e.g. salmon, tilapia, shrimp, cod, and catfish) per week. That amounts to about 2 to 3 servings of fish per week.9
**Note on iron: As your body begins to produce more blood (up to nearly 50% more may be pumping through you by your due date!)10 to support a growing baby, iron-rich foods will become more important than ever to accommodate this increased blood volume and help avoid anemia.
- Eggs; two egg yolks provide half the recommended daily intake of choline, a B-vitamin which one study suggests plays an active role in brain development. Hard boiled eggs make an easy grab ‘n go snack or a perfect protein topper on salad.
- Probiotic foods; these contain live and active cultures which help to rebalance the good bacteria in the gut.11 Typical sources of probiotics are fermented foods, e.g. yogurt, kimchi and kefir, a fermented dairy drink that provides beneficial bacteria for digestion and in some cases combats constipation. Kefir and yogurt containing calcium support baby’s bone and cardiovascular development.
Staying hydrated is especially important during pregnancy. Consume eight 8-ounce glasses of fluid each day; more may be necessary if you are active or live in a warmer climate. To track your fluid intake, fill a water bottle and add a rubber band to the outside after you finish each serving.
If you are finding it difficult to drink plain water, below are some ideas to ensure your hydration needs are met:
- Add ¼ cup or less of your favorite fruit juice to 2 cups of water for an easy, flavorful beverage.
- Make infused waters and spritzers. Using a large pitcher, place approximately 2 cups of fresh fruit and 2-3 sprigs of herbs or ginger slices and fill with 1-2 liters of flat or sparkling water. You can typically refill the pitcher 3-5 times before replacing fruit and herbs.
- Ginger orange infused water contains vitamin C and the ginger will help to settle an upset stomach.
- For a refreshing herbal infusion, try combining watermelon and rosemary or basil.
- If you’re in the mood for something fizzy, try making an infused spritzer with 1 cup of whole strawberries and 1 lime sliced added to sparkling water.
- Fresh fruits and vegetables are mostly comprised of water and contribute somewhat to your daily fluid intake- smoothies included. Nutritious smoothie recipes can be found in the OB Complete® 7-day Meal Plan.
- Consume decaffeinated beverages, like tea and juice. Limit juice to one cup per day and avoid sodas, sugar-sweetened beverages and energy drinks due to the caffeine and sugar content in these beverages.
Your urine should appear clear to lemonade yellow. Darker colors, like apple juice, could indicate dehydration. Be mindful that your first urination after taking a prenatal vitamin may be bright in color, and cannot be used as a reliable indicator for dehydration. Ask your healthcare provider if you have concerns about your hydration status.
Many women deal with constipation during pregnancy due to a variety of reasons, which may include hormones, iron supplements, anxiety, or lifestyle choices. Adequate hydration, fiber intake, and physical activity are all important as a first line of defense in helping prevent and address constipation. Below are some tips to keep in mind:
- Aim to drink at least eight 8-ounce glasses of water each day.
- Consume fiber-rich foods like fruits, vegetables, whole grains, beans and seeds with every meal, aiming to reach 25-35 grams of fiber per day.
- Try the Greek Salad with Red Wine Vinaigrette and Whole Wheat Pita (OB Complete® 7- Day Meal Plan, Day 6 Lunch) for a meatless combo that’s loaded with veggies and provides 17 grams of fiber.
- Walk or engage in some other form of exercise (e.g. prenatal yoga) for at least 30 minutes each day to stimulate bowel function. Attempt to take a walk around the office or the block after eating each meal to aid digestion
- Try a prune remedy. Eat 4-5 prunes or drink a cup of prune juice to help move things along within a few days.
- Eat 4–6 small meals over the course of the day instead of fewer large meals to prevent overloading your digestive system.
- Some people may be sensitive to different combinations of food. For instance, fruit or nuts may be better eaten on an empty stomach to avoid excess bloating.
- Avoid “laxative teas” that contain certain herbs (e.g. senna) as these can initiate contractions in the uterus.
Constipation can become a more serious problem for some women during pregnancy. Depending on the severity, there are pregnancy-safe tools that can become part of a more robust treatment plan including: stool softeners, supplements, over-the-counter or prescription laxatives, and prescription medications without contraindications for those with a chronic issue. Talk to your doctor to determine which course of action is right for you.
While there are unique recommendations for a pregnancy carrying more than one baby, these don’t necessarily equate to a need for double or triple the food intake. Calorie and hydration needs are higher– in general, women carrying multiples should plan to consume an extra 600 calories (beyond pre-pregnancy calorie consumption) per day with twins, the equivalent of 300 extra calories for each baby. If pregnant with triplets, weight gain should be individualized.13 Remember to take your prescription OB Complete® prenatal dietary supplement consistently to ensure you and your babies are obtaining adequate nutrition. Note that OB Complete® Meal Plans are geared toward pregnancies with one baby, but, they do provide a good baseline upon which to add healthy calories. Eating smaller meals up to six times a day is almost a necessity in the later stages of a pregnancy with twins or triplets as room inside the abdomen is scarce causing digestion to slow. You may find it helpful to set an alarm to remind you to eat every 2-3 hours. Additionally, alternating a liquid meal, like a smoothie, with solid food can be easier to tolerate physically, while helping to achieve the necessary energy intake.
While gestational diabetes is often a temporary condition during pregnancy, it’s an indication that the body is having a difficult time producing enough insulin to regulate sugars and carbohydrates. The good news is that eating healthy, balanced meals and engaging in regular, “feel-good” exercise can help you manage gestational diabetes. Your registered dietitian will provide nutrition education with specific recommendations for how you should manage your gestational diabetes with healthy eating patterns.
A pregnancy eating plan should provide a consistent level of carbohydrates at each meal and snack, balanced with foods that deliver protein, fat, and fiber. This can help you avoid excessive carbohydrate intake at any one meal which may in turn elevate blood sugar levels.
While it’s not necessary to eliminate sugars and carbohydrates completely, you do need to pay attention to the amount and quality of carbohydrates you’re consuming.
Choose higher-quality carbohydrates more often, such as:
- Starchy vegetables (e.g. corn, peas, potatoes, and winter squash)
- Beans and lentils
- Milk and yogurt
- 100% whole grain bread, rice, cereal
Eat fewer of these refined carbohydrates:
- Soda and sweetened beverages
- Honey, jelly, refined added sugars
- Desserts, sweets, and candy
Follow your health care provider’s recommended gestational diabetes menus and carbohydrate intake plan.
Unless your healthcare provider has prescribed a particular diet for medical reasons (e.g. gestational diabetes) or you have a food allergy or intolerance (e.g. celiac disease) then it isn’t necessary to follow a specific diet regimen. Instead, follow healthy eating patterns that incorporate plenty of vegetables, fruits, beans, nuts, seeds, whole grains, and protein-rich foods. The OB Complete® website has meal plans, recipes, and videos to help you eat well in all stages of pregnancy and lactation.
Dieting during pregnancy can be hazardous to you and your baby, especially if it restricts calories, or foods containing important nutrients (e.g. iron, protein) for your developing baby. In order to obtain the nutrients you need, variety is key, as is taking your prescription prenatal dietary supplement from OB Complete®.
Pregnancy is not the time to begin limiting carbohydrates; as they serve as the primary fuel for muscles, the brain, and red blood cells and are vital to baby’s growth and development. Diets like KETO, Paleo, and Whole30 restrict carbohydrates. The Keto diet (ketogenic diet) places the body into “ketosis” which is a starvation state and may risk reduced fetal growth and low birth weight. While the Paleo or the Whole30 diet may seem less extreme, they provide insufficient energy and nutrients. Additionally, following these diets can add to your stress level as strict compliancy can induce anxiety. Generally speaking, when a diet lacks quality carbohydrates, it may also be lacking in fiber, which can contribute to constipation, a symptom experienced by more than half of pregnant women.16 Choose nourishing carbohydrate sources, like whole grains, fruits, and legumes to provide important nutrients in addition to carbohydrate fuel.
There is no harm in drinking a pasteurized green juice during pregnancy, but, undergoing a juice cleanse, or ‘juicing’, is highly discouraged for many reasons including that it is typically a form of extreme calorie deprivation. While vitamins from fruits and vegetables may be high, so too is sugar intake. Additionally, ‘juicing’ provides almost no protein or fat17, two of the most essential nutrients for baby’s development.18 Medically speaking, there is no need to “detox” using a juice cleanse since the body is designed to do just that–removing unwanted materials using our liver, kidneys, lungs, GI tract, and skin.
Vegetarian and Vegan
It is possible to have a balanced and nourishing pregnancy diet that does not include meat or animal products with a foundation of fruits, vegetables, beans and legumes, healthy fats (e.g. seeds, nuts, avocado) and oils (e.g. olive oil). If you’ve been a vegetarian or vegan for some time, talk to your healthcare provider about your eating patterns and determine if there are any specific modifications to your diet needed during your pregnancy.
Meatless diets can be low in iron, so you’ll need to account for this to ensure intake of the recommended 27 mg per day.19 Iron found in red blood cells help carry oxygen to your organs, tissues, and baby. Women need more iron in their diets during pregnancy to support the growth of the baby and to produce extra blood necessary to carry another life – remember, this can be up to 50% more than a woman’s pre-pregnancy blood volume. The risk of anemia, or low iron levels, increases with pregnancy due to blood flow changes and can cause you to feel exhausted and weak. Anemia also carries with it the risk of low birth weight and developmental problems.
Vegetarians who consume dairy and eggs will have an easier time meeting protein and calcium needs, but those who follow a vegan diet can compensate through fortified, non-dairy products and careful meal planning. Talk to your healthcare provider about adequate iron, B12, calcium, protein, vitamin D, and DHA intake during pregnancy.
1https://www.cdrnet.org/about/who-is-a-registered-dietitian-rd. Accessed September 4, 2018.
2http://americanpregnancy.org/pregnancy-health/foods-to-avoid-during-pregnancy. Accessed September 4, 2018.
3https://www.fda.gov/Food/ResourcesForYou/HealthEducators/ucm082417.htm. Accessed September 4, 2018.
4https://www.fda.gov/Food/FoodborneIllnessContaminants/PeopleAtRisk/ucm083320.htm?utm_campaign…. Accessed September 4, 2018.
5http://americanpregnancy.org/pregnancy-health/caffeine-intake-during-pregnancy/. Accessed September 4, 2018.
6http://americanpregnancy.org/pregnancy-health/herbal-tea/. Accessed September 4, 2018.
7http://americanpregnancy.org/your-pregnancy/7-common-discomforts-pregnancy/. Accessed September 4, 2018.
8http://americanpregnancy.org/pregnancy-health/diet-during-pregnancy/. Accessed September 4, 2018.
9http://americanpregnancy.org/pregnancy-health/mercury-levels-in-fish/. Accessed September 4, 2018.
10https://www.ncbi.nlm.nih.gov/pubmed/4075604. Accessed September 4, 2018.
11http://americanpregnancy.org/pregnancy-health/probiotics-during-pregnancy/. Accessed September 4, 2018.
12 http://americanpregnancy.org/pregnancy-health/constipation-during-pregnancy/. Accessed September 4, 2018.
13https://www.acog.org/Patients/FAQs/Multiple-Pregnancy#gain. Accessed September 4, 2018.
14 http://www.diabetes.org/diabetes-basics/gestational/how-to-treat-gestational.html. Accessed September 4, 2018.
15http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/?loc=ff-slabnav. Accessed September 4, 2018.
16 http://americanpregnancy.org/your-pregnancy/7-common-discomforts-pregnancy/. Accessed September 4, 2018.
17https://www.nutrition.gov/subject/shopping-cooking-meal-planning/juicing-101/. Accessed September 4, 2018.
18https://www.ucsfhealth.org/education/eating_right_before_and_during_pregnancy/. Accessed September 4, 2018.
19https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/. Accessed September 4, 2018.
This Content is for informational and educational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, pediatrician, or other qualified health provider with any questions you may have regarding diet and exercise during and after pregnancy, or other medical condition.
These Q&As were developed by Rebecca Scritchfield, MA, RDN, EP-C. Rebecca Scritchfield is a paid spokesperson for Vertical Pharmaceuticals, LLC, the maker of the OB Complete? family of prescription prenatal dietary supplements.