The New Rules of Pregnancy

Eating & Drinking

Eat Clean

Pregnancy offers a natural reset for health habits. Enjoy the opportunity, keep things simple, and don't stress. It's not hard to nourish yourself and get all that your body needs. The key is to lean on nutrient-dense fresh foods that give you the most benefits per bite—organic, hormone-free, antibiotic-free. Do what you can to avoid processed stuff (not just snacks from the vending machine but anything packaged—fresh is best). If you have access to a farmers' market, take advantage—a rainbow assortment of vegetables and fruits is always a good thing. Cook meat and fish well. Take care where you buy prepared foods—stick with clean, reliable sources. Nutrition specs are on the next pages. You'll get a lot from your prenatal vitamin (see page 41), but it's only part of the story; nutrients from food are absorbed better, and eating well can also help you feel your best.

Protein, calcium, fiber

Protein makes babies grow. You want to build your pregnancy diet around it and aim to get somewhere between 60 and 70 grams a day. For reference, a chicken cutlet has about 25 grams of protein; a cup of lentils has 18. Two eggs deliver about 12 grams, and a half cup of tempeh is 15. A serving of salmon or steak has a whopping 40 grams of protein. If you're vegan by preference, consider eating eggs (and add Bragg's nutritional yeast to soups, avocado toast, or smoothies). If you're on the fence about meat, now is a good time to opt in. Calcium—also essential in pregnancy—builds babies' bones and teeth. Get 1,000 milligrams a day (a yogurt has 300 milligrams). Fiber is important for you, not the baby—to keep your digestive system working well. Have 28 grams a day (a serving of broccoli has 5 grams; a cup of raspberries has 8). This plan not only keeps you nourished but also keeps you full, so you're less likely to reach for foods without benefits (you know: bagels, cupcakes). Don't worry too much about precision—the amounts here are just guidelines. If you like, you can do an occasional check with an app like MyFitnessPal. Just type in what you ate that day to see how it all breaks down in terms of nutrients, then tweak as needed.

You're Eating for One

You only need to add about 400 calories a day to your diet, and those new calories should come from nutrient-dense foods. Wait till the second trimester to up your calories (if you start pregnancy underweight, your doctor might direct you to do it sooner). Think dairy, eggs, lean meat, dark leafy greens, cruciferous vegetables, and good fats like nuts and avocado. The omega-3 fatty acid DHA, which is found in fish, is especially important in pregnancy. You can get what you need by having two ser-vings a week of low-mercury fish—sardines, salmon, trout, shrimp, pollack, canned light tuna (don't eat high-mercury fish: marlin, skate, shark, swordfish, tilefish, ahi tuna, king mackerel); if you're a vegetarian, you'll get your DHA from your prenatal vitamin. Ideal weight gain in pregnancy is not the same for everyone. Your doctor will tell you how much she'd like you to gain depending on your starting weight. For most people, it's somewhere between 25 and 35 pounds. If you keep an eye on portion size, fill up on protein and fiber, and don't overdo the carbs, the weight should work out. This is important. Gaining too much is not just about having more weight to lose on the other end; it also raises your risk for certain complications, including gestational diabetes.

Six Small Meals

Your digestive system is slowed by progesterone during pregnancy, and there's an uptick in gas. Eating smaller, more frequent meals is a great strategy. It's easier to digest less food in a sitting. Speaking of sitting, even if you're having a busy day, try to sit down when you eat; take your time and chew thoroughly. If needed, digestive aids Beano, Lactaid, Mylicon, and Tums are fine, but don't take more than the specified dose. Smaller meals can also help if you're experiencing nausea. An empty stomach is not great (you're more likely to feel nauseated when there's nothing in your stomach), so frequent light eating is a better bet. If you're coping with morning nausea, see if you can get down a small breakfast of carbs plus protein (an egg and half a piece of toast, say, or last night's chicken and rice). Fat can be hard to digest when you're nauseated, so hold off on foods like avocado and yogurt till later in the day. Acid reflux is another side effect of pregnancy hormones; avoid tomato sauce, mints, fried foods, carbonated drinks, and vinegar (enjoy olive oil, a healthy fat, on salad)—and don't lie down right after eating.

Drink Lots of Water

Filter your water and have about eight glasses a day. It helps your cardiovascular system, reduces constipation, and prevents UTIs. If you're not a fan of plain water, add mint or lemon (wash citrus skin if you're going to put it in your drink). Drinking plenty of water also lowers the risk of blood clots, which can be a serious issue during pregnancy (see page 57). Use a glass or a stainless-steel water bottle—the BPAs in some plastic bottles can be endocrine disruptors. If you're coping with nausea and vomiting and can barely keep anything down in the first trimester, don't worry too much about nutrients, but do stay focused on hydration—this is so important; you can also sip ice-cold sports drinks or Pedialyte to replace electrolytes. Otherwise, it's water, water everywhere and all the time, from the minute you know you're pregnant.

Wash Produce Well

Buy organic whenever possible, especially when it comes to fruits and vegetables eaten whole (without peeling)—things like apples and pears, berries and grapes, celery and spinach. Produce like avocados, citrus, melon, and corn, which has a protective outer layer that you'll discard, is hit less directly by pesticides. Throw away the outer leaves on conventionally grown lettuce, cabbage, and Brussels sprouts. Wash everything—organic or conventional—with a quick vinegar-water spritz. Water removes most pesticides, but vinegar addresses bacteria and mold spores. Mix one part distilled white vinegar and three parts water in a spray bottle; spritz produce, let sit for a minute, then rinse well with cold water. Or submerge fruits and veggies in a vinegar bath (same proportions—one part vinegar, three parts water), then rinse well. If you're storing produce, as opposed to eating it right away, be sure to dry it thoroughly.

One Great Cup of Coffee

If you're inclined to drop caffeine while you're pregnant, you'll get no resistance here. Otherwise, keep consumption down to one cup of coffee per day. Make it count. Maybe you'll skip the morning coffee at home because the one you have at your desk (or after lunch) is more important to your mood or productivity. Black tea has about half the caffeine of coffee, so you can have two cups. Any combo that keeps you down to 200 milligrams of caffeine a day is fine. Enjoy caffeine-free teas like chamomile, mint, and ginger, but check the caffeine content of herbal blends. In general, approach herbal blends with caution (scientific studies haven't been done on all the ingredients they may contain). Or make your own blend, with decaf green or black tea plus fresh citrus rinds (wash them first) and cinnamon. So much coffee and tea drinking is about ritual, so if cutting back is tough, make a new ritual that comes with less (or no) caffeine—like taking a walk to refill your water bottle.

Save certain foods for Later

Runny cheese, smoked fish, pâté, hollandaise sauce, steak tartare, raw fish—this is the feast you can have after you've stopped nursing. While you're pregnant and breastfeeding, stay away from these foods and others that could present a risk of listeria, salmonella, or other contaminants. Though the odds may be small, the impact on pregnancy can be serious. Stay away from raw or bloody meat, foods that might contain raw egg (certain mayos and salad dressings—check the label or ask the server), hot dogs, jerky, and deli meats. Bean sprouts and alfalfa sprouts are impossible to clean properly, which means they can harbor bacteria. Skip them. If you're traveling outside the United States, be mindful that some dairy products may not be pasteurized; in France, pregnant women are told not to eat salad greens and raw fruit and vegetables at restaurants, due to concerns about toxoplasmosis (it's more prevalent abroad). A lot of patients ask us about product recalls. Don't panic. If you've eaten something that's then been recalled and you have symptoms like fever and diarrhea, call your doctor. If you have no symptoms but are freaking out, you can still call your doctor. Basically, you can always call your doctor.

A Treat a Day

We advocate a low-sugar diet (because a no-sugar diet is going to stress you out). Aside from everything you probably already know about the havoc sugar can wreak on our bodies, studies link high sugar consumption in pregnant women to infant asthma and allergies, among other things. Say no to soda and candy—and to diet soda too; it's full of chemical sweeteners (which also cause gas). Keep artificial sweeteners out of your coffee, and skip gum (more sweeteners); you're better off using mouthwash. Fruit juice and dried fruit are intense concentrations of sugar; eat a whole piece of fruit instead (you'll benefit from the fiber). If you want to enjoy a small sweet once a day, pick something nutrient-dense like dark chocolate rather than a vending machine offering. Pair it with fiber (say, an apple), which slows absorption. This way your blood sugar won't spike, then crash.

Extra Everything If You're Having Twins

Taking care of yourself while carrying twins means turning up the dial a little on everything that nourishes you. Extra rest, extra protein, extra folic acid, extra water. You should increase your caloric intake by 600 calories a day and take a prenatal vitamin with 1 milligram of folic acid. Recommended weight gain is about 10 pounds more when you're having twins, and doctor visits are more frequent; there's an increased chance of complications with twins, so you need extra care. Your doctor will guide you on exercise recommendations. Twins often mean a shorter pregnancy. They usually deliver earlier than the full nine months, and about half come before 37 weeks, in which case they may require extra time in the hospital.

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