A Nutritionist Shares What to Eat When You're Pregnant—and What to Avoid

From the minute those two blue lines appear on your home test (or the words "pregnant" on some) your whole world turns upside down. That's when the craziest rollercoaster you've ever taken (literally and figuratively) begins. It's an emotional ride of ups and downs and everything in between but just like the theme park version, it's also incredibly exhilarating. Nothing compares to that magical feeling of growing a new life inside of you. It is truly a miracle. But as your body changes, so too do your cravings, your mood, and your energy levels. It goes without saying that your appetite increases now that you're feeding two people but how much your current diet should change now that you're pregnant is the big question. 

One thing's for sure, the food you put in your mouth now doesn't just impact you anymore. According to Stephanie Middleberg, MS, RD, CDN, founder of Middleberg Nutrition, and author of The Big Book of Organic Baby Food this is when you really need to ramp up your nutrient intake and load up on whole foods (along with plenty of water). With so much noise around what to eat (and what not to), we asked Middleberg to set the record straight. Be sure to scroll to the end for her top supplements and food groups to eat or a healthy (and happy) pregnancy. 

MYDOMAINE: Being pregnant for the first time (even second, third times) can be daunting for any woman, there are so many things to consider and your health isn't just about you anymore. What are some of the diet guidelines or food philosophy you advise women to stick to when they discover they're pregnant?

STEPHANIE MIDDLEBERG: This is such an exciting time and can also be incredibly overwhelming, as your decisions don’t just impact you. I am often the first (okay maybe second or third) phone call my clients make as they want to ensure they are on a healthy path. I help weed out the myths and give them a structure to a fairly unpredictable time. This is really a time to start nourishing your body and your baby to be with nutrient dense, whole foods.  

I recommend all pregnant woman: 

Increase healthy fats

This is probably the hardest for mom’s to be and new mom’s because it seems counter intuitive. But it is really essential for many reasons. It’s vital to baby’s organ and brain development, YOUR metabolism, absorption of key nutrients like (A, D, E, and K) and future milk supply and quality of your milk. Women should focus on healthy sources like avocado, fish oils, eggs, olive/oil, coconut/oil, nuts and full-fat dairy (no low-fat foods!).

Focus on quality

When possible aim for organic produce (or look at the dirty dozen to help choose which fruits and veggies to go organic), grass-fed meats, pasture raised, organic eggs, wild fish (check out Monterey bay aquarium for a nice rundown on what fishes to select). This can be overwhelming so control the controllable, meaning I’d rather you eat non-organic produce if you can’t find organic options.  

Stabilise blood sugar

Stay armed with snacks! We often feel nauseous and low energy during pregnancy when really our blood sugar is low. Have a breakfast rich in what I call the two P’s, protein and produce. Morning is when our blood sugar is the lowest, and if you start the day with sugar, it can increase your hunger hormone ghrelin. Which in turn, leads to increased hunger and blood sugar issues during the day. Protein will keep your appetite and energy consistent throughout the day. Good options include eggs, full-fat plain yogurt, and nut butters.

Have a protein/fat with every meal, including your afternoon snack. Think apple with almond butter, crackers with cheese, veggies with hummus, dates with goat cheese.

MD: What are the top 5 supplements we should avoid?

SM: The FDA, nor any other government agency, reviews, investigates or regulates what goes into a vitamin.  Meaning when you read that ingredient list, there is no official verifying that what the manufacture says is actually true.  Pretty crazy right?  (Yes there are some third-party verification labels, but again the FDA does not regulate this industry). So it is vital that you go with trustworthy brands that go above and beyond what is required of them by the law. If you want to do your own research, check out Consumerlab. It’s basically the only 100% independent verification of supplements and it is a fantastic resource.

MD: There are multiple and conflicting stories out there about what not to eat when pregnant such as soft cheeses and raw fish. Can you set the record straight and list a few of the foods that women should steer clear of/avoid when pregnant and why?

SM: I know many people who eat whatever they want.  When I was pregnant I didn’t want to put myself in any unnecessary risk just because I was craving some lox. I’m not going to preach here but I would stay clear of raw fish, cured meats, unpasteurised cheeses, undercooked anything (meat, fish, eggs) and deli meats. I’d also stay away from any open salad bars. The risk being picking up some sort of food borne illness. Since you're pregnant, your immune system is compromised meaning a bug you could have shrugged off can now be very dangerous. It’s 10-months, you can enjoy all the sushi you want once that beautiful newborn is resting comfortably swaddled next to you. I asked for a huge spread of lox as my first meal once my son was born.

MD: There is now evidence to support the fact that what women eat when pregnant affects the baby's future health and that "avoiding overindulgence and eating healthily" should be a priority. What is your advice to women who are craving sweets or fatty junk foods when pregnant?

SM: We crave what we eat. It is very easy to go down the path of just eating carbs, cheese, and sweets. I certainly understand in the stages when you're not feeling well to rely on certain carbohydrates more often but I highly recommend to try and get in (even small) amounts of nutrient-dense foods like fresh veggies, fruits and high-quality protein early on (even when not feeling great).

Even if that means starting with two bites of a Bolognese sauce at dinner and three slivers of cucumbers. Slowly work your way up. You will have a much healthier pregnancy and recovery period. Then we need to look at why you're having these cravings. Are you letting yourself get too hungry, not eating enough during the day or not eating the right balance of foods to stabilize blood sugar, are you overly stressed and tired, etc. Once we get to the root we can work how and where to make changes.

Research is showing that what you eat can also affect your babies’ palate and food preferences later on. Try to include a variety of flavors and herbs like ginger, turmeric, sage, rosemary, etc. Try not to rely on bland foods because this is the first exposure your baby has to enjoy flavours. This also holds true for consuming too many sweets and fried foods.

Prenatal Vitamin

This acts as an insurance policy to ensure you are meeting your needs as they are much higher while pregnant.  Key here is ensuring it is a high quality prenatal (from a trusted brand) and that it contains Folate and not Folic Acid (which is the synthetic form). You want to aim for at least 600mcg. The rest you can obtain from green leafy vegetables in your diet. I personally recommend Mega Food.

Cod liver oil or DHA

Cod liver oil is really a preferred source of DHA and Omega 3 fatty acid ( EPA ) and is rich in Vitamins A and D.

Probiotics

They increase good bacteria to support gut health of the mom and baby. Research is also indicating that improving gut health in the womb can help minimise the incidence of food allergies as well as minimise infections and illness. 

Magnesium

This helps to minimise muscle contractions, preeclampsia, helps with sleep and constipation all concerns during pregnancy.

But remember, these are meant to supplement and not replace foods in your diet. While they can provide boosts in certain gaps in your diet, aim for food first.

Omegas

They are vital for brain development. Wild fish is your best bet.  Try to eat 2-3 servings per week of wild salmon, cod, halibut and if you like the taste, sardines.  Stay away from fish with high mercury like tuna and swordfish. 

High quality protein

Eggs preferably pasture raised and organic. I always aim to have hard-boiled eggs in my fridge along with Greek yogurt or Goat’s milk yogurt and hemp hearts. Protein helps the body to recover and satisfies a ravenous appetite. Think about aiming for 15 to 20 grams of protein per meal.

Egg: 6 grams
A piece of chicken: 25 grams
1 cup of beans has 15 grams
3 tbsp hemp hearts: 10grams
1 serving of Greek yoghurt: roughly 15 grams 

Fat

This is probably the hardest for mums to be and new mums because it seems counter intuitive. But it is really essential for many reasons. It’s vital to baby’s organ and brain development, your metabolism and milk supply and quality of your milk. Women should focus on healthy sources like avocado, fish oils, eggs, olive/oil, coconut/oil, nuts, full fat dairy, etc. 

Seeds

Think hemp, chia, pumpkin, and flax seeds. Filled with fiber, omegas and magnesium and zinc these seeds are superstars for pre and postnatal health. Magnesium helps combat constipation, headaches and aids in sleep. The fibre, protein and fat help stabilize blood sugar levels. Tahini: an excellent source of calcium, which is a key nutrient (along with magnesium, vitamin D and K) for bone health. During pregnancy and breastfeeding, the body draws from mom’s bones to provide for the baby so it is key for mom to keep up her stores. 

Veggie’s galore

Your Sweetgreen rewards will be off the charts. You can never have enough especially green leafy veggies which are rich in folate (necessary for fetal growth) in addition to being extremely high in antioxidants and other key nutrients like potassium, fiber, vitamin c, etc. In the beginning stages of pregnancy it can be tough to get in vegetables. I find that raw veggies are easier to take in at the start with a simple dressing of oil and lemon juice. I also recommend a cucumber salad with some rice wine vinegar, sesame seeds and olive oil. Or try blending into a smoothie.

Fermented Veggies

Essential for gut health and a happy gut = happy mum. Plus probiotics increases good bacteria in your stomach, which aids in absorption of nutrients, boosts immune system in you and your baby. 

Iron

Get to know your local butcher. About 1-2 servings of grass-fed meat or pasture raised poultry to supply absorbable form of iron. I also recommend bone broth: Delicious and comforting, it has become known as a bit of a cure-all, as it builds strong bones; boosts the immune system; improves digestion; and supports joints, hair, skin and nails. It's also an excellent source of calcium, magnesium and phosphorus (which make it great for our bones and teeth). It is rich in chondroitin, glucosamine (which is good for our joint health and inflammation), glutamine and other amino acids that are especially healing to the gut (and thus help nutrient absorption) and your immune system.  

Water

In addition to these foods, please hydrate! In pregnancy your blood volume thickens and fluid is needed especially for amniotic fluid. It also helps prevent constipation. Most preterm labor is due to dehydration. Plus, breast milk is 70% water. You want to aim for consuming ½ your body weight in ounces. When water wasn’t enough I found watermelon water and coconut water to be life savors. I would also blend coconut water, watermelon, lime and mint for a refreshing beverage.

What has been your craziest craving while pregnant? Let us know in the comments.

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