Relaxing with a glass of water, instead of a Cherry Pepsi, and snacking on an apple, instead of ice cream, are diet choices that expectant mom Renee Himberger gladly makes for the sake of her baby.
They're also representative of what health-care professionals recommend for pregnant women and any woman of child-bearing age.
“I try to be as healthy as I can for my baby,” Himberger said. “As soon as you know you're pregnant you're a lot more conscious of what you put in your body. Your baby is eating what you're eating.”
Himberger, 28 of Gretna, is 34 weeks pregnant with her second child. She and her husband, Tom, are also the parents of a daughter, Penny, 23 months old.
Himberger said she and her husband decided to eat as “clean” as possible when they were trying to conceive a baby. They limited processed foods and sweets in their meals and focused on healthy basics such as fruits, vegetables, whole-grain carbohydrates, lean protein and dairy products. Himberger conquered her craving for sweets, especially a daily craving for ice cream, by substituting fruit.
“My consumption of Honey Crisp Apples is definitely on the high end,” she said in mid-March when she was 31 weeks into her pregnancy. “Now I have ice cream once or twice a week. You can't completely deprive yourself.”
Himberger curtailed her craving for Cherry Pepsi to get caffeine out of her diet. Instead of having one soda a day, as she did before she was pregnant, she has a soda once or twice a week.
A balanced diet plays a key role in a healthy pregnancy and it should begin before you get pregnant, according to Omaha physician Rebecca Jacobi, an obstetrician and gynecologist at Methodist Physicians Clinic Women's Center.
“It's important to have an overall healthy lifestyle,” Jacobi said. “Well-balanced meals with fruits, vegetables, lean protein and dairy. Appropriate body weight. Regular exercise. Eliminate things that are harmful: cigarette smoking, alcohol, caffeine, illicit drugs.”
Jacobi recommends that any woman of child-bearing age take a daily dose of a prenatal vitamin-mineral supplement and to continue doing so during pregnancy. The supplements are available, without a prescription, where vitamins are sold. Just make sure it has 400 micrograms (mcg.) of folic acid, the physician said.
Folic acid is a B vitamin that reduces the risk of birth defects of the brain and spinal cord, also called neural tube defects.
Women need to take prenatal supplements at least three months before getting pregnant to build up the necessary stores of folic acid in the body, Jacobi said. The early days of pregnancy, when a woman is unlikely to know she is pregnant, are when a fetus is at the greatest risk for neural tube defects due to a lack of folic acid.
Having a healthy lifestyle, including an appropriate body weight, before you get pregnant is the ideal, Jacobi said.
“Women who are underweight sometimes have preterm and underweight babies,” Jacobi said. “Overweight moms have problems with overweight babies and prolonged pregnancies that result in problems with delivery.”
Women who are overweight or gain too much weight during pregnancy are also at increased risk for gestational diabetes, pre-eclampsia, vaginal-delivery problems and complications with a surgical delivery.
A woman who has a healthy body weight before pregnancy should gradually gain 25 to 35 pounds during the nine months of her pregnancy. Weight gain should be slow in the first three months of pregnancy so a woman needs only an extra 300 calories per day, on average, over nine months, Jacobi said.
The doctor may recommend that a woman who is underweight gain 40 pounds over the nine months.
An overweight woman should not try to lose weight during pregnancy. She should gain 10 to 20 pounds over the course of a pregnancy, depending upon how overweight she was at the outset, Jacobi said. “I don't want deprivation during pregnancy,” the physician said. “We may not need an increase in calorie count. We definitely want her to increase her exercise, low-impact exercise.”
A woman expecting twins, triplets or more will receive personalized advice on calories, protein and other aspects of diet, Jacobi said.
An expectant mother of twins, for example, might need to increase her daily calorie intake by 650 calories, on average, if she started the pregnancy at a normal weight.
Also needing special consultations are obese moms-to-be and those with chronic medical issues such as diabetes or a history of preterm pregnancy, Jacobi said.
“I encourage people to eat high-quality foods, high in nutrients and to avoid the drive-through lane,” Jacobi said. “Anyone who hands you your food through the car window is not your friend. I encourage real food, made with few ingredients, less processed. If you can recognize the words on the box and they don't seem like something out of science class, it's probably better for you.”
The notion that a little alcohol is OK during pregnancy is wrong.
“No alcohol,” Jacobi said. “None. Zero.”
Omaha dietitian Jessica Magilton finds that most expectant mothers are willing to forgo whatever could hurt their babies and strive to eat a healthy diet.
“Once you get pregnant, something inside of you wakes up,” Magilton said. “The majority of people put themselves aside for those months, for the sake of the baby. They're eating more fruits and vegetables when they don't necessarily like them. They're cutting down on pop. They recognize that this is the most important thing they've ever been in charge of and they take it very seriously.”
Magilton counsels pregnant patients and teaches classes on diet during pregnancy at Methodist Women's Hospital. Key among Magilton's diet recommendations for pregnant mothers and their families are these:
» Make half your plate fruits and vegetables.
» Choose whole grain cereals (not white bread, for example).
» Eat a rainbow of colors because foods of different colors have different nutrients.
» Don't go too crazy on one thing.
» Make sure you're eating basic good foods so special treats don't crowd out the foods you need.
» Choose low-fat meats such as turkey and 93 percent lean ground beef.
A good diet is not only important for the baby, it's also important for the mother's health. If nutrients needed by the fetus are not available in the diet, they can be taken from the mother's body, Magilton said.
A woman failing to get calcium through dairy products and her prenatal supplement pills, for example, may lose calcium in her bones to the growing fetus. The calcium loss to the bones puts the woman at risk for osteoporosis (brittle bone disease) later in life, the dietitian said.
Many diet recommendations for pregnant women have been around for years. Among the newer recommendations are those to eat eight to 12 ounces of fish per week and to select fish with low mercury content.
“A study showed that when expectant moms ate up to 12 ounces of low-mercury fish such as tuna or salmon, it helped neurological and eye development of the infant in utero (uterus),” Magilton said.
Cravings for particular foods during pregnancy are not necessarily harmful, Magilton said. An exception is alcoholic beverages. If you crave that, you should talk with your health-care provider, she said.
“Sometimes we crave things we need,” Magilton said. “During my last pregnancy I craved red meats and fruits.”
The risk of cravings is that they will create an unbalance diet, displacing the foods you need for a healthy outcome, so Magilton recommends moderation.
“Studies show that if you're craving chocolate, a couple bites will satisfy a craving,” she said. “So pause and see where you're at. Chocolate cake is probably OK, but just one piece.”
How to meet the nutrition goals for each trimester:
» 1 cup vegetable = 1 cup raw or cooked vegetables, 1 cup 100 percent juice or 2 cups raw leafy vegetables.
» 1 cup fruit = 1 cup fruit, 1 cup 100 percent fruit juice or one-half cup dried fruit.
» 1 ounce grain = 1 slice bread, 1 ounce ready-to-eat cereal or one-half cup cooked pasta, rice or cereal.
» 1 cup dairy = 1 cup milk, 8 ounces yogurt, 1½ natural cheese or 2 ounces processed cheese. (Skim or low-fat products recommended.)
» 1 ounce protein = 1 ounce lean meat, poultry, fish or seafood; one-fourth cup cooked beans (such as pinto beans), one-half ounce nuts (out of the shell), 1 egg or 1 tablespoon peanut butter.
» Note on protein: Include 8 to 12 ounces fish per week. Limit white albacore tuna to no more than 6 ounces. Do not eat tilefish, shark, swordfish and king mackerel because they have high mercury levels.
» Weight gain: If you are gaining weight too slowly, you may need to eat a little more from each food group. If you are gaining weight too fast, you may need to decrease sugar- and fat-laden foods like candy, soft drinks, hot dogs and ice cream.
» Caution: Observe safe food-handling practices such as washing hands before handling food. Avoid the bacteria listeria by not eating unpasteurized (raw) milk, cheese and juices; raw or undercooked animal foods, such as seafood, meat, poultry, and eggs; and raw sprouts. A pregnant woman and her unborn baby are at greater risk of getting sick from eating unsafe or contaminated food. Some foodborne illnesses may cause a woman to have a miscarriage or a premature delivery. They also might cause serious health problems for the baby after birth. Details on safe food handling and avoiding food-borne illness are at www.choosemyplate.gov/pregnancy-breastfeeding.html.
Sources: U.S. Department of Agriculture; Jessica Magilton, clinical dietitian at Methodist Women's Hospital.