Eating Well During Pregnancy: Nutrients, Foods, Safety

As pediatricians, we start thinking about your baby's health before we ever meet them. What you eat during pregnancy helps build your baby's brain, bones, and blood, and it helps keep you strong for the months ahead. You do not need a perfect diet or a special plan. A steady mix of everyday foods, a prenatal vitamin, and a few safety habits go a long way. This guide covers the basics. Your OB or midwife knows your health history, so follow their advice for your own needs.

The nutrients that matter most

Most of what you need comes from a balanced plate: vegetables, fruit, whole grains, protein, and dairy or other calcium foods. A few nutrients deserve extra attention during pregnancy.

Folic acid (folate)

Folic acid helps prevent serious birth defects of the brain and spine, such as spina bifida. These problems happen very early, often before a person knows they are pregnant. That is why the CDC advises anyone who could become pregnant to get 400 micrograms of folic acid every day. Food sources of folate include leafy greens, beans, lentils, oranges, and fortified cereals and breads. Your prenatal vitamin will also contain folic acid.

Iron

Your body makes much more blood during pregnancy, and iron is needed to build it. Low iron (anemia) can leave you tired and short of breath. Good sources are lean red meat, chicken, fish, beans, lentils, spinach, and iron-fortified cereal. Eating these with a vitamin C food, like tomatoes, peppers, or citrus, helps your body absorb the iron.

Iodine

Iodine supports your baby's growing brain and your thyroid. You can find it in dairy foods, eggs, seafood, and iodized salt. Not every prenatal vitamin contains iodine, so check the label and ask your OB or midwife whether you need one that does.

Choline

Choline helps your baby's brain and spinal cord develop. Eggs are one of the richest sources. Meat, fish, chicken, dairy, beans, and broccoli also have some. Many prenatal vitamins contain little or none, so food matters here.

Calcium and vitamin D

These two work together to build your baby's bones and teeth and to protect yours. Calcium comes from milk, yogurt, cheese, calcium-fortified plant milks, tofu made with calcium, and canned salmon with bones. Vitamin D comes from fortified milk, fatty fish, and eggs. Your OB or midwife may check your vitamin D level or suggest a supplement.

DHA (omega-3 fat)

DHA is a healthy fat that helps build your baby's brain and eyes. The best food source is fish that is low in mercury, such as salmon, sardines, trout, and canned light tuna. If you do not eat fish, ask whether a DHA supplement makes sense for you.

Prenatal vitamins

A daily prenatal vitamin fills in gaps that are hard to cover with food alone, especially folic acid and iron. Ideally, start one before you get pregnant, or as soon as you find out. A few tips:

• Ask your OB or midwife which one to take. Some people need extra iron or a different formula.
• If your vitamin makes you queasy, try taking it with food or at bedtime.
• Do not take extra vitamins or herbal products on your own. Some, like high amounts of vitamin A, can harm a developing baby.
• A vitamin adds to good food. It does not replace it.

Fish and mercury

Fish is a great source of protein and DHA, so most people are encouraged to keep eating it during pregnancy. The concern is mercury, which can harm a baby's developing nervous system. Choose low-mercury fish and avoid these high-mercury types: shark, swordfish, king mackerel, and tilefish. If someone in your family catches fish from local lakes or rivers, check local fish advisories before eating it. Ask your OB or midwife how much fish is right for you each week.

Foods to avoid

Pregnancy changes your immune system, which makes some food infections more likely and more serious. Listeria is the biggest worry. It can cause miscarriage, stillbirth, or serious illness in a newborn. The CDC suggests skipping or taking extra care with:

• Deli meats, cold cuts, and hot dogs unless heated until steaming hot.
• Refrigerated pâté and meat spreads (shelf-stable cans are fine).
• Store-made deli salads like chicken, egg, tuna, or potato salad.
• Unpasteurized (raw) milk and anything made from it.
• Soft cheeses like queso fresco unless they are cooked until hot. This one matters in San Antonio, where fresh Mexican-style cheeses are on many tables. Check the label for "pasteurized" and heat it when in doubt.
• Raw or undercooked meat, chicken, eggs, fish, and shellfish, including sushi with raw fish and refrigerated smoked fish.
• Raw sprouts, such as alfalfa and bean sprouts.
• Unpasteurized juice or cider.
• Raw dough or batter, because of raw eggs and raw flour.

See the CDC's full list of safer food choices during pregnancy.

Caffeine

You do not have to give up coffee completely. MedlinePlus advises pregnant people to keep caffeine to less than 200 milligrams a day, which is about one or two small cups of coffee. Caffeine also hides in tea, sodas, energy drinks, and chocolate, so count those too. Energy drinks are best skipped. Learn more about caffeine and how much is in common drinks.

Alcohol

There is no known safe amount of alcohol during pregnancy, and no safe time to drink. Alcohol can cause lifelong problems with a child's growth, learning, and behavior. This includes beer, wine, and mixed drinks. If you drank before you knew you were pregnant, stop now and tell your OB or midwife. Do not let worry keep you from talking about it.

Everyday food safety

• Clean: Wash your hands, cutting boards, and counters often. Rinse fruits and vegetables under running water.
• Separate: Keep raw meat, chicken, and seafood away from foods that will not be cooked.
• Cook: Cook meat, chicken, and eggs all the way through. A food thermometer takes out the guesswork.
• Chill: Put leftovers in the fridge within two hours, or within one hour on hot days. In a Texas summer, food in a hot car or at an outdoor party spoils fast.

A few practical tips

• Nausea early on? Small, frequent meals and plain snacks often sit better than three big meals.
• Drink plenty of water, especially in San Antonio heat.
• If you follow a vegetarian, vegan, or other special diet, or have trouble affording food, tell your OB or midwife. They can help you plan or connect you with programs such as WIC.

For more on building a healthy plate, see MedlinePlus on eating right during pregnancy.

When to call us

Your OB or midwife is your main source of care during pregnancy. Call them right away if you have trouble keeping food or fluids down, think you ate something unsafe and feel sick, or have fever, stomach cramps, or diarrhea. Call 911 or go to the ER for heavy bleeding, severe belly pain, fainting, or any emergency.

Many families meet their pediatrician before the baby arrives. If you have questions about choosing a pediatrician, feeding plans, or your baby's first visits, contact your A thru Z Pediatrics office or request a visit.