What to Eat When Pregnant (And Three Myths)

I do not like to tell pregnant people what not to eat!

So in this article, I’m going to talk about things you CAN eat. These might even be things that you thought were off the table during pregnancy.

What to eat when you’re pregnant is such a touchy topic. When you’re pregnant, food takes on whole new importance, and we may develop a very new relationship with it. For some of us, eating is difficult. I was nauseated through both of my pregnancies. I just didn’t really feel like eating very often. Normally, I LOVE FOOD, but during pregnancy, I had to work hard to eat enough. Luckily that made it easy to eat healthy things since nothing else sounded better anyway. But sometimes I could only stomach very few kinds of foods, and they might not have been the most nutritious options. We do the best we can!

Other people might get REALLY HUNGRY during pregnancy. Maybe they have never felt that way before. They might have to work hard to not overeat or to resist cravings for unhealthy or forbidden foods.

The Importance of Good Nutrition During Pregnancy

Nutrition is very important, especially during pregnancy. There are some important adjustments you will want to make to optimize how you feel and how your baby grows. You probably hear LOTS of advice related to food, and often not from your care provider. Statistics show that the large majority of care providers do not provide nutritional guidance to pregnant people! That was a difficult thing for me to hear. Some parents also report that when they do get advice from their care providers, it is often outdated. It can be hard to stay up-to-date on the very latest nutritional information because things change. For example, I was told to have 60 grams of protein per day during my first pregnancy. That number changed to 80 grams in my second! And now the recommendation is even higher!

I would love to address a few myths you may have heard about pregnancy nutrition:

MYTH #1: You are eating for two.

Sorry, but nope. Your baby is so tiny that they only need a small fraction of the calories that you do. Yes, we do need some extra energy to make a new little person, make a whole new organ (the placenta), and increase our blood volume BY 60%, but we don’t need to double our calorie intake. The actual number is closer to just increasing by about 300 calories per day during your second and third trimesters and less during the first. That’s not all that much! It’s definitely not doubling our own caloric needs.

We gain a total of about 30 lbs of baby and extra stuff to support the baby by the end of pregnancy. Here’s an approximate breakdown:

• Placenta: 2 pounds
• Baby: ~7.5 pounds
• Extra breast tissue (to get ready for breastfeeding): 2 pounds
• Increased fluid volume: 4 pounds
• Increased blood volume: 4 pounds
• Uterus: 2 pounds
  Maternal fat stores: 7 pounds

Most of this comes right out when we give birth. So if you gain about 30 lbs during pregnancy, you’ll be almost back to your pre-pregnancy weight right after giving birth.

The calorie recommendations may be a little different if you were underweight or overweight before you got pregnant. If you were underweight, you may want to increase the amount you eat by a little more than 300 calories. If you were overweight, you might not need quite as much to build up the maternal fat stores. I was in this category, so my difficulties in eating enough didn’t affect me badly! I had some wriggle room.

MYTH #2: Cravings tell you what your body needs.

Sorry, but nope again! Unless your diet is really good, cravings are not good indicators of what your body needs. They are indicators of where your body currently is. When we don’t have ideal diets, unhealthy foods do a great job of making us crave them more. This DOES NOT mean we need it. This carries over into pregnancy. We need to resist unhealthy cravings. This can be really hard, but if you take on the very big challenge of fixing imbalances by cutting sugar and junk, your body’s actual needs and cravings might be heard through the static. At that point, you might start having cravings that make sense, cravings that benefit your body and your baby. You’ll probably notice that you feel better, and you’ll be giving yourself an even better chance for an uncomplicated pregnancy, birth, and recovery experience.

MYTH #3: There are so many foods you CAN’T have.

This is changing! It’s still true that alcohol and caffeine aren’t so good for us, but some of the other “no-no” foods are being reevaluated. For example, we’ve been told not to eat undercooked egg yolks, raw cheese or soft cheeses, sushi, and certain fish. Lily Nichols is a registered dietician/nutritionist, author, researcher, and clinical practitioner. A couple of her books are even used as textbooks. Her specialties are pregnancy nutrition and diabetes. She does a great job discussing how we need to be balancing risks with benefits. Sometimes, avoiding certain foods means we don’t get the BENEFIT of the nutrition offered there and it might outweigh the risk to have some. Here are some of her more recent evidence-based findings and recommendations:

• Alcohol: Still recommended to avoid it.
• Caffeine: Still recommended to minimize it
• Foods that might have salmonella and cause food poisoning. This concern is the reason that a lot of foods are not recommended to eat in pregnancy. A pregnant person is at higher risk of severe illness from food poisoning, so we’re told to avoid things that carry a higher risk. HOWEVER, did you know that the foods that cause 46% of food poisoning cases in the U.S. are fresh fruit and leafy vegetables!?! Pregnant people are not being told to avoid those. And we shouldn’t! We would be a lot less healthy if we did that. It’s worth the risk because otherwise our health and our baby’s health might suffer more.

Here are some “risky” foods” we are told to avoid but may need to reevaluate:

• Undercooked egg yolks: If you like fried eggs with a runny yolk, you’re in luck! The risks of salmonella from undercooked egg yolks are very minimal, 1 in 30,000, and eggs from “Pasture-Raised” chickens are 7 times less likely to have salmonella. Egg yolk is the food that is highest in choline, which is a very important nutrient for a baby’s brain development. Choline might be as important as folate. Liver is nearly equal to eggs for choline content, but who wants to eat liver every day!? If you’re not a fan of eggs cooked in other ways, it might be worth the tiny risk to have a little runny egg yolk at breakfast.
• Raw fish: If you love sushi, this is good news for you! In Japan, sushi is definitely part of a pregnancy diet. The British National Health Service says it’s safe to eat sushi when pregnant. So why is that? Seafood is very well screened for microbes as a rule, and for this reason, contamination is rare. Also, fish used for sushi is most often flash frozen, and this process inactivates parasites. So unless you buy old sushi that’s been left out for too long, you should be very safe. Just avoid the buffet sushi! Raw fish is very beneficial because it has some extra nutrition that we don’t get in cooked fish. It’s high in selenium, which is a great nutrient that even helps prevent mercury toxicity. So in that way, it might make the fish even safer to eat raw than cooked! Raw fish is also higher in omega-3 fats like DHA and iodine which are important nutrients for baby development. AVOID RAW SHELLFISH THOUGH! These are the seafood choices mostly responsible for cases of foodborne illness caused by seafood. That includes oysters.
• Fish in general: We’re told to limit our consumption of fish to less than 12 oz per week in pregnancy in order to limit mercury toxicity. But seafood is so full of so many great pregnancy nutrients!! Vitamin D, DHA, protein, iodine, zinc, and selenium. Looking a little more closely, it is a good idea to limit certain fish, but maybe not all because of the great benefits of eating them. Swordfish, king mackerel, tilefish, and shark are highest in mercury, so limiting those is a good idea. Tuna has the next highest level of mercury and the recommendation is to limit that to 6 oz per week. Other fish are lower in mercury and much less likely to build up to toxic levels in our bodies, even if we eat a lot more. Eating more than 12 oz of fish per week during pregnancy has been shown to have great outcomes for babies including better IQ, fine motor skills, communication skills, and social development. So have some salmon, anchovies, sardines, catfish, flounder tilapia, and trout! Have cooked shellfish like crab, oysters, shrimp, and mussels. There are more safe options out there than I can list here.
• Raw cheese and soft cheeses: We are told to avoid these for the risk of bacteria, BUT some interesting information is that most of these cheeses tend to be EVEN LOWER in these pathogens than the pasteurized cheese we can buy at the grocery store. Small artisanal cheese makers and farmers making and selling raw cheese and milk products have to follow even stricter regulations and therefore tend to have squeaky clean operations and very safe products. Also, smaller dairy operations tend to have fewer animals as a whole, and more animals that are grass-fed and living in more pastured and sanitary conditions. That means fewer harmful bacteria appear in and around the milk.

MYTH #4: Avoid fat.

No again! Many kinds of fat are good and even essential for a healthy pregnancy. Fats from REAL FOOD sources such as nuts and seeds, avocados, whole milk products, meat and seafood, coconut, and olives are very healthy. We often need more than we think. Fats do not necessarily make you fat.

We tend to eat more low-fat foods because they’re not as filling, BUT many “low-fat” foods are higher in added sugar to make them taste better. Also, foods that have the fat removed, such as low-fat milk or yogurt, are lower in some essential nutrients such as protein and other vitamins. This is not a good trade-off! We end up eating more calories because of the sugar, which doesn’t help maintain a healthy weight. Plus, too much sugar has been shown to contribute to heart disease, diabetes, and other health problems.

Even saturated fats are not necessarily bad. Historically we’ve been told that they contribute to heart disease, but more recent research is showing that might not be the case. At the very least, getting SOME saturated fats is important. These are fats found in meats, butter, coconut oils, and palm oils. These are fats that are solid instead of liquid at room temperature. A moderate amount of these is healthy.

Babies need fat for good development and healthy fats tend to be tasty, so it should be easy to get plenty! Have some guacamole, whole milk yogurt, mixed nuts, coconut cream in your coffee, and buttered popcorn! Not hard, right? The only fats to avoid altogether are hydrogenated and trans fats.

When thinking about eating for a healthy pregnancy, the most important thing to remember is to eat “REAL FOOD” as Lily Nichols says. You might call them “whole foods” or “unprocessed foods”. Simply put, the majority of what you eat should be what you can buy from the produce section, the bulk section, the dairy aisle, and the meat and seafood counters. If you buy food in a package, how many ingredients does it list on the label? Are they recognizable words? Does it say “low fat”? For example, a bag of nuts might just list nuts and salt!

The rest of the packaged foods can be used in moderation, and as long as MOST of what you eat is “real food”, you can be pretty sure that you’re doing a great job. Have some guacamole for me!

If you want more detail about the topic of this article directly from Lily Nichols herself, this podcast episode has it all!