Truths and Myths about Nutrition During Pregnancy
If you are keen, you might have noticed that there isn’t a shortage of opinions in Australia on what you should or shouldn’t eat or drink while pregnant. However, the availability of this information can cause confusion since the advice is sometimes conflicting. Nutrition is a young science, and the current understanding of the nutrients’ roles in human psychology is still involved, causing some misperception.
But, there is one thing we can agree on all across the board – nutrition during pregnancy is fundamental. It will help keep your energy levels high to prevent or manage gestational diabetes. In turn, this will reduce the risk of developing type 2 diabetes. The food and drinks you consume equally determine the health of the developing fetus, all the way into adulthood.
The expectant woman’s nutrition status and environmental exposures are believed to influence the fetus’s genetic expression. This plays a significant role in determining the risk for chronic conditions during adulthood. The fetal programming might even extend from one generation to another, meaning the lifestyle choices made while pregnant can impact the genetic expression and thus the future generation’s health.
What do experts say about nutrition during Pregnancy?
Now that we understand the importance of diet, it’s time we dive into the existing research to clarify the confusion around common myths associated with pregnancy in Australia. We shall cover areas like complete abstinence to fish, soft cheeses, and coffee, or the concept of eating for two.
Why is pregnancy nutrition confusing?
Generally, pregnancy nutrition is prone to conflicting recommendations because we lack enough randomized controlled trials (RCTs), which are the standard methodology for research that makes it easy for scientists to create cause and effect statements such as ‘smoking leads to cancer.’ The randomized controlled trials begin with similar study participants, especially regarding lifestyle and demographic characteristics. Then, they are randomly separated into groups that receive a certain treatment (e.g., eat food) and a control group that doesn’t receive the treatment (e.g., doesn’t eat food).
In pregnancy, randomized controlled trials usually become ethically questionable. It’s not ethical to ask a group of pregnant women to binge drink so researchers can compare the health effects to a control group that’s abstaining from taking alcohol. For this reason, we do not have the needed research for more definitive recommendations for almost every controversial topic in prenatal nutrition, from deli meats to raw cheese to alcohol and caffeine.
Even so, there isn’t sufficient observational research to make well-supported recommendations. Researchers have managed to ask people to report on what they drank or ate while pregnant, and have managed to gather a reasonable understanding of what it takes to have a healthy pregnancy. This observational research will examine some of the popular pregnancy-nutrition myths and highlight what is more vital to pay attention to nutritionally.
Nutrition during pregnancy Myths
1st Nutrition Myth: You are eating for two
Truth: It’s essential to focus on nourishing for two instead
The Centers for Disease Control (CDC) and Australian and New Zealand College of Obstetricians and Gynaecologists (ranzcog) do not recommend adding calories during the first three months of the pregnancy. But, they suggest adding 300-400 calories each day during the second and third trimesters. The 300-400 calories may mean a large apple with a few tablespoons of peanut butter, a cup of plain nonfat yogurt with a ½ cup of granola, or two slices of whole-grain bread with a ½ medium avocado.
It is better to talk to your healthcare provider about the actual amount of calories you need. The recommendation you get will vary depending on your physical activity levels, starting weight, the number of fetuses growing in your womb, etc. According to medical advisors, some people might not want to gain weight during pregnancy, and others may prefer losing weight. But again, everyone is different but the consensus is to discuss all options with your doctor before making a decision.
Although the recommendation is not to double the quantity of food you eat, you will need more nutrients like choline and iron for a healthy pregnancy. So, focus on consuming nutrient-rich foods from all food groups – try building each meal around whole grains, vegetables, fruits, seeds, nuts, lean meat and proteins, and healthy fats. Also, do not forget to take your prenatal vitamins.
2nd Nutrition Myth: Coffee is unsafe
Truth: Taking 1-2 coffee cups a day is safe
One of the controversial topics you will hear is that no amount of caffeine is safe, while others will say it’s okay to take more than three coffee cups a day. The truth is that we know that caffeine crosses the placenta, and the effects aren’t fully understood yet. The key concern on caffeine is that it can cause a miscarriage, which is probably a concern for those who take over 300mg of caffeine daily. This is more than three strong coffee cups.
There are two primary factors in the controversy around the recommendation of caffeine during pregnancy:
Today’s studies have substantial limitations
As mentioned above, the lack of RCTs leaves us to rely mainly on people’s ability to remember the quantity of caffeine they take and report it truthfully. However, while this methodology is the reason we have some information, the technique has flaws due to poor memory and societal pressure bias. For instance, people who believe drinking coffee is bad but cannot avoid it will underreport their usage.
The nausea issue complicates research on caffeine
Nausea (aka morning sickness) is one of the symptoms of pregnancy experienced during the first trimester, and it’s often associated with decreased miscarriage risks for reasons that aren’t well understood. The catch with morning sickness is that it can make you loath coffee.
Women who have given birth severally report the first sign of a recurrent pregnancy before they notice a missed period is the return of their coffee aversion. This makes it difficult to interpret the association between the consumption of coffee and high miscarriage risks. If the people felt well to take two or more coffee cups a day, how can we tell if a miscarriage was due to weak placenta signalling or coffee intake?
Checking the literature with these caveats in mind, here is what researchers have managed to find:
- Certain prospective studies, meaning research that requests women to track their intake each day instead of relying on memory, report an association between caffeine intake and miscarriage risk.
- Others report that the miscarriage risk only increases after exceeding the 300mg caffeine intake per day.
Building on the second point, many studies have shown a dose-response risk. This means that the more caffeine you consume during the early days of the pregnancy, the higher the miscarriage risks.
- One systematic review noticed a 7% increase in the miscarriage risk for every additional 100mg of caffeine consumption.
- A 2017 systematic review suggests that miscarriage was 37% more likely to occur amongst pregnant women who took 300mg of caffeine each day, while expectant mothers drinking 600mg of caffeine each day had a 2.5 times increased risk of miscarriage.
- One consistent finding suggests that 200mg of caffeine or less possess little miscarriage risk. ACOG claims that consuming less than 200 mg of caffeine daily doesn’t appear to cause preterm birth or miscarriages. This means you can continue enjoying one or two cups of coffee (depending on how strong it is) each day.
What are the amounts of caffeine are suitable?
Here are the approximated amounts of caffeine in various beverages as reported by the Journal of American Dietetic Association and Mayo Clinic (note that the numbers will vary based on how strongly you brew the tea or coffee):
- 16 oz. latte: 100 mg
- 8 oz. coffee: 96 to 150 mg
- An espresso shot: 64 mg
- 8 oz. green tea: 20 to 30 mg
- 8 oz. black tea: 28 to 60 mg
- 8 oz. decaf coffee: 2 mg
- ½ a teaspoon matcha: 35 mg
If you love taking morning tea or coffee, you don’t necessarily have to cut it out entirely because of your pregnancy. All you have to do is replace the second and third cup with a less caffeinated drink such as a decaf latte, green tea, or matcha.
3rd Nutrition Myth: Fish isn’t safe in pregnancy
Truth: It is safe to take 2-3 servings of fish (low-mercury ones) every week
Two primary concerns on fish consumption during pregnancy: food poisoning risk from the raw fish and heavy metal toxicity, particularly from methyl mercury. However, these concerns don’t justify getting rid of fish entirely because it’s an excellent source of lean protein and many other nutrients like Omega-3 fatty acids, calcium, and vitamin D. In our opinion, the benefits you’ll get after eating fish will outweigh the risks. You simply need to make a smart choice about the kind of fish you eat.
First potential risk: Food poisoning
Raw fish like Sashimi or sushi can carry potentially harmful bacteria known as Campylobacter and salmonella. The bacteria can make you sick, but the risk of contracting food-borne illnesses is greater during pregnancy. Getting food poisoning while pregnant is not fun, and it’s essential to take extra care to avoid getting too dehydrated. The good news is that this bacteria causes minimal risks to the developing fetus.
If you take up some risks by consuming raw fish, you will need to follow some food safety precautions like taking sushi at a popular restaurant rather than a gas station. It would be best to avoid cooked, or raw fish kept at room temperature for over 4 hours.
Other caution measures you must consider are outlined below:
- Raw shellfish like clams and oysters usually carry an additional risk of toxoplasmosis – an illness transmitted by a parasite and can have severe effects on the fetus. Therefore it’s better to cook your clams and oysters while pregnant.
- Traditional lox is usually cold-smoked, a procedure that cures fish in low temperatures that cannot kill the harmful bacteria. Due to this, you will expose yourself to an additional listeria poisoning risk which is dangerous to you and the fetus. Therefore, if you get cured or smoked salmon, ensure the label reads ‘hot smoked’ or ‘high heat’ to minimize this risk.
Second potential risk: Mercury toxicity
Mercury is one of the heavy metals that may accumulate in our bodies, and in a case of overexposure, it can cause neurological damage. According to researchers, a higher mercury level in pregnant women can cause the unborn child to have slightly lower IQ scores.
Do not eliminate fish from your diet because of this information. It’s vital to remember that some fish varieties do not have high mercury levels. So, you can avoid the ones that are high in mercury.
Important rules to follow
- Stay away from larger fish high up in the food chain: Larger swimmers rack up more mercury as they eat small fish. This includes options like the tilefish or shark and other common varieties like ahi tuna, grouper, swordfish, and albacore.
- Go for smaller fish: Smaller kinds of fish like herring, sardines, king mackerel, and anchovies are low in mercury. You can also go for canned tuna, as it’s low in mercury and more sustainable fishing practice.
After assessing the risks and benefits, the Federal Drug Administration, ACOG, and Environmental Protection Agency recommend that pregnant women eat 2 to 3 servings of fish (low mercury varieties) each week. Limit tuna to one serving a week and avoid all the other high-mercury varieties.
Another consideration is if you will take fish. Most fish have the brain-building DHA (an essential omega-3 fatty acid) that might counteract any heavy metal exposure risk. One kind of fish that’s rich in DHA and low in mercury is salmon. You can take the DHA from an algae-based supplement if you prefer avoiding fish.
4th Nutrition Myth: Soft cheese is not safe too
Truth: Just avoid taking raw cheese – soft cheese is safe provided it’s pasteurized
The primary concern with soft cheeses is usually listeria poisoning. Even though this kind of poisoning is rare (around 80 cases are reported each year in Australia), it affects about 1 in 8,000 pregnancies every year. Listeria can be dangerous both for you and the developing fetus. However, as cheese ages, it may stave off the listeria risk. This is why hard cheese is recommended instead of soft cheese.
Nonetheless, aging is not the best way to eliminate listeria risks if the cheese is made with raw milk. The only ticket to safety is to know that listeria can only be killed by pasteurization. In this procedure, food is heated to a temperature that is lethal to bacteria. So, whether the cheese is hard or soft, pasteurization is the only safest bet during pregnancy.
Some people also do not recommend European cheese, even though the origin of the cheese does not matter. Whether they come from Wisconsin or France, it is important to ensure the dairy products undergo pasteurization.
What’s the most vital thing you should know about pregnancy nutrition now that we have debunked the myths?
Let us begin with the guidelines provided by the leading OB-GYN body. ACOG usually recommends that you get the following essential nutrients during pregnancy:
- Folate – (aka methyl folate or folic acid) helps to support the fetus’s neural tube (spinal cord and brain) development
- Choline – supports fetal neurodevelopment
- Iron – aids with the formation of red blood cells and hemoglobin – the protein in the blood that helps transport oxygen from the lungs to all parts of the body
- Vitamin C – promotes the growth of connective tissue and boosts the immune system’s health
- Omega-3 fatty acids – the EPA and DHA help in the development of the retina and fetal brain
- Vitamin B6 – boosts the energy levels during pregnancy
- Vitamin A – supports fetal eye development & good vision, and a healthy immune system
- Vitamin B12 – aids in keeping the central nervous system in check
- Iodine – aids in the development of a health effect on the brain and maintains thyroid health
- Vitamin D3 – promotes bone health and enhances the functionality of the immune system for you and the fetus
- Calcium – helps to keep the bones and teeth strong
If you are a vegan or vegetarian, the number of nutrients you need to pay attention to will grow longer. Most vegetarians do not get enough zinc, iron, vitamin D, B vitamins, choline, and Omega-3 fatty acids from food alone. Vegans are also deficient in calcium, so you may need to take supplements if you are not getting these nutrients from food.
Is there a reliable way to increase the body’s reserves of these essential nutrients?
Whether you are a vegan or not, it is vital to ensure you get all the basic nutrients during pregnancy. You can attain this through balanced eating and the consumption of prenatal supplements. Balance eating means eating foods from different groups and not the ‘pregnancy diet.’ In practice, this includes eating:
- Whole grains (like brown bread and rice) over the white options
- Tons of fresh vegetables and fruits (8 to 10 servings each day)
- A good quantity of plant-based proteins (from seeds, beans, lentils, quinoa, soy, or legumes)
- Nutrient-dense eggs (eat the yolk too)
- Low-mercury fatty fish for the omega-3 and vitamin D
Generally, you must get enough healthy foods throughout the pregnancy period. Health specialists recommend eating a colourful plate of food, not just brown/ yellow. Add some greens and other vibrant colours of different fresh fruits you can get in your area.
While the food-first approach is the best way to get many nutrients for a healthy pregnancy, do not hesitate to supplement. This is where prenatal vitamins come in handy. If you get an excellent assortment of nutrients required during pregnancy, including the 400 mcg of folic acid. This way, you will bridge the gap between the high nutrient demand and low food intake.
The bottom line: Pregnancy nutrition isn’t complicated
The foods you eat during pregnancy do not have to be radically different from a normal adult version of a balanced diet. What’s important is to adhere to food safety precautions, and reduce caffeine intake to one or two cups a day. Choose the pasteurized cheese over the unpasteurized options. Also, consider taking a variety of nutritious foods, and eat low-mercury fish two times a week (or take a DHA supplement).
Whether you are currently expectant, trying to conceive, or would like to think about getting kids in the near future, do not hesitate to join our online community. Here, you will get all the support you need and connect with people on your wavelength.