What are the two nutrients needed in large amounts during pregnancy for rapid cell proliferation are?

"Expectant moms need vital nutrients and calories to sustain their bodies and their pregnancy," Julie Paul, WakeMed registered dietian says. "Remember that babies are literally being built with the food we put in our bodies. For example, they need certain nutrients for brain development, and other nutrients for things like healthy bones, eyes and organs."

To make sure you and your baby get what you need, increase your daily intake by 300 calories, provided your pre-pregnancy diet was within a normal range. Specific nutrient recommendations include:

Protein
You need an additional 10 grams per day, but most women get this in their diets already.

Carbohydrates
Additional carbohydrates are needed for energy. The healthiest choices are whole grain breads, cereals, crackers, fresh fruits and milk.

Folate
Essential due to increased blood volume and rapid cell growth of your baby, and can be found in leafy green vegetables, legumes, fruit, seeds and yeast.

Calcium, Phosphorus and Magnesium
Needed to build your baby's skeleton. Good sources of calcium are dairy products, tofu, salmon and leafy green vegetables.

Iron
Iron absorption is increased three-fold during pregnancy so you can provide your developing baby with iron stores for the first three to six months of life.

Nutrient needs during pregnancy are higher than any other time in your life, says Julie Paul, a WakeMed registered dietitian.

Most women cannot meet the increased need with diet alone and, in many cases, a supplement is recommended. Meats, dried beans and peas, enriched cereals, whole grain and enriched breads, dried fruits, green vegetables and eggs are all good sources of Vitamin C, which aids in the absorption of iron.

Zinc
Zinc is found in high protein foods like meats, legumes and nuts. Many foods have more than one of the important nutrients that support a healthy pregnancy.

These include low-fat milk, lean meats, beans, eggs, dark green vegetables, Vitamin C-rich fruits and vegetables, whole-grain breads and cereals. Foods high in Vitamin C include citrus fruits, tomato juice, strawberries, cantaloupe, greens, broccoli and brussel sprouts.

"This may sound like a lot of food, but if you're taking a prenatal vitamin in addition to a well-balanced diet, you should be in good shape," advises Paul. "As your pregnancy progresses, it may become more uncomfortable to eat three large meals. It's perfectly fine to have smaller meals throughout the day."

Foods & Substances to Avoid During Pregnancy

Some foods and substances are known or suspected to be detrimental to the health of a growing fetus. For your baby's sake, it's best to be conservative and avoid the following foods or substances:

• Caffeine*
• Alcohol
• Herbal and botanical supplements
• Nitrites, nitrates and nitrosamines (found in cured meats)*
• Cigarettes
• Illegal drugs
• Fish that contain mercury, such as shark, swordfish, king mackerel and tile fish, as well as raw fish of any kind. You can safely eat up to 12 oz. per week of shrimp, canned light tuna, salmon, Pollock and catfish. If you prefer white albacore tuna, limit your servings to 6 oz. per week.
• Soft cheese, such as feta, brie, Roquefort and queso blano. These cheeses are more likely to become contaminated by listeria, a bacteria that can cause serious harm to your unborn child.

*Limited amounts are acceptable. For more specific information about those limits, consult your doctor or dietitian.

Source: Position of the American Dietetic Association: Nutrition & Lifestyle for a Healthy Pregnancy Outcome, October 2002

Smart Snacks

In your second and third trimester, you need an additional 300 calories per day. Here are some healthy snack ideas to fill those extra calories.

• 3 cups light microwave popcorn sprinkled with 2 tablespoons grated Parmesan cheese
• 1 serving frozen yogurt and 12 whole almonds
• 3 medium dates with 1 tablespoon soy nut butter
• 1/4 cup hummus and 1 large red bell pepper, sliced
• 1 hard-boiled egg and 4 wovenwheat crackers
• 2/3 cup nonfat caramel popcorn and 1/2 cup reduced-fat (2%) milk
• 1/4 cup low-fat cottage cheese and salsa and 5 wheat crackers

Eating well during pregnancy is not just about eating more. What you eat is as important.

You only need about 340 to 450 extra calories a day, and this is later in your pregnancy, when your baby grows quickly. This isn't a lot — a cup of cereal and 2% milk will get you there quickly. It's important is to make sure that the calories you eat come from nutritious foods that will help your baby's growth and development.

Eating Well When You're Pregnant

Do you wonder how it's reasonable to gain 25 to 35 pounds (on average) during your pregnancy when a newborn baby weighs only a fraction of that? Although it varies from woman to woman, this is how those pounds may add up:

• 7.5 pounds:  average baby's weight
• 7 pounds:     extra stored protein, fat, and other nutrients
• 4 pounds:     extra blood
• 4 pounds:     other extra body fluids
• 2 pounds:     breast enlargement
• 2 pounds:     enlargement of your uterus
• 2 pounds:     amniotic fluid surrounding your baby
• 1.5 pounds:  the placenta

Of course, patterns of weight gain during pregnancy vary. It's normal to gain less if you start out heavier and more if you're having twins or triplets — or if you were underweight before becoming pregnant. More important than how much weight you gain is what makes up those extra pounds.

When you're pregnant, what you eat and drink is the main source of nourishment for your baby. In fact, the link between what you consume and the health of your baby is much stronger than once thought. That's why doctors now say, for example, that no amount of alcohol consumption should be considered safe during pregnancy.

The extra food you eat shouldn't just be empty calories — it should provide the nutrients your growing baby needs. For example, calcium helps make and keep bones and teeth strong. While you're pregnant, you still need calcium for your body, plus extra calcium for your developing baby. Similarly, you require more of all the essential nutrients than you did before you became pregnant.

page 1

Nutrition for Expectant Moms

A healthy diet includes proteins, carbohydrates, fats, vitamins, minerals, and plenty of water. The U.S. government publishes dietary guidelines that can help you determine how many servings of each kind of food to eat every day. Eating a variety of foods in the proportions indicated is a good step toward staying healthy.

Food labels can tell you what kinds of nutrients are in the foods you eat. The letters RDA, which you find on food labeling, stand for recommended daily allowance, or the amount of a nutrient recommended for your daily diet. When you're pregnant, the RDAs for most nutrients are higher.

Here are some of the most common nutrients you need and the foods that contain them:

Scientists know that your diet can affect your baby's health — even before you become pregnant. For example, research shows that folic acid helps prevent neural tube defects (including spina bifida) during the earliest stages of fetal development. So it's important to get plenty of it before you become pregnant and during the early weeks of your pregnancy.

Doctors encourage women to take folic acid supplements before and throughout pregnancy (especially for the first 28 days). Be sure to ask your doctor about folic acid if you're considering becoming pregnant.

Calcium is another important nutrient. Because your growing baby's calcium demands are high, you should increase your calcium consumption to prevent a loss of calcium from your own bones. Your doctor will also likely prescribe prenatal vitamins for you, which contain some extra calcium.

Your best food sources of calcium are milk and other dairy products. However, if you have lactose intolerance or dislike milk and milk products, ask your doctor about a calcium supplement. (Signs of lactose intolerance include diarrhea, bloating, or gas after eating milk or milk products. Taking a lactase capsule or pill or using lactose-free milk products may help.) Other calcium-rich foods include sardines or salmon with bones, tofu, broccoli, spinach, and calcium-fortified juices and foods.

Doctors don't usually recommend starting a strict vegan diet when you become pregnant. However, if you already follow a vegan or vegetarian diet, you can continue to do so during your pregnancy — but do it carefully. Be sure your doctor knows about your diet. It's challenging to get the nutrition you need if you don't eat fish and chicken, or milk, cheese, or eggs. You'll likely need supplemental protein and may also need to take vitamin B12 and D supplements.

To ensure that you and your baby receive adequate nutrition, consult a registered dietitian for help with planning meals.

page 3

Food Cravings During Pregnancy

You've probably known women who craved specific foods during pregnancy, or perhaps you've had such cravings yourself. Some old theories held that a hunger for a particular type of food indicated that a woman's body lacked the nutrients that food contains. Although this turned out not to be so, it's still unclear why these urges occur.

Some pregnant women crave chocolate, spicy foods, fruits, and comfort foods, such as mashed potatoes, cereals, and toasted white bread. Other women crave non-food items, such as clay and cornstarch. The craving and eating of non-food items is known as pica. Consuming things that aren't food can be dangerous to both you and your baby. If you have urges to eat non-food items, notify your doctor.

But following your cravings is fine as long as you crave foods that contribute to a healthy diet. Often, these cravings let up about 3 months into the pregnancy.

Food and Drinks to Avoid While Pregnant

No level of alcohol consumption is considered safe during pregnancy. Also, check with your doctor before you take any vitamins or herbal products. Some of these can be harmful to the developing fetus.

And although many doctors feel that one or two 6- to 8-ounce cups per day of coffee, tea, or soda with caffeine won't harm your baby, it's probably wise to avoid caffeine altogether if you can. High caffeine consumption has been linked to an increased risk of miscarriage and other problems, so limit your intake or switch to decaffeinated products.

When you're pregnant, it's also important to avoid food-borne illnesses, such as listeriosis and toxoplasmosis, which can be life threatening to an unborn baby and may cause birth defects or miscarriage. Foods to steer clear of include:

• soft, unpasteurized cheeses (often advertised as "fresh") such as feta, goat, Brie, Camembert, and blue cheese
• unpasteurized milk, juices, and apple cider
• raw eggs or foods containing raw eggs, including mousse and tiramisu
• raw or undercooked meats, fish, or shellfish
• processed meats such as hot dogs and deli meats (these should be thoroughly cooked)
• fish that are high in mercury, including shark, swordfish, king mackerel, marlin, orange roughy, tuna steak (bigeye or ahi), and tilefish

If you've eaten these foods at some point during your pregnancy, try not to worry too much about it now; just avoid them for the remainder of the pregnancy. If you're really concerned, talk to your doctor.

page 4

More About Fish

Fish and shellfish can be an extremely healthy part of your pregnancy diet — they contain beneficial omega-3 fatty acids and are high in protein and low in saturated fat. But limit the types of fish you eat while pregnant because some contain high levels of mercury, which can cause damage to the developing nervous system of a fetus.

Mercury, which occurs naturally in the environment, is also released into the air through industrial pollution and can accumulate in streams and oceans, where it turns into methylmercury. The methylmercury builds up in fish, especially those that eat other fish.

Canned tuna can be confusing because the cans contain different types of tuna and varying quantities of mercury The U.S. Food and Drug Administration (FDA) recommends eating 2–3 servings per week of canned light tuna, but only one serving per week of albacore/white tuna (these are larger fish and contain more mercury). A 2017 review by Consumer Reports, though, showed that some canned light and albacore tuna can contain higher mercury levels than expected, and recommends that pregnant women eat no canned tuna at all. But the FDA stands by its current recommendations, saying that the levels are safe if tuna consumption is limited.

It can be confusing when recommendations from trusted sources differ. But because this analysis indicates that amounts of mercury in tuna may be higher than previously reported, some women may want to eliminate tuna from their diet while pregnant or when trying to become pregnant.

Almost all fish and shellfish contain small amounts of mercury, but you can safely eat up to 12 ounces (2 average meals) a week of a variety of fish and shellfish that are lower in mercury, such as salmon, shrimp, clams, pollock, catfish, and tilapia.

Talk with your doctor if you have any questions about how much — and which — fish you can eat.

page 5

Managing Some Common Problems

Constipation

The iron in prenatal vitamins and other things can cause constipation during pregnancy. So try to get more fiber than you did before you became pregnant. Try to eat about 20 to 30 grams of fiber a day. Your best sources are fresh fruits and vegetables and whole-grain breads, cereals, or muffins.

Some people use fiber tablets or drinks or other high-fiber products, but check with your doctor before trying them. (Don't use laxatives while you're pregnant unless your doctor advises you to do so. And avoid the old wives' remedy — castor oil — because it can actually interfere with your body's ability to absorb nutrients.)

If constipation is a problem for you, your doctor may prescribe a stool softener. Be sure to drink plenty of fluids, especially water, when increasing fiber intake, or you can make your constipation worse.

One of the best ways to avoid constipation is to get more exercise. Drink plenty of water between meals each day to help soften your stools and move food through your digestive system. Sometimes hot tea, soups, or broth can help. Also, keep dried fruits handy for snacking.

Gas

Some pregnant women find that broccoli, spinach, cauliflower, and fried foods give them heartburn or gas. You can plan a balanced diet to avoid these foods. Carbonated drinks also cause gas or heartburn for some women, although others find they calm the digestive system.

Nausea

If you're often nauseated, eat small amounts of bland foods, like toast or crackers, throughout the day. Some women find it helpful to eat foods made with ginger. To help combat nausea, you can also:

• Take your prenatal vitamin before going to bed after you've eaten a snack — not on an empty stomach.
• Eat a small snack when you get up to go to the bathroom early in the morning.
• Suck on hard candy.