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Eating for Two: Nutritional Guidelines in Pregnancy

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Margaret Freda
By Margaret Freda Ed.D., R.N., C.H.E.S., F.A.A.N.
"I've been a professional nurse working with pregnant women and parenting families since 1966," says Margaret Comerford Freda. "Pregnant women and parents need to know as much as possible about their own health and that of their children."

Margaret Comerford Freda, Ed.D., R.N., C.H.E.S., F.A.A.N., is a Professor in the Department of Obstetrics &; Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, and also serves as Director of Patient Education Programs for that department. Since 1993, Dr. Freda has been the Consultant for Nursing at the National March of Dimes Birth Defects Foundation and the Chair of the National March of Dimes Nurse Advisory Council. In addition, Dr. Freda serves as the editor of MCN, The American Journal of Maternal Child Nursing.

Dr. Freda received her Master's Degree in Nursing from New York University and her doctorate in Health Education from Columbia University. She has worked in women's health for her entire professional career. Dr. Freda has published 50 research articles in professional journals, and is a frequently invited speaker at nursing and medical conferences. She has written two books: Perinatal Patient Education, published by Lippincott Williams &; Wilkins, and Miscarriage After Infertility, published by Fairview Press, written with her daughter Carrie Semelsberger, who is also a nurse.

Dr. Freda has received several noteworthy awards, such as the Distinguished Professional Service Award and the First National Award for Excellence in Nursing Research from the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), the Woman of Distinction Award and the Maternal Child Nurse of the Year Award from the March of Dimes, the Patient Care Award for Excellence in Patient Education from the American Academy of Family Physicians, the Research Recognition Award from Molloy College, and several Outstanding Research Paper awards at national conferences. She serves on the Scientific Advisory Council for the March of Dimes, and was selected to serve on the Select Panel of the Centers for Disease Control to advise on prenatal health. Dr. Freda has developed patient education booklets and videotapes that are now distributed nationally.

Dr. Freda has been married for four decades. She has two daughters, two sons-in-law, three grandsons, and a granddaughter.
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When you're pregnant, your eating habits become more important than ever. They affect your health, the way you feel, and, of course, your baby! Your baby's organs need the right amount of protein, carbohydrates, and fats to develop properly, so you should pay special attention to your diet.

What is a good diet in pregnancy? First of all, don't diet! This is not the time to starve yourself. Eat a good, nutritious diet, and you'll lose your pregnancy weight gain just fine after your baby is born. If you have a weight problem —— if you are either underweight or overweight ——— then you may need to follow a special nutritional program during your pregnancy. Discuss this with your health care provider.

How much weight do women usually gain during pregnancy? The American College of Obstetricians and Gynecologists says that 25 to 35 pounds is normal. If you gain much more than that, it will take some time after pregnancy to lose it.

Good Things to Eat

The United States Department of Agriculture has recently revised its dietary guidelines. The new recommendations, which can be found at http://www.choosemyplate.gov, feature foods from five main groups: fruits, vegetables, grains, protein foods, and dairy. You can set up an interactive food plan, customized for your stage of pregnancy, or for when you're breastfeeding, by going to http://www.choosemyplate.gov/supertracker-tools/daily-food-plans/moms.htm.

Calories
Most pregnant women need about 300 additional calories per day. This translates to two cups of low-fat milk, one cup of ice cream, a bagel with cream cheese, or a tuna fish sandwich.

Food Cravings
No one really knows why some women crave certain foods during pregnancy, but cravings are not thought to be the result of food deficiencies. There is no reason to avoid foods you crave as long as you eat in moderation to avoid a large weight gain. Unfortunately, some pregnant women crave non-food items such as laundry starch or clay and want to eat them. This is a condition called pica. If you crave non-food items, be sure to tell your health care provider.

Protein
Pregnant women require about 71 grams of protein per day. A cup of milk or an ounce of red meat contains about 10 grams of protein. Good sources of protein include lean meats, poultry, fish, dried beans, lentils, nuts, eggs, and cheese. Avoid unpasteurized, soft cheeses such as Brie and jalisco. Also, avoid raw or rare meats, as these might contain bacteria that could harm your infant. Finally, avoid fish that are high in mercury, such as shark, swordfish, king mackerel, and tilefish.

Calcium
Calcium is needed during pregnancy for the formation of the baby's bones and teeth. The recommended daily allowance for calcium during pregnancy is 1,000 mg per day (1,300 mg a day if you are younger than 19). You can get your calcium from green leafy vegetables, orange juice, milk, yogurt, and cheese. 

Iron
You need 27 mg a day when you're pregnant. Fish, poultry, whole grain breads and cereals, green leafy vegetables, legumes, dried fruits, eggs, liver, and red meat are all good sources of iron. Most women take iron supplements in the second and third trimesters, but if you eat a diet rich in iron you may not require these supplements.

Prenatal Vitamins and Mineral Supplements
While vitamin and mineral supplements are probably not necessary for women who eat a balanced diet, most prenatal care providers feel that they are not harmful, and therefore can be used. Don't use them in place of eating a balanced diet, however. Consult your health care provider before taking any vitamins or supplements. Keep all vitamin and iron preparations in childproof, capped bottles if there are young children in the house to avoid accidental overdoses.

Caffeine
Moderate consumption of caffeine is best. Don't drink more than one to two caffeine-laden beverages, such as coffee and soda, per day.

Aspartame (Nutrasweet)
Aspartame has been approved by the Food and Drug Administration for consumption in pregnancy, and all reports suggest that it is safe in moderation.

Sodium (Salt)
Sodium is an important nutrient, and most women consume sufficient amounts of sodium in their diet. In the past health care providers restricted sodium during pregnancy, but we have learned that there is no problem for pregnant women in consuming salt unless they have a specific risk factor such as high blood pressure.

Alcohol
Fetal alcohol syndrome, in which newborn babies exposed to alcohol in the womb show signs of mental retardation and physical abnormalities, was first recognized in the 1980s. No one really knows how much alcohol causes the problem, so it is now recommended that pregnant women eliminate all alcohol during pregnancy.

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