One of the most annoying side effects of pregnancy? The overwhelming amount of (often unsolicited, not to mention inaccurate) advice about what you should and shouldn’t eat while you’re pregnant. This unhelpful guidance can come from a well-meaning relative or friend, an article you read online, or even a complete stranger, and can range from a subtly shaming comment about not eating brie to being refused service in an ice cream shop for ordering coffee gelato (true story!). While your ob-gyn or healthcare provider may provide some broad guidance about what foods to avoid during pregnancy, in my experience it’s inadequate to help women make healthy choices and still get sufficient nutrients that support them through pregnancy.
In my practice as a Certified Nutritionist and Licensed Mental Health Counselor, I hear from women all the time about how difficult it is to cut through the noise when it comes to eating well during pregnancy. Here are my top tips for making pregnancy nutrition simpler and less stressful:
1. Focus on Variety and Whole foods
Many nutrient requirements increase during pregnancy due to the physiologic changes of the woman and the metabolic demands of the baby. The primary nutrients of concern during pregnancy are protein, iron, zinc, folic acid, B12, choline, and magnesium. But there’s no need to get too focused on these specific nutrients or the amounts you need. Eating a variety of whole and nutrient dense foods is the best way to help you meet your increased nutrient needs during pregnancy.
So what is a whole food? Food that has not been processed or refined and is free of additives and artificial substances. It has one ingredient (or as close to one ingredient), such as fresh fruits, vegetables, fish, meat, eggs and whole grains like rice, quinoa and oats. Our bodies better digest and absorb nutrients from food in its whole form – even better than getting those nutrients from supplement or fortification. This is because different nutrients work synergistically in the body. For example, some nutrients aid in the metabolism and absorption of other nutrients, so mother nature was smart in designing food that way.
It’s important to note that some supplementation is important during pregnancy, and will be especially important for those who are vegan or vegetarian. I recommend taking a prenatal vitamin as an insurance policy, but not to rely on or replace a whole foods diet.
2. Eat Omega-3 Essential Fatty Acids
Omega-3 essential fatty acids, or EFAs, only come from your diet – your body doesn’t synthesize them on its own, and they’re important for both you and your baby’s health. Consuming enough omega-3s during pregnancy and breastfeeding is critical for brain and visual development in babies. Several studies have found that mothers who ate more fish had children who performed better on tests that measured memory, attention and recognition. (1). And for mom, getting enough omega-3s in your diet can help reduce inflammation, promote healing and lower the risk of experiencing postpartum depression.
Omega-3 fatty acid deficiency, due to inadequate dietary intake or depletion during pregnancy and lactation, is one of the risk factors of postpartum depression (PPD).(2) Similarly, adequate intake of omega-3s can be protective against developing PPD. Studies have shown that women in countries that eat high amounts of DHA have less postpartum depression. (3) 
During pregnancy your stores of EFAs are directed toward growth of your baby, which means deficiency is common. So how do you get enough healthy fats in your diet? Eggs, grass-fed meat and dairy, fish, such as salmon, sardines and cod, dark green leafy veggies, legumes, walnuts, flax chia and seaweed are all naturally high in omega 3s. Good sources of omega 6s include meat, whole-fat dairy, eggs, grains and nuts. Note that it’s beneficial to avoid the use of oils high in omega-6, such as corn, soy, cottonseed and safflower oils as these may promote inflammation and can disrupt the synthesis of DHA. These are often found in salad dressings and fried foods. In addition to eating whole food sources of DHA, I recommend taking a supplement of high-quality fish oil or cod liver oil.
3. Be Mindful of Food Safety
Ok, here’s the deal with that list of things you should avoid eating while pregnant. While it’s true that during pregnancy your body becomes slightly more susceptible to infections and food borne illness, you shouldn’t get too stressed out about it. Being mindful of food safety is important during pregnancy but avoiding all the foods that “could” cause food borne illness would make it difficult to meet your nutrient needs.
There are five main bacteria of concern when it comes to food safety: salmonella, e.coli, campylobacter, toxoplasmosis and listeria. It’s important to understand which bacteria are more likely to make you sick during pregnancy; and if you do get sick, which of these bacteria directly affect your baby.
Illness from salmonella, e.coli or campylobacter are not more likely during pregnancy, and they do not directly affect the fetus (4). This means you don’t need to stress out too much about your runny egg yolks or occasional sushi. In fact, the odds of getting salmonella from runny egg yolks is very rare, approximately 1 in 10,000 to 1 in 30,000.(5) E. coli exposure is greatly reduced by avoiding raw and undercooked meat and by washing your produce.
Toxoplasmosis is caused by a parasite and comes primarily from undercooked or raw meats and unwashed vegetables. It is harmful but largely avoidable as long as you avoid raw or undercooked meats and shellfish, such as oysters, and wash your vegetables well. The important thing to note here is that 25% of people in the U.S. already have this bacteria, (4) – you can get it from cleaning cat litter, gardening, or a previous infection from unwashed veggies – and if you’ve already have it, you can’t be reinfected and there is no risk to your baby.
Listeria is usually attributed to the consumption of deli meats, soft cheeses, unpasteurized milk, pate or smoked fish. While pregnant women are more susceptible to getting listeria, it’s actually very rare. In fact, 1 in 8,000 pregnancies per year are affected. (6) According to the U.S. Food and Drug Administration (FDA) there is one case of listeria per 83,000 servings of deli meat or 5 million servings of soft cheese.(7) It is best to avoid food that has been in the fridge for more than a few days, as Listeria grows well at refrigerated temperatures. As an extra precaution, you can heat deli meats to 165F before consuming to kill any potential bacteria.
You likely have been warned against eating certain kinds of fish during pregnancy. The thing to remember here is small, oily fish are best. Salmon, herring, sardines, cod, and catfish are all high in omega-3s and low in mercury. Big fish, like shark, grouper, swordfish, and king mackerel, have more concentrated levels of mercury and are better avoided while pregnant.
Here are some additional tips for food safety during pregnancy:
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Be selective about where you purchase your food. Eating a turkey sandwich made from cold cuts purchased at a deli are a safer bet than say a pre-made sandwich from a vending machine or gas station.
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Wash fruits and vegetables well
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Cook/eat raw meat within 3 days of being in your fridge.
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Wash your hands after handling raw meat
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Keep raw and cooked foods separate to avoid cross-contamination
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Refrigerate leftovers quickly after cooking
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Consume or freeze leftovers within 3-4 days
Eating well during pregnancy doesn’t have to be stressful! Following these simple guidelines will help you get the nutrients you and your baby need without all the frantic google searching.
Helping moms get the nutrition they need, without a lot of fuss, inspired us to create Mama Bar, a high protein nutrition bar made from whole foods! Mama Bar provides key nutrients that are important during pregnancy and postpartum, in a convenient, grab-and-go bar.
Amy Kovner MS, CN, LMHC is a Certified Nutritionist and Mental Health Counselor passionate about supporting the wellbeing of moms. Amy is the Co-founder of Mama Bar, a high quality nutrition bar created to support the increased nutritional needs during pregnancy, postpartum and breastfeeding.
Citations
1. Medina, J. (2014) Brain rules for baby: how to raise a smart and happy child from zero to five. Second edition, updated and expanded edition. Seattle, WA: Pear Press.
2. Hsu MC, Tung CY, Chen HE. Omega-3 polyunsaturated fatty acid supplementation in prevention and treatment of maternal depression: Putative mechanism and recommendation. J Affect Disord. 2018 Oct 1;238:47-61. doi: 10.1016/j.jad.2018.05.018. Epub 2018 May 16. PMID: 29860183.
3.Hibbeln JR. Seafood consumption, the DHA content of mothers' milk and prevalence rates of postpartum depression: a cross-national, ecological analysis. J Affect Disord. 2002 May;69(1-3):15-29. doi: 10.1016/s0165-0327(01)00374-3. PMID: 12103448
4. Oster, E. (2013). Expecting better: How to fight the pregnancy establishment with facts. London: Orion
5. Tam, Carolyn, Aida Erebara, and Adrienne Einarson. “Food-borne illnesses during pregnancy, Prevention and Treatment” Canadian Family Physician 56.4 (2010): 2202-2209.
6. V. Janakiraman, “Listeriosis in Pregnancy: Diagnosis, Treatment and Prevention” Review of Obstetrics and Gynecology 1, no. 4 (Fall 2008): 179-85
7. Einarson, Adrienne, et al. “Food-borne illnesses during pregnancy.” Canadian Family Physician 56.9 (2010) 869-870.