Eating While Pregnant: A doctor and a nutritionist weigh in.

Pregnant women often find themselves second-guessing their food choices. It is crucial for women to get prenatal care early in their pregnancies and establish trusting relationships with doctors, midwives and nurses. Physicians have access to the most up-to-date clinical information and often work closely with nutritionists—taking patients’ individual health histories into account.

Lisa Yarah and Luis Castro

Family physician Luis Castro and nutritionist Lisa Yarah with St. Joseph’s Hospital Health Center provide expectant mothers at Primary Care Center-West in Syracuse with nutritional guidance. Castro has been at the center for 17 years, while Yarah brought her 20-plus years of experience to St. Joseph’s last October. Family Times recently asked them about the recommendations for expectant mothers. (The interview has been edited and condensed.)

How concerned should women be about caffeine and sugar during pregnancy?

Lisa Yarah: Well, we know that caffeine can cross the placenta to the baby. So it is important to limit caffeine intake. The recommendation is for pregnant women to ingest no more than 200 milligrams per day—about the amount found in a 12-ounce cup of coffee.

Chocolate seems to be a harder thing for people to cut back on. (Laughs)

What effect does caffeine have on the baby?

LY: It could change the baby’s sleep cycle in the womb.

Luis Castro: Prolonged exposure to caffeine does affect the baby’s growth. And certainly when they are born. If they are exposed to high levels (in utero), they can go through almost a sort of caffeine withdrawal.

Expectant moms are prescribed a high potency multivitamin as soon as possible. Why can’t they just use a regular multivitamin?

LC: The main reason is the amount of folic acid pregnant women need. They need it to help prevent (neural) tubular defects. They need 0.4 milligrams, 400 milligrams if it is a high-risk pregnancy, or if the mother has a seizure disorder. The reason for that is the medications prescribed to treat those disorders can interfere with absorption. We also need to make sure they are getting enough iron.

LY: (Prescribing folic acid) is just added insurance. It’s found in green leafy vegetables, fortified foods (such as cereals and enriched pasta), nuts, beans and citrus fruits.

What are the current recommendations regarding consumption of certain varieties of fish?

LY: The concern comes from the high mercury levels in certain kinds of (predatory) fish such as shark, swordfish, mackerel and tilefish. Many women have questions about canned tuna. It’s recommended that pregnant women eat no more than 12 ounces per week. And it’s recommended that they choose the light tuna, not the albacore. Albacore tuna has more mercury than the other canned varieties. We recommend no more than six ounces of that.

LC: We do get a lot of questions about fish because people are eating more of it. It is a great source of omega-3 fats, which are very healthy. But we also have patients that are big sushi eaters. They need to know that there are varieties that they need to abstain from.

Morning sickness tends to vary from pregnancy to pregnancy. What advice do you give patients struggling with it?

LY: I recommend small, frequent meals throughout the day. One trick is to eat some crackers before even getting out of bed. The reason we recommend eating every three hours is because if you go much longer than that, the stomach becomes empty and the acid levels build up. Another tip is to sip drinks when eating or drink in between meals so that you don’t get too full while eating. And avoid high-fat foods. Also, cold foods tend to be better tolerated than warm foods.

Another thing that seems to help—and I’m not entirely sure why—is having something sour along with something salty.

LC: I tell patients who come in with morning sickness that not letting the stomach get empty can help ward off nausea. But we actually see more women these days with severe morning sickness that requires treatment. The majority of our patients have to be treated with medication for nausea. Those that have the most severe cases—which are rare—are hospitalized for dehydration.

People joke about pregnant women and their cravings, but what is really driving them? Are they motivated by nutritional needs?

LY: No one really knows for sure, but people do believe that they are related to hormone changes during pregnancy.

LC: People have a lot of theories about them being linked to nutritional deficiencies, but I don’t think there is a lot of real science behind that. Obviously, the cravings that motivate women to consume unhealthy foods—high in sugar and fat—are not driven by a nutritional need. But when we are talking about the more unique cravings, such as with pica (craving non-food substances), there can be some mineral cravings that are based on a nutritional need, such as iron. Pica is not a common problem.

Do expectant moms get stressed by the constant access to information—and misinformation—about prenatal nutrition found on the internet or the numerous how-to books targeting them?

LC: This is where the doctor-patient relationship plays an important role. Obviously, a lot of people are using the internet and we welcome the fact that patients are educating themselves. It is usually not a problem unless they are not sharing (the information or their questions) with us. We want our patients to come to us with any questions because an educated patient is better than one who is not.

LY: I’m seeing a lot of questions about the types of milk they should be drinking. There are questions about the hormones in cow’s milk, and about the protein in the soy or nut milks that are popular right now. There are a lot of questions about when to choose organic vs. non-organic. I definitely recommend hormone-free milk; it doesn’t have to be organic. Most (pasteurized) milk is hormone-free now, so that makes things easier. You do need three cups a day. Soy and lactate-free milk has added calcium and vitamin D, so you can get those nutrients in the amounts that are comparable to cow’s milk. The nut milks do not have enough protein.

Expectant moms seem generally more nutrition-conscious than they were generations ago. Continuing with bad habits such as smoking, or indulging under the “I’m eating for two” myth seems to be much less common. Are there any downsides to all this thoughtfulness?

LY: I am seeing a lot of positive aspects to that, especially with overweight moms. They decide that the pregnancy is a kind of wake-up call to get their eating habits in check. I do see that people want to eat healthier. Some women even lose weight during their first trimester.

As far as eating for two, during the second and third trimesters you only need an extra 300 calories per day, basically the amount of one small snack. A small apple, a piece of whole-wheat toast, or a glass of milk is really all you need.

LC: Women are more attuned to their diets now. I do still see some who justify some of the unhealthier choices with the eating-for-two mentality. But that’s less common.

What about lesser-known dietary concerns, such as pesticide exposure from produce?

LY: I see it coming up more often now, as people are trying to eat more fruits and vegetables. I recommend that everyone wash them well. Good old soap and water is fine. As far as buying organic, that can get expensive. But it’s helpful to know about the “dirty dozen” (foods that most often contain high levels of pesticides, as listed by the Environmental Working Group; see, foods which you should always buy organic, and the “clean 15,” which generally don’t absorb the pesticides as readily. If you can’t buy organic, washing the fruits and vegetables is really important.

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