expert opinion

Prenatal Nutrition Q&A with Registered Dietitian Tori Schmitt

NUTRI-FACTS Editors

September 26, 2019

If you are providing healthcare for a woman who is pregnant, you may get questions about food and nutrition. Pregnancy is an important time for both mom (and baby!) to get good nutrition, but circumstances like food aversions, food cravings, and traveling while pregnant might make getting good nutrition a bit more challenging. The NUTRI-FACTS team sat down with Tori Schmitt, registered dietitian and new mom, to answer popular prenatal nutrition questions.

NF: For a woman who has food aversions, food cravings and occasional nausea in pregnancy, is it possible for her to eat healthy while she’s pregnant?
TS: Absolutely! Eating healthy during pregnancy can sometimes be a challenge.  Just remember to remind your patients: balance is possible, even with food aversions, food cravings and occasional nausea.  

When able, a pregnant mom may be able to better approach mealtime when she focuses on the nutrient-rich foods she can add to her plate. Complementing a pizza slice with a side salad, mixing in almond butter and blueberries to yogurt or oatmeal, and adding in some veggies with hummus for a snack can surely make a positive difference in her total nutrient consumption. 

For assisting patients with food aversions, remember that one food can be prepared in multiple ways! So, perhaps it's not the entire vegetable food group that an expecting mom has a food aversion to, but maybe it's just that for the time being she can't stomach eating raw vegetables. That's okay!  In the meantime, she can eat vegetables cooked, pureed, in a soup, as part of a slow cooker meal, or in any other form she can tolerate. It can help her if she gets very particular with what she doesn't want to eat, and looks to alternatives when available.

It can be important to remind pregnant women that food cravings are often part of the pregnancy journey, too!  Crave-worthy foods can be eaten in balanced, respectful portions – and satiety can be maximized by ensuring that the eating occasion that includes some protein and fiber, too.

Q: How can a woman keep her nutrient supply up when traveling during pregnancy?
A: Remind her to keep it simple: focus on the fundamentals like drinking enough water, eating a balanced breakfast, and selecting a nutrient-rich dinner entrée while at restaurants or traveling. If a pregnant woman is not sure where or when food will be available while she’s away from home, she can pack healthy, portable snacks like homemade trail mix, bananas with peanut butter, or store-bought protein bars so that she always has options at her fingertips for when hunger strikes.  Fresh produce purchased at a local grocery store or farmer’s market while away from home is a good idea, too – just remember to remind her to wash her produce before eating it! Food safety is still of utmost importance during pregnancy, and that includes being extra food safe when away from home!

Q: What nutrients should be on a mother’s radar to help support a healthy pregnancy?
All essential vitamins and minerals should be on a mother’s radar! In pregnancy, the necessary amount of total calories and several nutrients increase. Of particular significance are nutrients including iron, folate, calcium, vitamin D, iodine, omega-3s and choline.A pregnant woman should follow a healthy, balanced eating pattern that optimizes her consumption of these important nutrients. Also, she should consider taking a prenatal vitamin that offers these nutrients plus others that are recommended by her physician.

Q: What are choline and omega-3s, and why are they important during pregnancy?  
Choline is a nutrient that helps support the growth and development of a baby, particularly for a baby's neural tube development in early pregnancy and for brain development in the third trimester.2 Omega-3s like DHA help support the health of a baby's brain and parts of his eyes.3 Despite their benefits, many pregnant women aren't getting adequate amounts of either.1-3 The good news?  Pregnant women can find both of these nutrients in salmon and omega-3 fortified eggs. Other animal proteins, beans and broccoli offer additional sources of choline.

Q: Speaking of fish, should pregnant women eat fish during pregnancy?
A: Yes. The United States’ Department of Health and Human Services and Department of Agriculture 2015-2020 Dietary Guidelines for Americans recommend that women who are pregnant or breastfeeding eat at least 8 ounces and up to 12 ounces of seafood each week. Ideally, food sources that offer DHA omega-3 and that are lower in mercury should be emphasized, including fish like salmon, sardines, skipjack tuna and anchovies.1,4 If a pregnant woman doesn’t eat fish, she should discuss with you (her doctor) about adding a DHA omega-3 supplement to her diet to make it easy to get some of the benefits of fish and seafood on a daily basis.

Q: What if the mother can’t stomach the idea of taking a daily prenatal vitamin or omega-3 supplement.  What are your tips for taking them?
A: I suggest focusing on a high-quality eating pattern and a high-quality prenatal vitamin in a form that is best tolerated. When it comes to selecting a prenatal, she might want to consider factors like:

  • The delivery method of the nutrients (does she prefer a capsule, tablet, powder, liquid, or gummy?)
  • The quantity recommended to take (is it one capsule or many?)
  • The time of day (does she feel better if she takes her supplements in the morning, with lunch, and/or at night?)
  • Her day by day preferences (do her preferences change depending on the day, week, or trimester of pregnancy?)

During my pregnancy, I discovered that I preferred a gummy when I felt like I couldn't swallow a tablet, and a tablet when I didn't want the sweet taste from a gummy vitamin.  With morning sickness in my first trimester, I found that taking my supplements before bed was a better time of day. By my third trimester though, I could consume them at any point in my day. In the end, I chose five (yes, five!) different supplements during pregnancy, all because certain products fit my needs and preferences better at certain stages. 

The bottom line: your patient may have unique needs and preferences related to her eating pattern and supplement choices, which may require your knowledge and guidance or your referral to another healthcare provider. Encourage pregnant woman to visit a doctor and a registered dietitian to discover the high-quality food and prenatal supplement options that work best for her (and her growing little one, too!).

Let us know other questions you receive from your patients by connecting with the NUTRI-FACTS team on Facebook @Understanding.Vitamins. We are here to support you in your endeavor to nourish and protect the motherhood journey with quality nutrition.

References

  1. Kaiser, LL, Campbell, CG. Practice Paper of the Academy of Nutrition and Dietetics. J Acad Nutr Diet. 2014;114(9).
  2. Caudill, MA. Pre- and Postnatal Health: Evidence of Increased Choline Needs. J Am Diet Assoc.  2010;110(8):1198-1206. 
  3. Swanson D, Block R, Mousa SA. Omega-3 fatty acids EPA and DHA: health benefits throughout life. Adv Nutr. 2012;3(1):1–7. doi:10.3945/an.111.000893
  4. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at https://health.gov/dietaryguidelines/2015/guidelines/.