TRANSCRIPT EPISODE 42 – All About Pregnancy & Birth With Dr. Nicole C. Rankins

Transcript episode #42:PROPER NUTRITION DURING PREGNANCY

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(00:00)

In this episode of the podcast we are talking about nutrition and pregnancy.

(00:11)

Welcome to the All About Pregnancy & Birth podcast. I'm your host, Dr. Nicole Calloway Rankins, a board certified OB GYN physician, certified integrative health coach and creator of The Birth Preparation Course, an online childbirth education class that will leave you feeling knowledgeable, prepared, confident, and empowered going into your birth. Quick note, this podcast is for educational purposes only and it's not a substitute for medical advice. See the full disclaimer at www.ncrcoaching.com/disclaimer.

(00:43)

Hello and welcome to another episode of the podcast. This is episode number 42 and I am so glad that you are here. This episode today is the culmination of a three part mini series of episodes that I've done related to weight during pregnancy. The first was on obesity in pregnancy. That was episode number 40 and then last week was weight gain during pregnancy. That was episode number 41 and I'll link to both of those in the show notes. And I felt that after those two it was really important to wrap things up with some practical information and advice on how you can best optimize your weight during your pregnancy with your nutrition. So today we are talking all about nutrition during pregnancy. I'll talk about macronutrients, micronutrients, we'll learn about food safety things. I'll also tell you some groups who should probably be referred to a dietician.

(01:53)

Now before we get into the episode, let me give a quick a listener shout out. This is to Sarah Beth Harmon and she left this review in Apple podcast and it says, the title of it is evidenced based info for hospital births. And the review says, "I have so appreciated listening to Dr. Rankin's podcast during my third pregnancy. I'm a birth junkie of sorts. I love learning about all aspects of pregnancy and birth and this podcast has been a great addition to my learning. I really appreciate how Dr. Rankins gives evidence-based materials and helps women understand aspects of pregnancy and birth in medical settings, as that is where most women will end up giving birth in the US. Even after learning much in my preparation from my first two unmedicated hospital births, I have learned much on this podcast for aspects of pregnancy not often covered elsewhere. For example, I just listened to the episode on GBS in preparation for my own GBS culture this week. Thank you Dr. Rankins."

(03:01)

Well thank you so much Sarah Beth Harman for leaving that wonderful review at Apple podcasts. I really appreciate it and appreciate that I can help you this third time around. And ladies, let me ask you this. Have you also checked out my online childbirth education class,The Birth Preparation Course? This is a comprehensive online childbirth education class that ensures you are knowledgeable, prepared, confident and empowered to have the birth you want. And like the podcast I cover topics related to birth that often aren't covered elsewhere, like mindset, like placenta encapsulation, how to do that safely, circumcision, what exactly happens in the hospital after you have your baby. And then of course you learn about all the fundamental things as well, like labor and how exactly to push a baby out.

(03:55)

So you can learn more about The Birth Preparation Course at www.ncrcoaching.com/enroll. That link will be in the show notes of course. I'll let you in on a little secret. If you go through my free online class on how to make a birth plan, you can get a big discount on the course. The free class is at www.ncrcoaching.com/register and that class is all about how to make a birth plan that works to help you have the birth that you want. And again, that little insider secret is that if you go through that free course, you can get a discount on The Birth Preparation Course. So definitely check that out.

(04:33)

All right, so let's get to today's episode on nutrition. So the first thing I want to say about nutrition during pregnancy is that OB providers do a horrible, horrible job in general with teaching pregnant women are helping women understand the importance of nutrition despite the fact that food can really be considered like medicine in so many ways and is crucial to the way we nourish our bodies and our health, we actually do not get much training on it in medical school. That may be changing these days some but not a ton and we definitely don't get it in residency training to be an OB GYN despite how important it is. So we really just don't know a lot of details about nutrition so don't be surprised if what you get from your OB doctor really just consists of a pamphlet of information because we really just don't know a lot.

(05:35)

Now with that being said, I'm going to do my best today in the episode to kind of give you a broad overview of some important aspects for pregnancy related nutrition. And really when we think about nutrition in pregnancy, the goal is that you really want to eat, and this is the goal regardless whether you're pregnant or not, is eating whole foods, unprocessed foods as much as possible or minimally processed, staying away from junk food, those kinds of things, and you want to do it so that you gain the appropriate amount of weight during pregnancy but not too much.

(06:12)

You also want to be sure during pregnancy that you have the appropriate supplements for vitamins and minerals because you do need some supplements during pregnancy. And I'll talk about that. Of course, avoiding alcohol and tobacco. And then finally, something that I don't think we talk a lot about is how to handle food safely to avoid those food borne illnesses. Okay. Now here's the truth. I have to shut down one of the most common myths that we've heard about pregnancy and that is of course that pregnancy is a time where you are eating for two. That absolutely is not the case. I hate to burst your bubble. I don't want to spoil your cupcake run or piece of cake or anything like that, but actually pregnant women only need an additional 300 to 450 calories or so per day depending on what your pre pregnancy weight is.

(07:12)

And really most of that should happen in the second and third trimester. You really don't need to increase your energy intake that much in the first trimester. Now the thing about it is with that being said, even though you only need an additional 300 or 400 calories a day, some of the nutrient requirements during pregnancy go up a fair amount, and I'll talk about that in a moment. So you really have to focus on making sure those calories count, so you're putting good food into your body. So you really want to be sure that you're taking in high quality, nutrient dense food and you want to limit those empty calories and that processed food and sugary beverages.

(08:04)

Now keep in mind, as I talk, I know we all have like, you know, cravings for things sometimes, and I don't want this to turn into like you can't eat anything at all. Like there's nothing wrong obviously with having a dessert here and there, he'd just want to do things and moderation and most of what you eat should be those high quality foods and not so much junk and empty calories. All right. Now before I get into the details of nutrition, I want to say right off the bat that there are some groups of people who would really benefit from seeing a registered dietician from the very beginning. And this is not something that I think we do a very good job of in OB GYN, of connecting with dieticians to refer women, you know, at, in my experience, it's not something that I see happen as often as it should. Some of that is just limits of not knowing people or some of it is limits of insurance, but there really are some groups of people who would benefit from more formal counseling from a dietician in regards to nutrition during pregnancy.

(09:16)

Okay, so let me go through who those groups of people are. So if you have diabetes, whether you had diabetes before pregnancy or you developed diabetes during pregnancy, you'd probably benefit from seeing a registered dietician. If you have hypertension, you'd probably benefit from seeing a registered dietician. If you have gastrointestinal conditions like ulcerative colitis or Crohn's disease that affect the way you metabolize food or absorb food, I should say. Then you should see a dietician. If you have a history of having a bariatric surgery for weight loss, then again your ability to absorb nutrients is going to be different. So you should talk to a registered dietician. Also, if you are overweight and particularly if you are obese, you should speak to a registered dietician to come up with some recommendations to help you with healthy eating choices during your pregnancy.

(10:14)

And then also finally, and this was maybe a soft call, but if you are a vegan or you are a vegetarian, making sure that you get all of your nutrients in. You may also benefit from talking to a registered dietician. And as I said, we really under utilize dieticians in our practice. I think we should refer more folks to them. There may be some insurance barriers, but it's certainly worth a look to find out. Now places you can go online to potentially look for yourself is the Academy for Nutrition and Dietetics website. And I'll link that in the show notes and you can put in your zip code and search by expertise and look for people who have an expertise in maternal nutrition. Now this isn't of course an exhaustive list. It's not going to list everybody that's available, but it can at least give you a place to start.

(11:07)

All right, so let's get into some of the food choices. So first I'm going to start with macronutrients and then I'll go with micro nutrients. And those are just fancy words for macronutrients are just foods that you need in bigger amounts like proteins, carbohydrates, fats, micronutrients are those things that you need in smaller amounts like minerals, vitamins, like iron, those kind of things. So as far as the macronutrients, let's first talk about protein. So the National Academy of Medicine, they're the same people who make the recommendations for weight gain during pregnancy. They recommend that pregnant women have 1.1 grams per kilogram per day of protein, which is a little bit higher than the 0.8 grams per kilogram per day that's recommended when you're not pregnant. Now you probably hear that and you were like, "what the heck is she talking about? One point whatever grams per kilogram per day?" Well, kilograms and grams are a unit that are used internationally. Like the United States is kind of the only backward place that uses units that don't make sense in relation to each other very well, like pounds and ounces and feet and inches, kilograms, milligrams, grams, all of those things relate better. So that's a better international standard. So let me just break it down for you in terms of numbers that we understand like pounds. So if you weigh 150 pounds, then in order to convert that to kilograms, you divide it by 2.2 and you get 68 kilograms. So if you weigh 150 pounds, then you weigh 68 kilograms, and then you need 1.1 grams per 68 kilogram. So per each kilogram per day for protein. So that works out to be 75 grams of protein a day.

(13:10)

I hope you followed that math with me, you know, I have a background in math. I majored in math in college. So math kind of comes easily to me. I know it doesn't necessarily come easily to everybody else. So 75 grams if you weigh 150 pounds. So just to give you an idea of some sources of protein, it's not that hard to get the 75 and the egg has six grams of protein. The chicken breasts will have 53 grams of protein, and that's like a typical serving, not like a whole breast you find in the package. A serving of chicken breast is actually just like what you can fit roughly in the palm of your hand. Non-fat Greek yogurt will have 17 grams of protein, a couple of lentils has 18 grams of protein. So there are plenty of options and choices that you have to get to the amount of protein that you need and do so healthily. You can also do it with nuts. That's another good way to get protein in. We do discourage using things like protein powders or protein shakes or anything like that. There is some evidence that they may be harmful during pregnancy.

(14:16)

Now let's move on and talk about carbohydrates. So carbohydrate requirements also increase during pregnancy up to 175 grams a day. When you're not pregnant, it's 130 grams for a day roughly for women. And what you really want to focus on is consuming those whole foods. So fruits, vegetables, whole grains for your carbohydrates. Those are called complex carbohydrates, and they have lots of protein fiber, so you get more bang for your buck with those carbohydrates. So again, whole fruits, vegetables, whole grain breads, beans, potatoes that are steamed or baked, including their skin. Those are all good sources of complex carbohydrates.

(15:14)

You really want to stay away from those highly processed or simple carbohydrates. Simple carbohydrates provide a lot of calories and they provide energy, but they have very little nutritional value. So some simple carbohydrates are things like white bread, white rice, white pasta, white sugar. All of those things are simple carbohydrates with very little value, junk food, refined sugar, sweet cereals, all of those things. Again, they will provide the grams, but they don't really provide much nutrition with it. You want to focus on those more complex carbohydrates. The other thing you want to do with carbohydrates is make sure you're getting carbohydrates that have lots of fiber. I think we underestimate or underemphasize the importance of fiber, not just in our regular diet and not just in pregnancy, but also in our regular diets. As a matter of fact, I did an episode with a gastroenterologist, I can't remember the number off the top of my head, but I'll link it in the show notes with Dr. Serena, and she talked about gut health and the gut microbiome and pregnancy and one of the things she talked about is the importance of fiber and how we really need to do more fiber in our diet.

(16:38)

So in addition to the carbohydrates, you want to make sure that you have fiber? Now, just some examples of the content amount for different types of foods. So whole wheat bread, will have 17 grams of carbohydrates, one gram of fiber, bananas 27 grams of carbs, three grams of fiber, a whole pear will have 28 grams of carbs and six grams of fiber. A cup of corn has 41 grams of carbohydrates, five grams of fiber. A potato has 37 grams of carbs, four grams of fiber. So there are options for you that are healthy, that taste good, that can help you have more of those complex carbohydrates and stay away so much from those simple carbohydrates. Now again, I don't want you to like completely deny yourself or you don't have to be like crazy obsessed about it. Of course you can have a cupcake or a piece of cake or a cookie every now and again. You just don't want that to be the primary content of your diet.

(17:43)

Now as far as fat. Interestingly, when I looked this up and I was kind surprised about this, but the optimal types and quantity of fat intake during pregnancy hasn't really been nailed down. There's not a lot of data that tells us what's the right amount of fat to eat during pregnancy. So I would say for this, just kind of do it in moderation, like other things. Now, one thing we do know is that trans fatty acids are bad during pregnancy, but we really shouldn't be eating those trans fatty acids anyway. Trans fatty acids are what's called an unsaturated fatty acid. They are found in things like margarine and manufactured cooking oils and it comes from the way that they are processed. You can look for trans fatty acids by looking for partially hydrogenated oil in the ingredients and it's also trans fatty acids are listed in the nutritional facts or information on foods. So you want to avoid those. I also personally, you know, I can't, this podcast is for educational purposes only. I can't tell you what to do, but I personally don't eat margarine. I only eat real butter. So that's my 2 cents about what I do personally to help avoid trans fatty acids.

(19:12)

Okay, so that's it for the macronutrients. Let's talk about the micronutrients. So there are a whole slew of things that have recommended amounts during pregnancy and I'm just going to go through all of them and what they are. So there are recommended amounts for vitamin A, vitamin D, vitamin E, vitamin K , those are what's called fat soluble vitamins. Then there's also recommendations for vitamin C, thiamin, riboflavin, niacin, vitamin B6, and vitamin B12. Those are the water soluble vitamins and then for minerals there are recommendations for calcium, phosphorus, iron, zinc, iodine and selenium.

(20:09)

Now I'm going to talk about a couple of those in a minute, but the short story is that we do not have a varied enough diet in the US and our soil is pretty nutrient poor, so you are going to need some sort of vitamin supplement during pregnancy in order to meet all of those requirements. It's quite challenging to meet the requirements with just your diet alone. It's possible, but in our US diet it's just really, really challenging. Now, Dr/ Anne Kennard who is a fellow OB GYN of mine, she's trained in integrative medicine and she's also an nutritionist and herbalist. She came onto the podcast on episode 24 and talked about the supplements that she recommends during pregnancy and I'll link to that episode. It's www.ncrcoaching.com/episode24.

(21:05)

Now, let me talk for a minute about a few of those specific ones that are more common or that you hear more about. The first one is iron. Iron is quite necessary for both your baby to grow and for the placenta to grow. It also helps you to have an increased amount of energy and iron stores to help feed this growing baby. Now we know that iron deficiency is actually fairly common in pregnant women, roughly up to 20% or so of pregnant women can have iron deficiency anemia and that can go up to be about 30% even in the third trimester. It tends to be more common in black women. Also tends to be more common in Mexican American women. Now pregnant women definitely need additional iron compared to when you're not pregnant. Just really twice as much, an additional 15 milligrams. So a total of 30 milligrams of iron per day.

(22:02)

Now there are two different types of iron and the reason that I'm telling you this is because they are absorbed differently. So the one that's absorbed easiest, meaning it's most bio available to the way humans absorb iron, is iron that's found in meat, that's found in poultry and that's found in fish. So that type of iron is more bio available and that's heme iron. Now non heme iron is the type of iron that is found in all plant foods. It's found in supplements, it's found in grains and it's a little bit harder for our bodies to absorb it. It makes it easier for us to absorb it if that iron is accompanied with vitamin C rich foods or if you eat it with meat, whether or not the meat has iron or not. So you may hear your doctor talk about, oh, you need to take iron and make sure you have enough vitamin C as well.

(23:07)

Now on the flip side, absorbing that non heme iron is even made more difficult if you take it with dairy products or if you take it with coffee. So just be mindful of that. If you're taking an iron supplement that you may want to take it with something like orange juice, that's vitamin C rich, in order to help the absorption in your body. Now most women, can get the extra iron that they need from a prenatal vitamin. But if you happen to be anemic, if you fall into that 20 to 30% category, you may need to take extra iron. Now, most often we recommend that you take it on a daily basis, but you even take it intermittently like three times a week and still get a lot of benefits. Sometimes iron can be rough on your stomach. So if you notice that you can't take it every day, then try to back it down to every other day and see if you can tolerate it like that. And then of course, you want to try and increase your iron through natural sources as well. So things like spinach, lentils, fortified cereals are a good way to get extra iron. Lean beef, salmon, canned tuna are all great sources of iron.

(24:20)

Alright, let's move on and talk about calcium and vitamin D. So the recommended amount of calcium actually does not change with pregnancy it's the same as when you are not pregnant. So that is 1000 milligrams a day of calcium. And roughly about 24% of pregnant women do not get the recommended amount of calcium. On the flip side, that's 75% of pregnant women who do, but there are about one in four women who don't. Now we know that dairy products are like a tried and true good source of calcium, a couple pieces of cheese and some milk will get you, a glass of milk will get you the calcium that you need. And that can be cow's milk, can be goat's milk. I personally don't like milk, I don't drink milk. So for me, that's not a great source. Now I do love cheese. I love just about any type of cheese, except cottage cheese, I find cottage cheese to be disgusting, but if you want to eat any type of cheese including cottage cheese then those are good sources of dairy and again, milk as well, a little ice cream every now and again also is a good source of dairy or not a bad source of dairy. How about that? If you want to do those milk substitutes like soy milk or almond milk, then those are also reasonable sources of calcium. If you're a vegetarian, then tofu is a good source of calcium. I was vegetarian for a long time probably like 15 years, 10 years or so, but now I eat chicken and fish. I never could quite get into tofu for some reason. The texture doesn't quite sit well with me, but tofu is a great source of calcium as well. Also, spinach, white beans. I personally get calcium through calcium fortified orange juice is a good source for me. That's what I drink. And kale and broccoli as well.

(26:21)

Now calcium and vitamin D kind of go together because of the way they're absorbed. Now. Vitamin D we know has been like all the rage, vitamin D this, vitamin D that, vitamin D everything and I swear everyone has low vitamin D. Now, it's recommended that pregnant get 600 international units of vitamin D. most prenatal vitamins have 400 international units so you will get most of what you need through a prenatal vitamin and then some other sources that you can go to are salmon shrimp. Again, fortified milk fortified orange juice, most fortified orange juice with calcium is fortified with vitamin D as well. And then fortified cereals as well can give you a good source of vitamin D. if your vitamin D is super duper low, then your Dr. may recommend giving you extra amounts for us for a period of time to get it back up. There've also been lots of studies looking at whether or not extra supplementation with vitamin D may be helpful for pregnancy and outcomes, but there's no evidence that it will be helpful.

(27:35)

And then the final one that I want to talk about is folic acid. I'm sure you've heard about folic acid and how you need to take extra folic acid because it prevents something called neural tube defects. Those are issues with how the spine of forms and you really need to be taking folic acid at least one month before pregnancy because these defects happen very early in pregnancy, so you really should be taking it one month before. That's why if you're just thinking about getting pregnant, you can go ahead and start taking your prenatal vitamin now even if you're not pregnant, and then you also want to take it for the first three months after conception to reduce that risk of neural tube defects. Most prenatal vitamins, I should say actually all prenatal vitamins, will have the recommended amount of folic acid that you need to get in order to prevent neural tube defects. And then some other natural sources are spinach, broccoli, asparagus, again, those fortified cereals and beans.

(28:38)

Now. It's also important to note that vitamins in particular can also be a problem, in excess during pregnancy, so it's not necessarily that you take, take, take, take, take to the highest levels possible. It can actually be detrimental if you take too much of some specific vitamins. A particular one is vitamin A. Vitamin A in excess can affect a developing embryo, so when very, very tiny in one food source that has a lot of vitamin A is liver. So if you happen to eat a lot of beef liver especially, then you need to decrease that. Particularly during the first trimester. Now, I personally cannot stand liver. Oh my gosh. I remember once, and I'm getting off on a tangent here when I was growing up and my mother substituted liver for steak and tried to get us to think that this liver with steak, that substitution did not work, we did not eat it. But anyway, if you happen be a lover of liver and no judgment here, then you do need to back it down. Particularly beef liver in the first trimester. Also excess iodine can cause issues with thyroid development in babies and then excess vitamin C, D and E have been associated with adverse pregnancy outcomes like preterm labor or your water breaking early.

(30:05)

Now really quickly before I finish up or wrap up talking about and go on to food safety, I wanted to quickly touch upon a couple of things. Gluten free diet, artificial sweeteners, probiotics, and DHA. I feel like I'm talking really fast this episode, so I hope you guys are getting everything that I'm saying here. I'm trying to get in a lot of content. All right, so let's talk about gluten free diet. There is no evidence that a gluten free diet has any significant health benefits in women who don't have a specific condition called celiac disease or proven gluten sensitivity. With that being said, I know tons of folks who say they just feel better after a gluten free diet and there's absolutely nothing wrong with that. You do need to be aware though, that if you eliminate gluten rich foods, you may not be getting enough thiamine, niacin, folate and iron, but as long as you're substituting with other whole grains that are gluten free or and also your folic acid vitamins, then you should be okay. You really shouldn't have any nutritional issues if you have a gluten free diet.

(31:20)

As far as artificial sweeteners, there's no evidence that using artificial sweeteners, NutraSweet, Splenda, sweet and low, Stevia, that any of those increase the risk of birth defects any more than in the general population. Now, there is some concern that chronically using these actually increases the risk of obesity in some type of metabolic diseases in adults, but that really hasn't been studied in pregnancy. So as far as we know, there is no harm if you use artificial sweeteners. Now for probiotics, we know that probiotics are increasingly popular. We also know that probiotics have some benefits, at least outside of pregnancy. There haven't been a lot of studies about probiotic use during pregnancy, but there certainly haven't been any increased risks of bad outcomes that we are aware of. There's not a lot of data available, but as best we can tell, it certainly doesn't cause any harm. And there is some limited evidence and it may be beneficial. It may reduce preeclampsia, may reduce your ability to metabolize glucose, so reduce your risk of gestational diabetes. But again, those are tiny studies so there's not a recommendation either way. Maybe it helps as far as we know, probiotics don't hurt.

(32:46)

And then lastly, you may have heard about DHA. I'm not going to say the long name for it because I just can't pronounce it, but DHA is a type of fat and it's necessary for normal development of your baby's brain and your baby's eyes. Now the best source of DHA is fish. And I'll talk about the types of fish that are safe to eat in a minute. But if you happen not to eat fish, then definitely get a prenatal vitamin with DHA added so you can support the development of your baby's brain.

(33:19)

Okay, so we are in the home stretch. Let's finish up by talking about food safety. And really what I want to talk about here is just avoiding it. Those food borne infections, there are food borne illnesses that can happen during pregnancy that can cause issues with miscarriage, can cause preterm labor, they can even cause death or for babies to be born with congenital malformations or diseases. Probably the biggest one that we hear about and worry about and that can be quite toxic is listeria. And listeria is actually fairly common at low levels in processed and unprocessed foods. Now the thing about listeria is that it is not present in hot cooked foods, so that is why you may often hear the recommendation of if you eat processed food, make sure it's warmed up because listeria is not present in hot cooked foods. It can be present, however, in processws deli meats, hotdogs, soft cheeses, some smoked seafoods and meat spreads. It's also rarely transmitted by fresh fruits and vegetables. So you know, I think it's okay, I should say this, everybody's a little bit different about the recommendations for processed food because you know you have some people who eat, you know, Turkey sandwiches for lunch or that kind of thing. If you want to be extra cautious then heat the meat up. But do know that's a risk if you don't have listeria is potentially there. There are lots of OB GYN who are comfortable with saying, you know, most likely that it's safe as long as you, you know, wash your hands and all that kind of good, great stuff. So really just to reduce the risk of food borne illness, much more important than say like not eating lunch meat is just good old fashioned clean practices.

(35:24)

So wash your hands frequently. Only eat meats, fish, poultry, eggs that are completely, fully cooked. Nothing raw. Definitely avoid unpasteurized juice and unpasteurized dairy products. It should clearly say on the label if it's pasteurized or unpasteurized. If you can't tell for sure and then don't eat it. You went to rent your fruits and vegetables, particularly anything that you're not going to peel under running water for at least 30 seconds. Also, avoid eating raw sprouts. It's actually nearly impossible to wash all of the bacteria out of raw sprouts, so alfalfa, sprouts, bean sprouts, clover sprouts. It's very, very difficult to wash all of the bacteria out. So if you can avoid those raw sprouts and then also wash everything that comes in contact with raw meat or fish or poultry, so all of your raw meat products, you really need to wash those prep surfaces well.

(36:38)

You can do your countertops, you can do your cutting boards with a solution of a teaspoon of liquid bleach, and then put that in a quart of water. Or you can just use like Clorox wipes. Those things are great and you just leave them to dry as you wipe it down and leave it to dry. I also personally recommend that you have a separate cutting board for vegetables and a separate cutting board for raw meats, so you're not cross contaminating in that regard. My husband is a stickler for that. We have like two meat cutting boards and three vegetable cutting boards.

(37:14)

All right. And then the last two things is I'm talking about, whew, we talked about a lot in this episode are caffeine. You want to limit the amount of caffeine to 200 milligrams. Some sources say 300 but 200 to 300 milligrams a day. That's the equivalent of an eight ounce cup of coffee a day. I personally drink that at least during both of my pregnancies. I'm a big coffee addict I should admit and say I drink coffee every day. And then also the last thing is fish. So pregnant women really should only eat cooked fish. However, don't like freak out if you've eaten sushi grade fish before you knew you were pregnant, most likely that is generally safe. Just don't eat anymore raw fish going forward. And as far as fish, if you followed any information about fish during pregnancy, you know that we have gone back and forth and forth and back and eat fish don't eat this fish, don't eat that fish. But I think we have finally kinda settled that discussion and debate about, and it all centered around mercury and it's still for a large extent the concern about mercury, but I think we kind of took it too far at one point and cut women completely off fish without realizing that fish has some benefits like the DHA like I talked about.

(38:39)

So you want to avoid eating fish that is high in mercury and some types of fish that may be high in mercury are sharks, swordfish, marlin, tilefish and orange roughy. Now, I don't know about you, but none of those are fish that are typically on a regular basis. Maybe they may be in a fancy restaurant, but like what you go and pick up at the store and your local fish market probably not one of those types of fish. Now what you do want to eat is two to three servings a week if you can. Even that kind of feels like a lot, but yeah, two to three servings per week. If seafood that's low in mercury. And examples of low and mercury seafood are catfish, cod, crab, flounder, lobsters, salmon, shrimp, and light tuna. So those are all common things that you may pick up in the fish market, so you can eat those two to three times a week or one serving of what's called a better, a good choice. So not quite as ideal as the ones I've just mentioned, but still okay once a week, like halibut, snapper or sea bass. Those are the fish that you can eat. Again, just a little bit less frequently than the other ones that I mentioned.

(39:59)

Okay, cool. So that is it for nutrition during pregnancy. I know that was a lot of information, but I hope you found it helpful. Now just to recap, I know women only need an additional 300 to 450 calories a day. It doesn't take much to get that, so we are not eating for two and you want to get to that number with a variety of foods, whole foods, limit processed foods. You want to try to eat things as close to nature as possible. A rough estimate of what you can eat every day and stay within your calorie content limits are two to two and a half cups of fruit, three to three and a half cups of vegetables, six to 10 ounces of grains, six to seven ounces of protein, which is like a nice big chicken breasts. Three cups of dairy. So when you hear that, that's actually quite a bit of food. Two cups of fruit, three cups of vegetables, the amount of protein, it's actually not like a restrictive sort of diet. So you have plenty of options if you make it good food choices. And let me tell y'all guys good food doesn't have to taste bad. I think there's always been this association that good or healthy food tastes bad, but in actuality healthy food can be quite delicious. It just depends on how you cook it and finding good recipes.

(41:27)

One of my favorite places for delicious vegetarian recipes is the website Cookie and Kate. They have tons of great stuff there. And I'll link to that in the show notes. I also get some great recipes by email from the New York times cooking. They send like five recipes, free recipes a week. I also get some great recipes from a website called Gimme Some Oven and I'll link to those in the show notes as well and tell me you're afraid to try things like lentils, different types of things like chickpeas. You'd be surprised how much like adding garlic and onions and spices and a little bit of heat with things like red pepper flakes can really make your food be delicious. Healthy food does not have to be bland and taste bad.

(42:18)

It also doesn't have to be expensive. If you look in most grocery stores these days, there are organic sections that are store brands. Like around here we have Kroger and Kroger has like, I think it's called simply selective or simple select, something like that. But they have their own store brand of organic products. Yes, they're a little more expensive than than non organic products, but they're not like break the bank. So you certainly have some options available to you to have good, healthy foods that tastes good and is not terribly expensive. Now if you have a great resource for tasty recipes, then post in the All About Pregnancy & Birth Facebook group. I also post recipes sometimes there as well. And if you're not a part of the group you definitely should be. It is a great place to connect with other pregnant women and I will link to how you can join the group in the show notes or you can just search all about pregnancy on Facebook and it should pop up for you.

(43:22)

Now also be sure to subscribe to the podcast and Apple podcast or wherever you listen to your podcast and if you feel so inclined, please leave me a review. It helps other women find the show, it helps the show to grow. And most importantly, I can give you a shout out on a future episode. Now next week on the podcast, I initially intended to have an interview cause y'all probably tired of hearing my voice for these last three episodes and ready for me to get back to some interviews. But, I need to talk about something that's really important right now and also time sensitive and that is, influenza in pregnancy. Yes, the flu and pregnancy. So that will be next week. So come on back next week. And until then, I wish you a healthy and happy pregnancy and birth.

(44:19)

Today's episode is brought to you by Women's Wellness Coaching by Dr. Nicole Calloway Rankins. Head to www.ncrcoaching.com to check out my free one hour mini course on how to make your birth plan as well as my comprehensive online childbirth education class, The Birth Preparation Course with over eight hours of content and a private course community. The Birth Preparation Course will leave you knowledgeable, prepared, confident and empowered going into your birth. Head to www.ncrcoaching.com to learn more.

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