The best time to begin eating a healthy diet is before you become pregnant. This will help you and your baby start out with the nutrients you both need.

If you are planning to become pregnant, visit your doctor. Getting good health care before you are pregnant will help you throughout your pregnancy. As part of your visit, you will be asked about your family life, work, and lifestyle, including your diet. You and your doctor will discuss how to eat right before and during your pregnancy and which nutrients are especially important, such as folic acid.

A Healthy Diet

The first step toward healthy eating is to look at the foods in your daily diet. Early in pregnancy, morning sickness can affect your eating habits. You may crave certain foods or not feel like eating. If this happens, you still should try to eat a variety of foods each day to help ensure you are getting the right amount of nutrients.

Having healthy snacks that you can eat during the day is a good way to get the nutrients and extra calories you need. You may find it easier to eat snacks and small meals throughout the day rather than three big meals a day. This also may help you avoid nausea and heartburn.

Healthy eating also means avoiding things that may be harmful. This includes alcohol (beer, wine, or mixed drinks) and illegal drugs, which may cause birth defects and other problems for the baby. Smoking cigarettes is especially harmful to a pregnant woman and her baby.

You also may want to avoid or limit your caffeine intake during pregnancy. Although some studies suggest drinking three or more cups of coffee per day may increase the risk of miscarriage, there is no proof that caffeine causes miscarriage.

Meal Planning

Planning meals in advance can help ensure you and your family eat a balanced diet. The food pyramid developed by the U.S. Department of Agriculture can help you choose what to eat (www.mypyramid.gov) (see Table 1). It takes into account your age, sex, and your amount of daily physical activity and shows the number of servings you should have each day from each of the six food groups:

1. Grains
2. Vegetables
3. Fruit
4. Oils
5. Milk
6. Meat and beans

Every diet should include proteins, carbohydrates, fats, vitamins, and minerals. To be sure your diet provides you with the right amount of nutrients, you should know which foods are good sources of each.

The RDA—recommended daily allowance—on food labels shows the levels of nutrients you need every day. During pregnancy, the RDAs are higher for most nutrients. Table 2 shows the key nutrients you and your baby will need during your pregnancy.

Extra Nutrients

Pregnant women need extra iron and folic acid, and these are usually prescribed in pill form as supplements. Sometimes a prenatal supplement that contains these two nutrients plus vitamins and minerals is recommended. Ask your doctor or nurse how your needs can be best met.

Women should take 400 micrograms of folic acid daily, in addition to a well balanced diet, for at least 1 month before pregnancy and during the first 3 months of pregnancy. This can help prevent neural tube defects, which affect the spine and skull of the fetus.

Women who have had a child with a neural tube defect are more likely to have another child with this problem. These women need much higher doses of folic acid—4 milligrams daily. It should be taken for at least 1 month before pregnancy and during the first 3 months of pregnancy. Women who need 4 milligrams should take folic acid as a separate supplement, not as part of a multivitamin.

Check with your doctor before taking any vitamins, herbs, or other supplements that are not prescribed for you. They might be harmful during pregnancy. Just because a product is natural does not mean it is safe to use during pregnancy.

Weight Gain

When you are pregnant, you need to eat more to help the growth and development of your baby, as well as for the changes in your own body that promote a healthy pregnancy. During at least the last 6 months of pregnancy, you need to eat or drink about 100𤬜 more calories per day than you did before you were pregnant.

How much weight you gain during pregnancy depends on your weight before pregnancy (see box). A healthy gain for most women is between 25 and 35 pounds. If you are overweight, you should gain less, but some weight gain is normal. If you are underweight, you should gain more. Talk with your doctor about the amount of weight you can expect to gain. This may vary if you are pregnant with more than one baby.

Special Concerns

Vegetarian Diets

If you are a vegetarian, you can continue your diet during your pregnancy. However, you will need to plan your meals with care to ensure you get the nutrients you and your baby need. Be sure you are getting enough protein and that it is the correct type. You will probably need to take supplements, especially iron, vitamin B12, and vitamin D.

Lactose Intolerance

Milk and other dairy products are the best sources of calcium in your diet. Some women have symptoms such as bloating, diarrhea, gas, and indigestion after drinking milk or eating dairy products. This is known as lactose intolerance.

During pregnancy, these symptoms often improve. But if you still have problems after eating or drinking dairy products, talk with your doctor or dietitian. He or she may prescribe calcium supplements if you cannot get enough calcium from other foods. Calcium also can be found in cheese, yogurt, sardines, certain types of salmon, spinach, and fortified orange juice.

Mercury

Fish and shellfish are good sources of protein, omega-3 fatty acids, and other nutrients. However, pregnant women should not eat certain kinds of fish because they contain high levels of a form of mercury that can be harmful to the developing fetus.

You should avoid eating shark, swordfish, king mackerel, or tilefish during pregnancy. These large fish contain high levels of mercury. Albacore tuna also is high in mercury so you may want to choose canned chunk light tuna instead. Other types of fish are fine in limited amounts. You can eat up to 12 ounces (about two meals) of other varied fish and shellfish per week.

Check local advisories about fish caught in local rivers and streams. If there is no advice about them, it may be safe to eat up to 6 ounces (one meal) per week of fish from local waters. During that week, do not eat any other fish.

Listeriosis

Listeriosis is an illness caused by bacteria that can occur in unpasteurized milk and soft cheese and prepared and uncooked meats, poultry, and shellfish. It can be particularly harmful to pregnant women and their babies.

Symptoms occur several weeks after you eat the food. They can include fevers, chills, muscle aches, and back pain. In some cases, there may be no symptoms at all. When a pregnant woman is infected, the disease can cause miscarriage or stillbirth.

Because the symptoms of listeriosis are like the flu, it can be difficult to diagnose. If you have a fever or flu-like illness, check with your doctor who may take samples from your vagina, cervix, and blood to be checked. If the bacteria are found, you and your baby can be treated with antibiotics. If there is a chance that a newborn is infected, he or she also can be tested and treated.

To prevent listeriosis, wash all fresh fruits and vegetables before using them. While you are pregnant, do not eat:

• Unpasteurized milk or soft cheeses
• Raw or undercooked meat, poultry, shellfish
• Prepared meats, such as hot dogs or deli meats, unless they are reheated until steaming hot

Pica

During pregnancy, some women feel strong urges to eat non-food items such as clay, ice, laundry starch, or cornstarch. This is called pica. Pica can be harmful to your pregnancy. It can affect your intake of nutrients and can lead to constipation and anemia. Talk with your doctor if you have any of these urges. He or she may be able to suggest other things you can do when you feel the urge to eat non-food items.

Finally...

Eating right during your pregnancy is one of the best things you can do for yourself and your baby. Take a look at the foods in your daily diet. Make sure they provide the nutrients you and your baby need. It is never too late to start eating a healthy diet.

This Patient Education Pamphlet was developed under the direction of the Committee on Patient Education of the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women's health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as "superior." To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.

Copyright © June 2008 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

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