Pregnancy, turkey and hotdogs

What can I eat when I'm pregnant?

This post has taken me awhile as I wanted to do some research first. Unfortunately, in regards to nutrition and safety in pregnancy, there is very little "proven". As you know, there are many claims of vitamins, herbal remedies, diets etc out there. Because most of this stuff is not controlled, there are very few studies that prove efficacy or safety of any of these things. I've tried to go through the scientific literature and get you the best answers I could find. I will not address herbal and natural remedies. I agree that these may work, but I can not attest to their safety. I do want to talk about obesity in pregnancy but I will do that in a later post.

So, back to diet, you're not supposed to eat tuna or hot dogs or foods that cause allergies or soft cheeses, or melons, or smoked seafood.....and you need to take your vitamin everyday or your baby will have three eyes, right? Wrong.

The thing about nutrition is that it should be commonsense. If a good balanced diet is good for mom, it is good for the baby. Nothing extreme. All things in moderation. Exercise, good diet, appropriate food handling, avoidance of drugs and alcohol; these are all recommended to all women, pregnant or not.

So lets look with a little more detail.

Listeriosis: The topic that made me even think of writing this blog is deli meats. I can't tell you the number of phone calls that I get asking if someone can have a hot dog at their family reunion. This recommendation is based on some science, though probably blown way out of proportion. Listeriosis is a bacteria that can be found in many sources, including deli meats. It is not killed by refrigeration and so can be on many preprocessed foods. It is found in dirt, on drinking fountains, in deli meats, melons, soft cheeses, hummus, corn salad, many animals, food from delicatessen counters, pasturized and unpasturized dairy products, fruits and vegetables. In otherwords, it can be found most everywhere. Two large outbreaks were from turkey meat, thus the warning against that. For some reason, when people are exposed to listeriosis, it is the immunocompromised (cancer pts, HIV) and pregnant women in the third trimester that are most succeptible to getting sick. If a third trimester patient gets listeriosis there is a risk of fetal death as well as maternal death. There is no doubt this is a terrible disease.

The important thing to note, though, is that it is a very rare disease. The risk of getting it is 3 people per 1 million (all-comers, not just pregnant women). On the other hand, there is a 4100 women/million ( pregnant women) chance of getting hospitalized for a trauma-most are car accidents. There are some areas where the biggest risk to a pregnant women is homicide. From what I can indirectly calculate, you are approximately 1000 times more likely to be murdered in your pregnancy then you are to get listeriosis. That being said, cautious intake of cold, preprocessed foods is probably wise.

The FDA provides a website www.fda.gov/food/resourcesforyou/healtheducators/ucm082539.htm for more information.

Just keep things in perspective.

Macronutrients: There are many sites that talk about protein, fat and caloric intake. I think it is safe to say, again, that a balanced diet is best. You only need about 300 more calories a day when you are pregnant if you start at a healthy weight. Obviously if you are underweight or overweight you may need to eat more or less. I'll address this more next time with a chat about obesity.

Fish/fat and IQ: Fat is a necessary evil. Low cholesterol and saturated fat is going to be best. There is some strong evidence that long chain fatty acids found in fish is very good for brain development. Several studies show that there is a significant increase in IQ of young children born to women that eat fish or take fish oil. The warning about this is mercury. We also know that mercury can cause brain damage. So do you eat fish or not?
The best advice I can give is to avoid big fish that contain more mercury-swordfish, fresh tuna and shark for example. A can or two of tuna per week has been deemed safe by the fda. I would encourage you to eat other fish though, such as salmon, trout, talapia, cod. In this area (UT) the river fish are safe. Some areas of the country the rivers are polluted with mercury and so you should check with the local health depts. One to two servings a week would be good. Of all the vitamins and nutrients out this, this is one of the most studied and most convincing.

Micronutrients: The other most studies nutrient is folate. It is clear that folic acid helps to prevent spina bifida. I've also been to conferences where they have reported some decrease in heart defects and abdominal well defects. This has not been published yet that I've seen. Regardless, we know it is a good thing. Our flours and cereals are now fortified with folate so we are getting more than ever now. The key point of this is: the folate needed for spine and heart formation is what is in your body when you concieve--NOT what you take afterwards. If you are planning on concieving, that is when you should be taking vitamins.

All the other vitamins have not necessarily been proven to give better outcomes for the pregnancy, the baby or the mother. My advice it that if you feel better on a prenatal vitamin then continue to take it. If it makes no difference, or if it makes you sick and you can otherwise eat a normal diet, then dump the prenatal vitamin for a healthy diet.

If you are undernourished for whatever reason, (heavy smoker, vegetarian, lactose deficiency, carrying twins) vitamins have been shown to grow a little larger baby.

Iron has only been shown to be helpful if you are already anemic. This is usually tested in your first prenatal labs.

Caffeine:
There is no good data on caffeine. One study I read only found a correlation with bad outcomes when consuming 6 cups of coffee a day. It has been linked with miscarriage and so you may not what to drink large amounts in early pregnancy. (more than 200mg) One can of coke has 46 mg. 1.5 oz of Hersheys had 10mg. 8 oz of brewed coffee has 135mg. to give you an idea.

Artificial sweeteners have not been linked with any ill outcomes though these are still being studies.

Flouride: Supplementation with flouride has not been seen to make any difference in your baby's teeth and is not recommended. Topical flouride-with washes etc-has been the only source shown to make a difference.

In summary the motto of nutrition in pregnancy is balance and moderation. What is good for you is good for your baby.