In the run-up to and during pregnancy, the food you eat becomes all the more important. Your body needs more nutrients to provide the best nourishment, both for you and for your baby.

Dr. Anthony Shaya talks about what you should be eating more of, what you should be keeping away from, what’s healthy in terms of weight gain, and how diet and labor may be connected.

Daniela: Good morning and welcome to Dreaming of Baby! We have with us today Dr. Anthony Shaya of Partners in Women’s Health in Jupiter, Florida with whom we shall be discussing nutrition in pregnancy. It’s a pleasure to have you with us today, Dr. Shaya! Before we start with our discussion, it would be great if you could introduce yourself to our readers.

Anthony Shaya MD MPH FACOG: I am a board certified ob/gyn working in private practice in Jupiter Florida. I’m involved in prenatal care and ‘deliver’ over 100 babies/year.

Daniela: That’s impressive, thank you for this overview. To start addressing our subject today, how can a woman improve her diet once she finds out she’s pregnant? Are there any specific changes she should be making?

Anthony Shaya MD MPH FACOG: Several points. Generally, we recommend just eating healthy. Several small meals per day. In terms of specifics though, let’s talk about that. It is recommended about an extra 300 cal/day. However, in practice, most patients do not need to worry about that as just about everybody gets an adequate amount of calories in their diets. I tell patients you do not need to actively eat for two. I recommend healthy eating, meaning a balanced diet between protein, fat, and carbohydrates and ideally including a good amount of vegetables. One thing that is recommended to limit is seafood intake. This is because of the risk of mercury from any seafood. This basically means one serving of seafood per week. But patients must avoid fish that is high in mercury. This includes shark, king mackerel, swordfish and tilefish. Those fish should not be eaten by pregnant patients, or even breastfeeding patients or patients that are going to potentially going to conceive.

“You do not need to actively eat for two.”  Dr. Anthony Shaya

Fish in pregnancy

Daniela: You mention limitations on specific fish. If a woman finds out she’s pregnant late in the day and has had these food items, what sort of effects could mercury potentially have?

Anthony Shaya MD MPH FACOG: Unfortunately, mercury can have some profound and adverse effects on developing babies. It can affect all organ systems and specifically can impact brain function, hearing and vision. When we say brain function, it can cause neurodevelopmental problems, in lay terms ‘brain damage’. However, I would counsel a patient to not stress about this and just change their eating habits going forward. We can also test for mercury levels. This said, there is also a very good benefit of seafood, it is high in omega 3 fatty acids, DHA. One study looked at this, and there is potential that the benefit from DHA counteracts some of the risk from mercury for patients that eat a lot of seafood.

Daniela: That is very good to know. In these first appointments, is blood work usually done with the aim of identifying any specific nutrition-related deficiencies?

Anthony Shaya MD MPH FACOG: At the first visit, a whole set of bloodwork is done. It is focused on checking for anemia. In terms of other general deficiencies, we do not check that. But we interview patients to further testing if needed.

Should I be taking supplements during pregnancy?

Daniela: Thank you for clarifying. A question which our readers have been asking: is supplementation a must during pregnancy or if a mom-to-be eats healthy, it’s enough?

Anthony Shaya MD MPH FACOG: Folic acid is very important for the development of babies and, specifically, their neurological system. Hence the idea of prenatal vitamins. We ideally want to have patients on prenatal vitamins with folic acid, prior to conception. However, we also want to continue that through the pregnancy. In today’s modern society, if someone is eating healthy, they probably get adequate amounts of folic acid and other vitamins. However, I still recommend supplementation with prenatal vitamins.

“In today’s modern society, if someone is eating healthy, they probably get adequate amounts of folic acid and other vitamins. However, I still recommend supplementation with prenatal vitamins.” Dr. Anthony Shaya

Morning sickness and nutrition

Daniela: Thank you. Unfortunately, many women experience morning sickness in early pregnancy – when does this become a concern, nutrition-wise?

Anthony Shaya MD MPH FACOG: We are always pressing patients to eat healthy and take their prenatal vitamins. In reality, some patients are unable to. In these situations, we ask patients to do their best, but I tell patients to do not force feed themselves. If for a month or two you cannot eat, and vomiting daily, it’s probably not going to affect your baby. Nausea and vomiting is generally a good predictor of pregnancy outcomes and most patients with severe morning sickness will go on to have a normal pregnancy. So basically, in that case, don’t worry.

Weight gain in pregnancy

Daniela: In terms of weight gain, what is healthy and what isn’t?

Anthony Shaya MD MPH FACOG: The recommended weight gain for a patient who is of normal weight starting pregnancy, is a total of 25-30 pounds. For underweight patients, 35 pounds for the whole pregnancy. For overweight patients, 15 pounds. Low weight gain can put patients at risk for placental problems and a low birth weight baby. Excessive weight gain can put patients at risk for gestational diabetes and large babies.

Weight gain in pregnancy
Patient starting pregnancy at normal weight: total of 25-30 pounds.
Underweight patients: total of 35 pounds.
Overweight patients: total of 15 pounds.
Dr. Anthony Shaya

Gestational Diabetes, Preeclampsia and Food Choices

Daniela: You mention gestational diabetes; would you say then that gestational diabetes can be avoided through better food choices?

Anthony Shaya MD MPH FACOG: I would not say it can be avoided. But a pregnant patient can reduce the likelihood of getting gestational diabetes with better food choices.

Daniela: Thank you for clarifying. Would this also apply to preeclampsia?

Anthony Shaya MD MPH FACOG: Good question, there is no clear data on adjusting diet and reducing preeclampsia risk at this time.

Does nutrition in pregnancy affect labor?

Daniela: Thank you for this, Dr. Shaya. A penultimate question which some of our readers have been asking. Would you say there is a connection between nutrition during pregnancy and ease of delivery? Could they be, in some way, connected?

Anthony Shaya MD MPH FACOG: What we can say is that if there is excessive weight gain, and the patient develops or doesn’t develop gestational diabetes, there is increased risk of a larger baby and more likely birth trauma or cesarean section. So in that sense, yes, good nutrition and healthy eating through pregnancy will help at time of delivery.

Daniela: Thank you for clarifying this, Dr. Shaya. It’s been a pleasure discussing this important subject with you. On a final note, what would be that one piece of take-home advice that you always share with an expectant mom?

Anthony Shaya MD MPH FACOG: Eat healthy but don’t stress and freak out about everything that you eat. Two important points; probably people know this, but there is no known safe amount of alcohol in pregnancy. So, no alcohol in pregnancy. Caffeine in moderation/small amounts is considered fine.

Daniela: That is indeed imperative advice. Thank you for your time today, Dr. Shaya. The insight you have shared will be very helpful to our readers.

Dr. Anthony Shaya is a Board Certified Ob-Gyn assisting patients at Partners in Women’s Health in Jupiter, Florida. Click here to connect with Dr. Shaya.

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