Pregnant and googling every food under the sun? Making wise food choices may seem trickier in pregnancy. In between aversions and cravings, balancing nutritional needs may sometimes be easier said than done.

Deborah Malkoff-Cohen, Registered Dietitian and Nutritionist shares with Dreaming of Baby insight on pregnancy nutrition, calorie-intake, and the ideal diet for managing gestational diabetes.

Daniela: Good morning and welcome to Dreaming of Baby! We have with us today Deborah Malkoff-Cohen, a Registered Dietitian and Nutritionist with whom we shall be discussing pregnancy nutrition. It’s a pleasure to have you with us today, Deborah, we’re very much looking forward to what you have to share with our readers on this subject! Before we start our discussion, it would be great if you could introduce yourself to our readers.

Deborah Malkoff-Cohen, MS RD CDN CDE: Hi everyone! My name is Deborah and I am a new mom and Registered Dietitian. I started my mommy “journey” a little later in life and chose the IVF route for many different reasons and have a delicious little healthy chunky 9-month-old! I love everything nutrition-related and specialize in maternal and pediatric nutrition. I am also a Certified Diabetes Educator and counsel women with gestational diabetes, Type 1 and Type 2 diabetes to ensure a happy mommy and healthy baby. I also work with families pre-pregnancy to get them ready for what’s about to come. Can’t wait to work together!

How many extra calories do I need in pregnancy? Should I be eating for two?

Daniela: Great, thank you for this introduction Deborah, and congratulations! Before we delve in into the specifics, what does the ideal pregnancy diet look like?

Deborah Malkoff-Cohen, MS RD CDN CDE: The first step is to assess maternal weight to see where we are starting off at and to get an estimate of how much Mom should gain overall. Then discuss Mom’s current diet to see how well-balanced or not it is. There are certain nutrients of concern during pregnancy we want to make sure are being eaten or if not, supplemented to help the baby grow! These include folic acid, iron, calcium, Vitamin D, Omega 3, Choline, Iodine, Fluids, etc… We will also be asking: Is mom Vegan / Vegetarian? Coffee/soda intake? Artificial sugar intake? The least processed the better… Also, in the first trimester, no additional calories are needed. During the 2nd trimester, add 340 calories and in the 3rd, you need 452 extra calories daily. The old saying you are “eating for 2” is not true!

 

Extra calories you need during pregnancy:
1st trimester – 0 calories
2nd trimester – 340 calories
3rd trimester – 452 calories
Deborah Malkoff-Cohen, MS RD CDN CDE

 

Daniela: Great, thank you for this overview! I was actually going to ask about that – many times moms hear about the need to eat for two. The calorie additions you spoke of, do these increase if the mom is expecting multiples?

Deborah Malkoff-Cohen, MS RD CDN CDE: Yes….not in terms of daily calorie needs but in overall weight gain and it’s based on pre-pregnancy weight. The more you weigh before the less you’re expected to gain.

What should I be eating during each trimester?

Daniela: Thank you for clarifying. Looking at the pregnancy as a whole, would you say that there are different nutritional requirements for every trimester?

Deborah Malkoff-Cohen, MS RD CDN CDE: Yes, for example, folic acid is essential pre-pregnancy and for the first trimester to prevent neural tube defects. The organs and bones are developing so calcium/vitamin D are important. During the 2nd trimester, the baby’s brain is growing so omegas are important. Vitamin C helps those supporting structures of the bones like muscles and cartilage. In the third trimester, iron is important in anticipation for birth and to feed the baby’s brain and tissues with oxygen and fiber/water to prevent constipation in mommy!

Daniela: This is a very helpful overview for moms-to-be. It also shows the extent to which nutrition affects pregnancy! Let’s talk a little about cravings – should a mom-to-be succumb to these? Do cravings point to a specific deficiency?

Deborah Malkoff-Cohen, MS RD CDN CDE: I think it depends….and what it is. If it is a pickle every few days ok…as long as you are not retaining too much water. I think cravings are just part of pregnancy, as long as it does not endanger Mom and baby it is ok. No raw fish etc. If Mom is eating or chewing ice or non-food items that could be a sign of Pica which could mean she could be iron deficient.

What is Pica?

Daniela: Can you please elaborate a little on Pica?

Deborah Malkoff-Cohen, MS RD CDN CDE: PICA is craving and eating items that have no nutritional value like ice, clay, paper detergent, hair, paint chips, etc. This can be harmful!

Daniela: So if a mom-to-be gets this strange urge, she should immediately alert her OBGYN?

Deborah Malkoff-Cohen, MS RD CDN CDE: Absolutely, and they should run her iron panel. Remember, your blood volume DOUBLES when you’re pregnant.

Can I eat this when pregnant?

Daniela: Thanks for elaborating on this – Moving on to foods that a mom-to-be should be keeping away from, what does this list include?

Deborah Malkoff-Cohen, MS RD CDN CDE: All meats/eggs should be cooked through… No soft-boiled eggs or medium-rare burgers, no unpasteurized cheese, no sushi, nitrates, cold cuts (unless heated). Stay away from hot bars and salad bars you are not 100% confident in, anything where the temperatures cannot safely stay in the colder than 40- hotter than 140 range. Also, foodborne illnesses, hand washing is essential wherever you eat out, as well as for kitchen staff.

Can I drink coffee when pregnant?

Daniela: You also mentioned coffee earlier on – is this also unsafe during pregnancy?

Deborah Malkoff-Cohen, MS RD CDN CDE: It is. 200mg daily/one cup of coffee is ok. That being said, it’s not the actual coffee, it’s the caffeine. Watch the other sources like dark chocolate, tea, hot chocolate, soda, etc… These are added into the 200mg daily.

How can I manage Gestational Diabetes?

Daniela: Ah – that’s very good to know. So, it’s not just the coffee, it’s anything that has caffeine in it. Moving on to a more specific question: If a mom-to-be has been diagnosed with gestational diabetes, what should her diet look like?

Deborah Malkoff-Cohen, MS RD CDN CDE: Everything can be worked into the diet…it is the portion size. Higher in protein and healthy fats, less carbs. For instance:

Gestational Diabetes – safe meal plan:
Breakfast – 2 eggs/avocado/berries
Lunch – salad/grilled chicken or any protein veggies, or protein in low carb wrap;
Dinner – protein: 1/2 baked potato or 1/2 cup rice, unlimited veggies.
Snacks: apple/nut butter or cheese, nuts. All fruits need to be eaten with a protein to delay sugar spike.

Deborah Malkoff-Cohen, MS RD CDN CDE

Daniela: Less carbs – this relates to the sugars in the carbs?

Deborah Malkoff-Cohen, MS RD CDN CDE: Only portioning out the carbs. I work full-fat ice cream into the lifestyle, but it is 1/2 a cup and no carbs with dinner just protein and veggies. Carbs break down into sugar. Blood glucose needs to be 90 before a meal and less than 120 an hour after.

Daniela: Thanks for clarifying, the insight you have provided us with today will be helpful to many of our readers! On a final note, what would be your one piece of advice that you’d always share with an expectant mom nutrition-wise, also based on your own experience of pregnancy?

Deborah Malkoff-Cohen, MS RD CDN CDE: Especially for the first trimester, I was so nauseous. Eat healthy when you can. Do NOT feel guilty. All I could stomach for 12 weeks were crackers and pasta with cheese. Your body is feeding the baby from your stores, this is why prenatal vitamins and eating well BEFORE you conceive is so important. Enjoy every second, it goes so fast. You are growing a HUMAN. It is the BEST thing ever. I craved the weirdest things, things I never would think to eat before. As long as it is healthy give into it. Listen to your body. And CONGRATULATIONS!

Daniela: Wow, thank you for this Deborah! It’s been a pleasure speaking with you on such an important subject! All the best in your work with other expectant moms!

Deborah Malkoff-Cohen, MS RD CDN CDE: Thank you!

Need help with pregnancy nutrition? Read more from Deborah by clicking here.

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