Nutrition in Pregnancy: Before, During and After

A woman’s role as a responsible parent begins not only when the baby is born but 3-6 months before she tries to get pregnant. All the foods and supplements she will take in, eating habits and previous diseases can affect her baby’s health and performance in the future.

Pregnant woman holding fresh salad illustrating healthy eating

Pregnant woman holding fresh salad illustrating healthy eating

I will try to discuss each supplement and food item necessary for a healthy mommy and baby.

Folic Acid:

Women planning to get pregnant should be on folic acid capsules, at least 3 months before they get pregnant. The dose is 0.6 mg for most women but you may take as much as 4 mg per day if you have a family history of congenital birth defects. There is no fear of overdosing. Folic acid has been proven to prevent defects especially related to the brain and spinal cord. If you are not using any birth control method, it is best to always be prepared. So take folic acid as your daily supplement. Mabuti na ang laging handa!

Cigarettes, alcohol and drugs all pose a direct health risk to the developing fetus. All these things should be avoided during pregnancy. Even being beside a person who smokes exposes your baby to second-hand smoke. This can lead to small and low birth-weight babies.

Vitamin A in the form of retinol, tretinoin, or isotretinoin found in anti-acne and anti-aging creams should be avoided during the first 3 months of pregnancy. It is known to cause severe birth defects. For women on these beauty regimen, it is best to complete treatment before attempting to get pregnant or use some form of birth control while on therapy.

Calcium is an important mineral that you have to supply to your growing baby or else she will take it from you. It is not a myth when they say that each pregnancy is equivalent to one tooth lost if you don’t take supplements. We find this true in the provinces, where lolas  who’ve had 10-12 kids have lost all their teeth because calcium tablets and milk were not yet popular then. The requirement for calcium is 1,200 mg per day but most supplements contain 300-600 mg. The rest of your requirement may be taken in through milk.

Diarrhea and vomiting in pregnancy is an OB’s nightmare. Whereas, in a non-pregnant person, you just take in Diatabs or Imodium and you are done. In a pregnant patient, it is different. These drugs cannot be given to them. You just advise her to allow the toxins to get out of her system and keep drinking Gatorade or some other electrolyte-rich fluid to prevent dehydration. Apples and bananas three times a day also helps.

Tips to avoid diarrhea and vomiting in pregnancy:

1. Wash hands before and after eating.

2. Eat only FULLY cooked food: no sushi, sashimi, “medium rare” steaks and burgers, carpaccio, cookie dough ice cream ( it contains uncooked flour with raw egg) and Ceasar’s salad dressing (it also contains raw egg).

3. Avoid unpasteurized milk found in homemade pastillas and kesong puti.

4. Rinse all raw fruits and veggies before eating.

5. Avoid eating raw alfalfa sprouts and monggo sprouts found in salads, sandwiches and lumpia (the sprouts and cracked shell may harbor bacteria which may be very difficult to wash off especially in a restaurant where the staff are in a hurry).

6. Wash kitchen surfaces, chopping boards and utensils that were used to prepare raw meat.

Fish and Mercury:

Fish intake in pregnancy should be monitored. Mercury is a neurotoxin. It poisons the nervous system of the body. Mercury exposure through intake of contaminated fish have been correlated with the increased incidence of the following diseases: arthritis, alzheimer’s, multiple sclerosis, fibromyalgia, lupus, chronic fatigue syndrome, depression, bipolar disorder, schizophrenia, learning disabilities and ADHD.
The FDA and Environmental Protection Agency (EPA) have these recommendations:

1. Avoid eating shark and sharkfin soup (frequently served in authentic chinese restaurants), tuna steaks, mackerel (alumahan, tambacol, tanigui, galunggong, hasa-hasa) and tilefish (matang-baka).

2. Eat only 2 servings a week of other fishes and seafoods with lower mercury content (take note, no fish or seafood is mercury-free anymore: They either have high or low mercury contents. That’s how polluted our waters are.) Low mercury levels have been found in: shrimp, canned tuna, salmon, and catfish (hito).

Coffee, Tea or Baby?

Caffeine intake has been reported in some studies to cause miscarriage and small babies. The studies are not consistent because of different brands, size of cups (tall, grande, etc) and brewing method. I just ask my patients this: Would you give your baby a cup of coffee when he is born? It’s the same thing…everything you drink or eat now goes to your baby, too. The fact that you just don’t see it actually entering your baby’s mouth doesn’t mean its not happening.

Weight gain: Should I Eat for Two?

No! The ideal weight gain for a normal, average sized female is 25-35 lbs for the entire 40 weeks of pregnancy. I didn’t know better in my younger years. I gained 40 lbs on my first pregnancy and my hips have never been the same since. I tell my patients to weigh themselves at home. Beginning on the 12th week or 3rd month of pregnancy, which is usually the end of the vomiting and dizziness ordeal, she must try to limit her weight gain to 1lb per week. Anything she gains beyond that will just go to her hips and thighs.

Finally, there are more than a dozen prenatal vitamins in the market. Which is the best brand for my baby?

The answer again is not clear. The different drug companies have formulated their supplements in such a way that they are not all exactly the same. Brand A has more iron, Brand B has more folic acid and Brand C has more calcium. The important thing is to try to choose a brand which has the closest amount to the recommended daily requirement, which are:

Iron 30 mg, Zinc 15 mg, Copper 2 mg, Calcium 250 mg, Vitamin B6 2 mg, Folic Acid 0.6 mg, Vitamin C 50 mg and Vitamin D 5 mcg.

Supplements are especially recommended for pregnant and breast feeding women who have prolonged periods of vomiting, vegetarians, lactose-intolerance, diabetes and high blood pressure with food restrictions from their internists. If you think, you are eating a balanced diet with adequate amounts of protein, fat, carbohydrate, vitamins and minerals, you may choose not to take a multivitamin supplement. Just take a pure iron and calcium tablet or milk. That should ensure a healthy baby and a happy mommy after 9 months. Eat right!

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5 Comments

  1. filipinamd says:

    Dear Doc D,
    Hi po. Safe po ba ang duphaston para sa 5-6 weeks pregnant. nagcliclinic pa po ba kayo sa intellicare sa benlife bldg? thanks po.
    L.

    Hi L,

    Yes. Duphaston is safe for a 5-6 week pregnancy. It is a progesterone or, in other words, a pregnancy hormone. Ito yung tinatawag na pangpakapit.

    Usually, this is given to pregnant patients who have spotting or who have signs of hemorrhage by ultrasound.

    Please see http://www.filipinamd.com/about-me/ for my clinic schedule.

    Good luck!

    Doc D

    • tintin says:

      doc d,,
      pano po kung di naman po nag spotting,,4 weeks pa lang po pregnant eh binigyan na ng duphaston,,pero my history po ng miscarriage 2 yrs ago,,,

      thanx

      • filipinamd says:

        Dear T,

        Even without spotting, with a history of miscarriage, some doctors prefer to be on the safe side and they prescribe Duphaston to support the pregnancy. Medyo mahal lang pero better to be safe, right?

        I personally ask for a vaginal ultrasound first. If there is subchorionic hemorrhage I give Duphaston 3x a day and re-evaluate every two weeks. Also, if there is no corpus luteum in a less than 12 weeks pregnancy, I also give Duphaston because baka kulang si baby ng pampakapit. Sometimes the ultrasound is normal pero may spotting, then all the more I would start Duphaston.

        Doc D

  2. clarissa de guzman says:

    doc, is it ok to take pampakapit agad? my friend went to an ob-gyne and they did a pregnacy test which turned out positive. then the doctor already gave my friend pampakapit for her to take without even checking first if she needed it. no ultrasound whatsoever. is that ok?

    • filipinamd says:

      No harm naman to take pampakapit, But since the medicine is so expensive, it is better to do an ultrasound muna to check kung kailangan nga ba ito.