Nutrition & Health in Pregnancy

Pregnancy can affect your emotional health because hormonal changes are numerous and significant. You may experience heightened emotional sensitivity or feel moody or anxious. At least 1 in 10 pregnant women suffer from episodes of depression.

Most women have 10 to 15 prenatal visits. Even if you feel well, your doctor will monitor your baby with an ultrasound, check your blood pressure, and your urine. Throughout pregnancy, you will undergo a series of tests to check your health, as well as specialized tests on the fetus to rule out various anatomical and chromosomal abnormalities.

A few women have a complication in pregnancy and need special care and closer monitoring to ensure the best possible outcome. Prolonged bed rest, which was often recommended in the past, is now avoided in most cases, because it has not been shown to help and it increases the risk of blood clots.

The basic principles of nutrition in pregnancy

Nutrition in pregnancy does not need to be complicated. There is no “magic” food or special diet that suits everyone. What matters is variety, quality and regular meals, day after day, for nine months.

The Mediterranean pattern, which most of us know from home, is a very good foundation. A balanced plate looks roughly like this:

• Half the plate vegetables and fruit, in as many colors as possible. They provide fiber, folate, vitamin C and potassium.
• One quarter whole grains or legumes: whole wheat bread, oats, brown rice, lentils, chickpeas.
• One quarter protein: fish, poultry, lean meat, well-cooked eggs, legumes.
• Dairy every day, always pasteurized, for calcium and iodine.
• Olive oil as the main fat, plus a handful of unsalted nuts.

Choose three main meals and two or three small snacks rather than a few large ones. This keeps glucose more stable, nausea and heartburn bother you less, and hunger does not “hit” you late at night. You will find detailed food lists, by group and by trimester, in the guide on foods for pregnancy.

Weight gain in pregnancy according to Body Mass Index

How many kilos it is “right” to gain depends on your weight before you got pregnant. The guidelines of the US Institute of Medicine (IOM), used internationally, are based on pre-pregnancy Body Mass Index (BMI):

• BMI below 18.5 (underweight): 12.5 to 18 kg in total.
• BMI 18.5 to 24.9 (normal weight): 11.5 to 16 kg.
• BMI 25 to 29.9 (overweight): 7 to 11.5 kg.
• BMI 30 and above (obesity): 5 to 9 kg.

In a twin pregnancy the ranges are higher: for a woman of normal weight, about 17 to 25 kg. In the first trimester the gain is small, usually 0.5 to 2 kg. From the second trimester onward, a woman with a normal BMI gains on average about half a kilo per week.

Why does it matter? Excessive weight gain is linked to a higher risk of gestational diabetes, hypertension, a very large baby and cesarean section, while the kilos left after delivery are hard to lose. Very little weight gain, on the other hand, is linked to low birth weight and preterm birth. Pregnancy, however, is not the time for a weight loss diet, even if you start out heavier. The goal is the right food choices and movement, not deprivation.

Micronutrients that need special attention

Your need for certain vitamins and minerals increases much more than your need for calories. That’s why food quality matters more than quantity. Some are covered by diet, others require a supplement.

Folic acid

It significantly reduces the risk of neural tube defects, such as spina bifida. The usual recommendation is 400 mcg a day, starting at least one month before conception, ideally two or three, and continuing until week 12. For some women, for example those with a previous pregnancy affected by a neural tube defect, diabetes, obesity or treatment with certain antiepileptic drugs, the doctor recommends a higher dose. Green leafy vegetables and legumes help, but are not enough on their own.

Iodine

It is essential for the mother's thyroid hormones and for the development of the baby's brain. Needs in pregnancy reach about 220 to 250 mcg a day. Good sources are dairy, eggs, fish and iodized salt in small amounts. Many scientific societies recommend a 150 mcg iodine supplement, usually as part of a prenatal multivitamin. If you have a thyroid condition, the dose is decided with your doctor.

Iron

Blood volume increases by 40 to 50% in pregnancy, and iron needs rise with it, to about 27 mg a day. Iron deficiency anemia causes fatigue, shortness of breath and dizziness, while severe anemia is linked to preterm birth. Testing is done with a complete blood count and ferritin, and a supplement is given when needed. Two practical tips: iron is absorbed better with a source of vitamin C, such as an orange, and worse when you take it with coffee, tea or milk. Because it often causes constipation, read what helps with constipation during pregnancy.

Vitamin D

It is involved in calcium metabolism and in the healthy development of the baby's bones. Despite the sunshine, deficiency is common in Greece too, because we spend many hours indoors and use sunscreen. The usual recommendation is 400 to 600 IU (10 to 15 mcg) a day. If tests show a deficiency, your doctor will suggest a higher dose.

Omega-3 fatty acids and DHA

DHA is a building block of the baby's brain and retina. International recommendations call for at least 200 mg of DHA a day, an amount covered by one to two servings of low-mercury oily fish per week. Large reviews also show that adequate omega-3 intake may reduce the risk of preterm birth. If you do not eat fish, ask your doctor about a supplement, which is also available in a plant-based form from algae.

Calcium, vitamin B12 and vitamin A

Calcium, about 1,000 mg a day, is usually covered by three servings of dairy. Vitamin B12 is found only in animal foods, so women who follow a vegan diet definitely need a supplement.

There is also something you do not need: vitamin A in large doses, which in excessive amounts can harm the fetus. That’s why vitamin A supplements and frequent consumption of liver are avoided. Choose products designed for pregnancy rather than general-use multivitamins.

Food safety in pregnancy: listeria, toxoplasma and mercury

Pregnancy changes the body's defenses against certain microbes. Three risks are directly linked to what you eat.

Listeria screening

Listeriosis is rare, but in pregnant women it is much more common than in the general population and can cause miscarriage, preterm birth or serious infection in the newborn. The mother often has only mild, flu-like symptoms. Listeria multiplies even in the refrigerator, that’s why you should avoid:

• Unpasteurized milk and cheeses made from it.
• Soft cheeses with a white rind, such as brie and camembert, and soft blue cheeses, unless cooked until steaming hot.
• Refrigerated cold cuts and pâté, unless heated thoroughly.
• Cold-smoked salmon and other cold-smoked fish.
• Ready-made salads and dishes that have been in the refrigerator for several days.

Hard cheeses, such as graviera, and pasteurized feta are fine to eat.

Toxoplasma

This parasite is transmitted mainly through raw or undercooked meat, unwashed vegetables and soil, and cat feces. If you are infected for the first time during pregnancy, it can pass to the fetus. Your initial tests check whether you are already immune. If you are not:

• Eat meat well cooked, with no pink in the center.
• Avoid cured meats, such as prosciutto and dry salami, unless they are cooked.
• Wash fruit, vegetables and herbs very thoroughly.
• Wear gloves in the garden and leave the cat litter to someone else.
• Wash hands, knives and surfaces after contact with raw meat.

Mercury in fish

Fish is one of the best foods in pregnancy, as long as you choose correctly. Large predatory fish accumulate mercury, which affects the baby's nervous system.

• Avoid: swordfish, shark, fresh steaks of large tuna and king mackerel.
• Choose, two to three times a week: sardines, anchovies, salmon, mackerel, sea bream, sea bass, cod and well-cooked shrimp.
• Avoid raw fish and seafood, such as oysters, as well as preparations with raw egg, such as homemade mayonnaise.

Caffeine and alcohol: where the limits are

Caffeine crosses the placenta and the fetus metabolizes it very slowly. The 200 mg daily limit covers all sources combined, not just coffee. The content varies a lot depending on how it is made. As a rough guide:

• An espresso or a Greek coffee: about 50 to 80 mg.
• A mug of filter coffee: about 100 to 140 mg.
• A cup of black or green tea: about 30 to 50 mg.
• A can of cola-type soft drink: about 35 to 40 mg.
• Energy drinks often contain 80 mg or more per can, along with other stimulants. They are best avoided completely.

For alcohol, the answer is simple: there is no safe amount and no safe time in pregnancy. Alcohol can cause fetal alcohol spectrum disorders, with permanent effects on the child's development, learning and behavior. If you drank before you knew you were pregnant, do not panic. Stop from the moment you found out and let your doctor know.

Nausea and vomiting: how to eat when you can't eat

Most pregnant women have nausea in the first trimester, which usually eases around weeks 14 to 16. At this stage, the goal is not a “perfect” diet. It is to eat and drink enough.

• Small meals every two to three hours. An empty stomach makes nausea worse.
• A few rusks or crackers before you get out of bed.
• Cold or lukewarm foods, which smell less than hot ones.
• Fluids in small sips between meals rather than with them.
• Ginger, as tea or candies, which helps many women.
• If your iron supplement bothers you, ask your doctor whether it can be delayed or changed.

When simple measures are not enough, there are medicines that are safe in pregnancy, such as the combination of doxylamine and pyridoxine. Contact your doctor right away if you cannot keep down even fluids for 24 hours, you are losing weight, your urine is very dark or you feel dizzy when you stand up. These may be signs of hyperemesis gravidarum, which needs treatment and sometimes IV fluids.

Digestive system and oral health over the nine months

Progesterone relaxes smooth muscle throughout the digestive tract, and this explains two of the most common complaints. The first is heartburn, mainly in the second half of pregnancy, when the uterus also presses on the stomach. Small meals, not lying down right after eating, and less fatty and spicy food all help. You will find more in the article on heartburn in pregnancy.

The second is constipation. Fiber from vegetables, fruit, legumes and whole grains, together with enough fluids and a daily walk, is the first line of treatment.

Changes also happen in the mouth. Hormones make the gums more sensitive, and pregnancy gingivitis is very common. A visit to the dentist is safe throughout pregnancy and is best done at least once. If you are vomiting, rinse your mouth with water and wait about half an hour before brushing, so the enamel is not worn down. See the details on oral health in pregnancy.

Exercise in pregnancy: what is good for you and when to stop

Regular activity reduces the risk of gestational diabetes and excessive weight gain, helps with back pain and mood, and is linked to a lower chance of cesarean section. If you did not exercise before, start gradually, with 10 to 15 minutes a day. A simple guide to intensity is the “talk test”: while exercising, you should be able to talk comfortably.

• Suitable activities: walking, swimming, stationary cycling, gentle aerobics, pilates and yoga adapted for pregnancy, pelvic floor exercises.
• To avoid: contact sports, activities with a risk of falling, such as horse riding or skiing, scuba diving and exercise in a very hot environment, such as hot yoga.
• In the second half of pregnancy: avoid prolonged exercise lying flat on your back, because the uterus presses on the large veins of the abdomen.

Exercise is not recommended in certain conditions, such as placenta previa after 26 weeks, risk of preterm labor, ruptured membranes, preeclampsia, cervical insufficiency or severe anemia. Stop immediately and contact your doctor if you have vaginal bleeding, fluid leakage, painful contractions, chest pain, dizziness, shortness of breath before exertion, or pain and swelling in the calf.

When nutrition in pregnancy needs to be individualized

In some situations, general guidelines are not enough and the meal plan becomes part of the treatment. The most common are the following:

• Gestational diabetes. It is usually checked with a glucose tolerance test between the 24th and 28th week. Spreading carbohydrates through the day and recording glucose are the main tools. See the detailed guide on gestational diabetes.
• Hypertension and preeclampsia. Strict salt restriction has not been shown to prevent preeclampsia. In high-risk women, the doctor may recommend low-dose aspirin from week 12, as well as adequate calcium when intake is low. More on high blood pressure in pregnancy.
• Cancer during pregnancy. Nutritional support is part of multidisciplinary care, especially when treatment is given. Read about breast cancer and pregnancy.
• Vegetarian or vegan diet. It is feasible, with attention to B12, iron, iodine, calcium, DHA and protein. Supplements are usually needed.
• History of bariatric surgery. Close monitoring of vitamins and iron is required, and the standard glucose tolerance test is often replaced by another testing method.
• Hypothyroidism. The thyroxine dose usually increases in pregnancy. Take it on an empty stomach and at least four hours apart from iron and calcium.
• Celiac disease, twin pregnancy or anemia. They need an individualized plan, often in collaboration with a dietitian.

In any case, the meal plan is adjusted to how the pregnancy progresses and to your test results. If you don't know where to start, bring a list of what you eat in a typical week to your next visit. It is the quickest way to spot the gaps.