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Chapter 1

Getting Ready: Pregnancy, Nutrition, and Breastfeeding

When you are pregnant, you quickly become aware of the connection between what you eat and how it affects your growing baby, and you don't have to work too hard to seek out information. It seems everyone from your doctor to your sister to your sister's best friend has an opinion on what you should have for breakfast, lunch, and dinner.

"Don't drink coffee."

"Our patients do fine with a small amount of coffee-but be careful with fish."

"Stay away from soft cheese. And watch out for the fat content in hard cheese."

"Cheese is packed with calcium you need-why aren't you eating any cheese?"

"Take your prenatal vitamin and you'll be fine."

Eventually you separate the wheat from the chaff (speaking of which, don't forget to eat a lot of whole grains) and grow more confident about your food choices as you strive for a healthy pregnancy. The best advice tends to lie somewhere between extreme restriction and complete indulgence. Most experts and research agree, for instance, that a cup of coffee a day is usually okay but limit your caffeine intake to no more than 200 milligrams per day;1 soft, unpasteurized cheese is among the foods that may contain dangerous listeriosis- causing bacteria and so should be avoided during pregnancy; certain fish, such as swordfish, can carry high levels of mercury and should be off your pregnancy menu; be aware of the high saturated fat and calorie content of hard cheeses such as cheddar; and yes, prenatal vitamins are really important. (We'll return to these and other dos and don'ts later in this chapter.)

If you are reading this book, we're assuming you're already probably taking good care of yourself and your growing baby, and that you're regularly checking in with your physician for advice and information. We're also assuming that since you're planning to breastfeed, you undoubtedly have questions about how what you're eating now will impact how you nourish your baby after she's born.

As we pointed out in the introduction, there is no magical breastfeeding diet that can be consumed during pregnancy (or afterward) that will guarantee a robust and steady supply of breast milk. However, as you undoubtedly have discovered, maintaining a healthy diet during pregnancy has numerous, excellent benefits for mother and child, whether or not breastfeeding is a goal. And you are more likely to be successful with breastfeeding if you stay healthy and feel strong.

Once you are holding your new nursling in your arms, you'll naturally be less inclined to spend your time planning and preparing meals for yourself and any other members of your household, though your own nutritional needs will still be extremely important! (If you're fast- forwarding to what mealtime will look like after the baby comes, remember that we're here to help. A major goal of this book is to help you balance your dietary needs with those of your nursling, as well as those of other family members.) Therefore, these months and weeks before you give birth and begin breastfeeding are an ideal time to focus more precisely on your diet.

Your Body Is Changing-What About Your Diet?

In the first trimester of a normal pregnancy, a healthy mother-to-be's nutritional and caloric needs won't differ dramatically from what she ate before pregnancy.

If you're eating properly, you'll be able to nourish your growing baby adequately on your prepregnancy diet (with the exception of items to eliminate for safety reasons; see pages 31-32 later in this chapter), though your tastes for certain foods may be altered due to morning sickness or other hormonal changes. It's when you reach the second trimester, however, that the picture begins to change and the increased need for certain macro- and micronutrients, as well as calories, becomes apparent. This phase generally coincides with when you can't button your old jeans!

How much more do you need in terms of nutrients and calories? How much weight should you gain?

Generally, physicians and experts in maternal nutrition recommend that in the second trimester you should up your calories by about 300-350 per day; in your third trimester, you may be advised to increase this by another 100 calories.

As for weight gain, the recommended amount depends on your prepregnancy BMI (body mass index). It simply doesn't make sense to tell a 5'2" woman who is slightly overweight to gain the same amount of weight as a 5'7" woman who is exceedingly thin. Before the widespread use of BMIs, however, pregnant women were frequently given overly general guidelines. Check with your physician to get the number that is right for you, and start with an accurate prepregnancy BMI. (If you are overweight or obese, it's especially important to consult with your physician regarding weight gain.)

While weight gain will vary from woman to woman, less than half of the amount will come from true "baby weight"-that is, the combined weight of the fetus itself, the placenta, and the amniotic fluid. The balance of the weight gain is maternal reproductive tissues such as increased uterus size, blood (its volume increases by 50 percent), breast growth, and additional protein and fat stores. Your heart size alone increases by 12 percent. (We like to think that mothers have the biggest hearts in the world!)

Depending on where you are in your pregnancy, you have undoubtedly noticed that your breasts are changing, beginning with tenderness and soreness that are completely normal. They are also growing rapidly as your body works to make more milk ducts to prepare for breastfeeding. Whether you start out small-breasted or full-figured, the size of your breasts during pregnancy does not impact your ability to nurse your child.

Does your intention to breastfeed mean that you need to supplement or alter those numbers for recommended weight gain and extra calories-in any way? Not at all. Beyond following a healthy and balanced diet during pregnancy, which we will look at in the next section, you don't need to take any special nutritional measures to prepare your body for breastfeeding.

What to Eat Now

You've got your to-do list in hand to get your baby's room or sleeping space ready ahead of time-perhaps it means you'll assemble some furniture, launder some tiny clothing, stockpile diapers, or hang the cow-jumping-over-the-moon picture on the wall. The room, either the nursery or the bedroom where Mom sleeps, will be ready, but what about that other part of your house-the one with the food? Baby's new home can wait a little longer, but let's take a look at what's in your kitchen right now. Whether you're battling morning sickness or you're constantly ravenous (or both), whether you're a reluctant meal planner or absolutely love to cook, now is the time to get your food organized.

Naturally, it makes sense to plan around your changing nutritional requirements. In the first trimester, as we pointed out, if you're eating a healthy diet your body doesn't need much more in the way of calories and nutrition. But starting in the second trimester, and as mentioned earlier, your physician will probably recommend about 350 more calories per day until you give birth. (Remember, this calorie recommendation depends on your BMI-check with your doctor to find out how many calories you need to add.) Generally, that translates to a well-planned snack or two, or perhaps a larger portion of a nutritious food during mealtime-but not an entire extra meal or double portions of an entrÈe or dessert. If you overeat, the extra weight gain will not vanish without significant effort. (Yes, you will use extra calories when you are breastfeeding, but postpregnancy weight loss is still harder than pregnancy weight gain. For more on this topic, see page 203.)

A Blueprint for a Lifetime of Healthy Meals

Here's a simple formula for putting together a healthy meal-not just right now but after your baby arrives, and even after your children are old enough to take you out for Mother's Day brunch and when they have kids of their own. This is also a basic but balanced blueprint for assembling just about any family meal. Growing children will require a serving of dairy at each meal, too; if you are pregnant or nursing include three servings of dairy (skim milk is a good choice) for yourself as well. If you or your family does not consume dairy, talk to your doctor or a nutritionist about alternative calcium sources. The chart in the next section includes some nondairy calcium sources, but there are more.

Strive to include each of the following "big three" in every meal you consume.*

1. Lean protein (eggs, dairy, meat, fish, legumes)-1 serving.

2. Vegetables and fruits (add whole fruit for breakfast)-2 or more servings. (Nutrition experts recommend filling half your plate with veggies and fruit.)

3. Complex carbohydrates (from whole-grain bread products or starchy vegetables such as potatoes, corn, and peas)-1 serving. (For more on complex carbohydrates, see the box on pages 14-15. n

* For average serving sizes of items such as meat and other protein sources, fruits and vegetables, dairy products, and whole grains, see the sample food listings in the chart on pages 10-11 later in this chapter. When serving sizes are given in weight, it's more helpful to picture an everyday object for a visual cue. Some common examples: 3 ounces of fish, chicken, or beef is about the size of a deck of cards; 1 ounce of hard cheese is about four dice; one serving of fruit is the size of a baseball; 1/2 cup of veggies is a rounded handful.

Getting the Dietary Components You Need: What, Why, and How Much

Here are some of the major nutrients you should focus on right now, along with some suggested food sources and calorie counts per average serving. Make sure these items are finding their way into your grocery cart and your kitchen. (See our pantry and freezer/refrigerator lists later in this chapter.) Many of these foods can and should also play an important role in your diet after your baby is born. We'll refer you back to this chart in subsequent chapters, with postpartum information on these nutrients.

In some cases, you'll see a comment such as "easiest to get in supplement form." If you are wondering about the food sources versus supplements with regard to calcium and iron, turn to pages 15-17.

A note on adding calories: We don't recommend you get all your extra daily calories from one food source, as it's preferable to vary your diet so your body gets a balance of different nutrients. (And to get 350 calories' worth of vitamin-rich leafy greens, for instance, you'd have to consume about 30 cups of cooked spinach!) Look at the calories per serving of each food on the next pages to mix and match and put together your own balanced 350-calorie boost.*

WHAT AND HOW MUCH

In general, about 70 grams per day; amount depends on the mom's weight and number of babies she is carrying

WHY IT'S GOOD FOR YOU NOW

Gives you building blocks for new tissue synthesis, curbs your hunger, and contains amino acids necessary for fetal growth.

WHERE TO FIND IT IN YOUR KITCHEN

Eggs, poultry, meat, milk, beans, nuts

CALORIES/KEY NUTRIENTS PER SERVING OF SOME SAMPLE FOODS

1 egg: 80 cal, 6 g protein

3 oz chicken (breast): 163 cal, 26 g protein

3 oz beef: 292 cal, 21 g protein

1 cup skim milk: 86 cal, 8 g protein

1 cup soy milk: 79 cal, 6.6 g protein

1/2 cup cooked chickpeas: 143 cal, 8 g protein

1/2 cup cooked soybeans: 149 cal, 14 g protein

1 oz almonds: 174 cal, 6 g protein

1 oz peanuts: 164 cal, 7 g protein

1 oz walnuts: 190 cal, 4 g protein

2 tbsp peanut butter: 188 cal, 8 g protein

1,000 milligrams per day

Bone health (yours and your baby's). Best absorbed from dairy products. Difficult to get daily requirement from vitamin supplement alone-see pages 16-17 on calcium supplements.

Milk, yogurt, cheese (low-fat), fortified cereals, fortified tofu and other fortified soy foods, sardines, salmon, collard greens, beans, peas, seeds, nuts, and whole grains

1 cup skim milk: 86 cal, 300 mg calcium

1 cup low-fat flavored yogurt: 220 cal, 300 mg calcium

1 cup plain yogurt: 127 cal, 452 mg calcium

6 oz Greek yogurt: 225 cal, 150 mg calcium

4 oz soft-serve frozen yogurt: 115 cal, 106 mg calcium

1 cup fortified soy milk: 79 cal, 300 mg calcium

2 sardines: 50 cal, 92 mg calcium

Salmon, farmed, 3 oz cooked with dry heat: 151 cal, 10 mg calcium

Salmon, wild, 3 oz cooked with dry heat: 119 cal, 38 mg calcium

1/2 cup chopped boiled fresh collards: 18 cal, 15 mg calcium

30 milligrams per day

Helps carry oxygen to your baby. While you can get iron from food, it's often easiest to get in supplement form, such as in a prenatal vitamin; see pages 76-77.

Red meat, in particular, but also poultry and pork. Iron-fortified cereals; soybeans, white beans, and lentils; raisins; roasted pumpkin and squash seeds; supplements.*

3.5 oz cooked red meat: 367 cal, 2.13 mg iron

3 oz chicken breast: 163 cal, 0.80-1.00 mg iron

1/2 cup cooked white beans: 125 cal, 3.30 mg iron

1/2 cup cooked lentils: 115 cal, 3.25 mg iron

1/3 cup raisins: 150 cal, 1.04 mg iron

1 oz roasted pumpkin seeds: 148 cal, 0.39 mg iron

Iron-fortified cereal (for example, 3/4 cup Total): 100 cal, 18 mg iron

28 grams per day

Prevents constipation, common during pregnancy. Fiber absorbs water and keeps things moving along regularly in your gastrointestinal tract. Remember to drink water when consuming high-fiber foods.

Fresh fruits and vegetables, whole grains, beans

1/2 cup cooked beans: 100 cal, 8 g fiber

1 slice whole-wheat bread: 69 cal,

1.9 g fiber

1 cup cooked broccoli: 44 cal, 4.6 g fiber

1 navel orange: 60 cal, 3.1 g fiber

1/3 cup raisins: 150 cal, 2 g fiber

600 micrograms per day

Used to develop the baby's neural tube, which becomes its spinal column and brain. Because the neural tube develops in the first month of pregnancy, folate is especially recommended during the first month of pregnancy (and prior to conception), but it is important throughout pregnancy. Occurs naturally in some foods and may be included in a prenatal vitamin.

Chickpeas, lentils, spinach, asparagus, romaine lettuce, orange juice, canned pineapple juice, sunflower seeds, avocado, supplements

6 oz orange juice: 82 cal, 35 mcg folate

1 cup cooked enriched rice: 170 cal, 130 mcg folate

1 cup cooked spinach: 54 cal, 204 mcg folate

1/2 cup cooked Great Northern beans: 100 cal, 90 mcg folate

*Note that the amount of calories and iron in a serving of red meat varies based on how lean the cut is. Listed here are averages. Also note that iron in meat is best absorbed when combined with vitamin C. Some examples: a tomato-based meat sauce for pasta; meat garnished with citrus slices or served with cranberry sauce; a glass of orange juice with your meal. Drinking caffeinated beverages with meals will decrease iron absorption.