We should always eat healthy, but it's particularly important during pregnancy. After all, the building blocks needed to create a baby comes from what a pregnant woman eats. These six guidelines are a good place to start.

Weight gain is a natural part of pregnancy but it's not an excuse to overeat. Women usually need about three hundred extra calories per day during the second and third trimesters of pregnancy, although those carrying multiples need more. Let your appetite be your guide. Eating smaller, more frequent meals can help minimize morning sickness and heartburn. A healthy weight gain is usually between twenty and thirty-five pounds. Women carrying multiples may gain up to forty-five pounds.

Pesticides can disrupt the balance of sex hormones in the body and increase the risk of developing gestational diabetes. Pregnant women can minimize their exposure to pesticides by eating organic and, when organic food isn’t available, avoiding the most highly contaminated fruits and vegetables. The Environmental Working Group, a nonprofit organization that researches health and the environment, found that certain non-organic produce items contained significantly higher levels of pesticides than others, and some contained highly toxic organophosphate insecticides. These “Dirty Dozen Plus” fruits and vegetables include strawberries, apples, nectarines, peaches, celery, grapes, cherries, spinach, tomatoes and cherry tomatoes, sweet bell peppers and hot peppers, cucumbers, kale, and collard greens. They should be avoided if they are not organic. For the full report, see EWG's 2016 Shopper's Guide to Pesticides in Produce at www.ewg.org/foodnews.

It's important for pregnant women to eat a wide variety of foods that provide fiber, protein, and healthy fat. Fiber-rich foods include fruits, vegetables, and legumes like beans, lentils, and peas. Whole grains contain some fiber but foods made from refined grains like flour – including pasta, breakfast cereal, bread, and other baked goods – do not. During morning sickness, an empty stomach can make nausea worse and eating bland, easy-to-digest foods like soda crackers can be helpful. In these cases, the benefits may outweigh the risks, but when morning sickness isn’t an issue, eating flour-based foods should be avoided because they increase the risk of gestational diabetes. Protein can come from eggs, dairy products, poultry, meat, wild game, fish, seafood, beans, and nuts. Healthy fats are found in avocados, olives, cold-pressed oils (extra virgin olive, coconut, flax, walnut), pure coconut milk, raw nuts, raw nut butters, raw seeds, and non-toxic fish and seafood. The best choices for fish and seafood are high in omega-3 fats like DHA and low in toxins. These include wild Alaskan salmon, Atlantic mackerel, herring, sardines, and anchovies. Fish that contain high levels of environmental toxins should be avoided, like tuna, swordfish, shark, marlin, Spanish and king mackerel, and freshwater fish like lake trout, walleye, and white fish. Use the Environmental Defense Fund's Seafood Selector at seafood.edf.org to find a complete list of the most current seafood safety ratings. Other animal products like eggs, poultry, meat, and dairy products should come from grass-fed or pasture-raised animals that were never exposed to pesticides, antibiotics, or hormones. 

Food-borne illness can be especially concerning for pregnant women and the most serious infections are caused by Listeria bacteria. Most of the time, pregnant women with Listeriosis don't have any symptoms, but they can still pass the infection on to their unborn babies, putting them at risk for miscarriage and infant death. Listeria bacteria are commonly found in our environment, primarily in soil, water, and animal feces. They can also live inside refrigerators and even humans. Studies suggest that up to ten percent of people may be unknowingly carrying this bacteria in their intestines. Foods that have been linked to Listeria infection include raw produce, meat and milk from infected animals, and ready-to-eat foods, but the most common causes are Mexican-style cheese, paté, and turkey deli meat. While it’s a good idea to avoid Mexican-style cheese and processed meats, it doesn’t make sense to avoid all possible sources of contamination because the nutritional benefits of eating fresh fruits and vegetables and unprocessed animal products outweigh the risks that come from random outbreaks. Instead I counsel women to opt for home-cooked foods over ready-to-eat foods and to practice prevention by following these basic food safety strategies:

· Wash hands, knives, cutting boards, and countertops thoroughly with warm, soapy water before handling and preparing food.

· Wash kitchen towels and cloth grocery bags frequently in hot, soapy water.

· Rinse raw fruits and vegetables thoroughly before eating.

· Scrub firm produce like carrots, cucumbers, and melons, even if you don’t eat the outer layer, since cutting into these foods can transfer bacteria from the outside to the inside.

· Use warm, soapy water to keep your fridge clean.

· Separate raw meat from other foods in your fridge.

· Store foods in clean, air-tight containers to prevent leakage.

· Keep your fridge and freezer cold: a minimum of 40 degrees Fahrenheit inside the fridge and zero degrees inside the freezer.

Because blood volume and fluid retention increase during pregnancy, it’s especially important for expecting mothers to drink plenty of liquids. Filtered water is always the best beverage, but unsweetened herbal teas and pure coconut water are also good choices. Sweet beverages like fruit juices and drinks with added natural or artificial sweeteners are not good choices because they increase the risk of developing gestational diabetes. Caffeine should be limited to 200 milligrams per day which is equivalent to one or two eight-ounce cups of brewed coffee, one or two shots of espresso, or four cups green tea. A good general rule for staying hydrated is to drink half your body weight (in pounds) in ounces of fluids, which means that a 150-pound non-pregnant woman should drink 75 ounces of unsweetened liquids per day. During pregnancy, this number should increase by 30 percent or more, so the minimum goal for a 150-pound pregnant woman would be close to 100 ounces of liquids or twelve eight-ounce glasses daily. Pregnant women who have kidney disease may need to limit their consumption of fluids and should ask their health care providers for individualized recommendations. 

While eating a healthy diet is essential, a prenatal multiple vitamin-mineral supplement ensures that women are getting everything needed for a healthy pregnancy. This is especially important for vegetarian and vegan women whose diets lack adequate iron, vitamin D, and the omega-3 fatty acid DHA. Women who have low levels of vitamin D may need to take extra vitamin D. Women who are not eating enough non-toxic fish and seafood need to supplement with fish oil or algae oil. Quality is extremely important when it comes to supplements. Products should contain activated vitamins including folic acid in the form of methylfolate and bioavailable minerals without any additives. Fish oils should meet the Norwegian Medicinal Standard (NMS) or European Pharmacopoeia Standard (EPS) which set maximum allowances for heavy metals, dioxins, PCBs, and peroxides. For the best supplement recommendations, talk to your naturopathic doctor.

References are available upon request.