Which of the Pregnancy Food Rules Are Worth Paying Attention To?

“Healthy eating” is complicated, and it gets even more so when you add your soon-to-be baby into the mix. But what pregnancy food rules are worth paying attention to, and which ones are just overblown?

While it’s always a good idea to eat a generally well-balanced diet full of nutrient-rich choices, it becomes even more crucial when you’re pregnant. You don’t need to suddenly double your calories to “eat for two” once you’re expecting—yep, that’s one of the pregnancy food myths right there—but you do need to eat enough of the right nutrients to keep your body running smoothly and your baby developing properly.

“Nutrition is always important, but especially so during pregnancy because what you eat is going to be the main source of nutrition for the baby,” Jaime Tucker, R.D., a dietitian in the ob-gyn department at UC Davis Health, tells SELF.

That’s why the time when you’re thinking about getting pregnant can be a great opportunity to take a look at your eating habits to see where you’re at currently, and what you may need to focus more on.

It’s a chance for you to make a change in your life that you can continue after your child is born, Manijeh Kamyar, M.D., a high-risk ob-gyn, member of the editorial task force for Your Pregnancy and Childbirth, a book published by The American College of Obstetricians and Gynecologists (ACOG), and a past member of ACOG’s Patient Education Review Panel, tells SELF.

Healthy eating during pregnancy looks a little different for each person (though there are some general recommendations), and misconceptions about what to eat and what not to eat at this major life stage abound. Cutting through the noise and focusing on the expert recommendations that actually deserve your attention will make it easier to take care of both you and your baby.

Because the truth is, healthy eating during pregnancy doesn’t look that different from healthy eating before and after pregnancy—save for a few key things.

Pregnancy nutrition is about focusing on a healthy diet in general.

The most basic tenets of healthy eating are the same when you’re pregnant and when you’re not. “If you follow the general guidelines for appropriate nutrition outside of pregnancy, you’re pretty much following what you’re supposed to do inside pregnancy as well,” Dr. Kamyar says. That means focusing on eating nutrient-rich foods, like fruits, vegetables, lean meats, whole grains, poultry, and fish, and limiting the amount of foods you eat that are low in nutrients and high in added sugars and saturated or trans fats, she says. If you’re already doing that, you’re off to a good start.

The exact amount of protein and carbohydrates you need to get every day will depend on multiple factors, including your health going into pregnancy, how your baby is developing, your dietary restrictions, and your activity levels. ACOG does, however, note that fats should make up about 20 to 35 percent of a pregnant person’s total calorie intake. Fat is important for fetal brain development, and your body needs it to properly absorb and use some vitamins.

To get a general idea of how many grams of carbs, protein, and fat you should eat each day, ACOG recommends starting with the food-planning guide at MyPlate, which can help you determine a well-balanced diet. (Of course, it’s important to recognize that this kind of tracking can be triggering for people with disordered eating.) If you can work with a registered dietitian for a more personalized plan, that’s great too.

As for nutrients, certain vitamins and minerals are important in any diet, not just during pregnancy. While eating whole foods can make it easier to check off important pregnancy nutrients (more on that later) without thinking too hard about it, not everyone has the same access to fresh foods. It’s totally fine if packaged and “processed” foods are part of your diet for whatever reason, whether because of access or because of cravings (or both). In fact, processed foods—which just mean a food has been combined with another ingredient or changed from its natural state—can include nutrient-rich choices like whole wheat bread, almond butter, and yogurt, as SELF reported previously. And people’s cultures often impact the foods that make up their usual diet, Amy Valent, D.O., maternal-fetal medicine specialist and assistant professor of obstetrics and gynecology in the Oregon Health & Science University School of Medicine, tells SELF. That’s all the more reason why our societal understanding of what automatically is or isn’t “healthy” to have (during pregnancy and otherwise) needs to change.

What’s more, pregnancy nutrition isn’t all or nothing: It’s not about being perfect every single day, but making choices that help promote great health most of the time. “Do your best with what you have, and whatever efforts you’re able to put in,” Dr. Valent says. Even learning how to read nutrition labels so that you can make informed choices where possible—say, looking to see if a food has a lot of saturated fats so you can consider opting for a similar option with less—is a great first step, she says.

On top of the basics, there are some nutrients you do need more of when you’re pregnant.

Folic acid

Folic acid is the human-made version of folate, a B vitamin. (Folic acid and folate are often used interchangeably.) The vitamin is important for pregnant people because it may help prevent defects in the neural tube, the part of the embryo that eventually becomes the baby’s brain and spinal cord.

Because these defects form in the early stages of pregnancy, guidelines suggest supplementing with folic acid before you even start trying to get pregnant. If you’re thinking about getting pregnant (or are having sex with someone who can get you pregnant and are not using protection), you should be on it, Dr. Kamyar says.

ACOG guidelines recommend pregnant people get 600 micrograms of folate or folic acid per day. Since it’s hard to get that much from food, they recommend supplementing with a prenatal vitamin containing at least 400 micrograms of folic acid, starting at least one month before you start trying to become pregnant, and then continuing for the first 12 weeks of pregnancy. For the other 200 micrograms, you can find folate in fortified cereal, bread, and pasta products, dark leafy greens, orange juice, beans, and peanuts.

Choline

Choline is a nutrient that plays a role in fetal brain development. Getting enough of it during pregnancy may help prevent some common birth defects, according to ACOG. The U.S. Department of Health & Human Services recommends pregnant people get 450 milligrams per day. It’s actually not very common in prenatal vitamins, so it’s important to make sure you’re getting it from the foods you eat. Chicken, beef, animal liver, eggs (especially the yolk), milk, soy, and peanuts are all good sources of choline. Potatoes, cruciferous vegetables (Brussels sprouts, broccoli, cauliflower), and some beans, nuts, seeds, and whole grains also contain some choline.

Iron

Iron is a mineral that your body uses to transport oxygen in your blood. During pregnancy, your body uses it to make the extra blood you and your baby need. If you don’t take in enough of the mineral, you can develop iron-deficiency anemia, which can make you feel really weak or tired. Recommendations suggest pregnant people get 27 milligrams per day (compared to the 18 milligrams recommended for non-pregnant women).

You may be able to get enough iron through your diet, though Dr. Valent notes that iron-rich foods—like red meat, poultry, and fish—may be tough to consume in large enough amounts. (These animal sources are known as heme iron.) Plant-based sources of iron (known as non-heme iron), like soybeans, spinach, and lentils, contain a type of iron that’s a little harder for our bodies to absorb than heme iron sources. Combining these foods with foods rich in vitamin C (like citrus fruits) can help your body absorb the iron better. Also, most prenatal vitamins contain some iron to fill in the gaps in your diet. If you do wind up developing iron-deficiency anemia during pregnancy, your doctor may suggest taking an iron supplement that has more of this mineral than a prenatal—and it’s worth noting that iron supplements may cause a whole host of unpleasant GI symptoms in some people. While it’s not always possible to avoid iron-deficiency anemia, trying to stay on top of your iron intake during pregnancy is a great call.

Iodine

Iodine is a mineral that your body uses to make thyroid hormones, which are important for fetal bone and brain development. Pregnant people should get 220 micrograms daily (up from 150 micrograms for non-pregnant adults).

Most people in the U.S. get plenty of iodine because it’s added to table salt. But Dr. Valent says that since more people are cooking with sea salt and kosher salt, both of which are generally not fortified with iodine, it may not be easy for everyone to get enough during pregnancy. The American Thyroid Association recommends that all pregnant and breastfeeding people take a daily prenatal vitamin that contains 150 micrograms of iodine to make up for any gap you may have in your diet—dietary sources include dairy, eggs, saltwater fish, shellfish, seaweed, and soy milk.

Calcium, Vitamin D, and Vitamin C

Vitamin C, calcium, and vitamin D play a role in building your baby’s bones. (In fact, if you don’t get enough calcium during pregnancy, your baby can take what they need from your bones.) In addition, vitamin D contributes to skin and eye development, and vitamin C helps your immune system function properly.

All three of these nutrients are important during pregnancy. The recommended daily amount of vitamin C during pregnancy is slightly elevated from non-pregnancy, from 65 to 80 milligrams for people 18 and under, and from 75 to 85 milligrams for those 19 and older. Citrus fruits, broccoli, tomatoes, and strawberries are all good sources of vitamin C.

There’s no recommendation for increasing intake of calcium or vitamin D during pregnancy; it’s just extra important to make sure you’re getting the usual recommended daily amounts. For calcium, that’s 1,300 milligrams for those who are 18 and younger and 1,000 milligrams for those 19 and older. For vitamin D, that’s 600 international units (IU) or 15 micrograms. Fortified milk and fatty fish such as salmon and sardines are the best food sources of vitamin D. (Sunlight is also a source of vitamin D, but you should wear sunscreen whenever you’ll be outdoors for more than a few minutes, so getting enough vitamin D from food is going to be easier.) You can get calcium from dairy products like milk, yogurt, or cheese, or other foods like sardines, kale, and broccoli.

There are general guidelines for extra calories and weight gain, but it’s not an exact science.

Tucker says that while yes, you’re eating for two in a sense—what you eat gives your growing baby the nutrients they need, too—you don’t need to double the quantity of food you consume once you’re pregnant. In fact, your calorie needs don’t increase all that drastically during pregnancy, she says.

“During the first trimester, you don’t really have additional calorie needs, and then you only need about 340 more per day in the second trimester and 450 in the third trimester,” Tucker says. (Those ACOG guidelines are higher if you’re pregnant with multiple babies—about 300 more calories per additional fetus.) You can meet those needs by adding one or two extra snacks throughout the day. Of course, everyone’s calorie needs vary depending on things like body size and activity level, so it’s important to think of it as 340 or 450 calories more than your non-pregnancy norm, rather than looking for specific numbers that all pregnant people should aim for.

What’s more, the weight situation becomes even more complicated since some people may actually end up losing weight in the first trimester due to food aversions, nausea, or vomiting. Plus, weight gain isn’t exactly consistent through pregnancy, and some of what you are gaining is increased fluid and blood volume.

Dealing with confusing pregnancy guidelines surrounding the already fraught topic of weight is incredibly stressful. Focusing on developing a healthy lifestyle and healthy pregnancy overall is paramount to worrying about specific calorie counts (and if you do have aversions to “healthy” foods, getting some fuel in you is more important than being strict about what you are eating). This broader approach can also be especially helpful if you have issues with or difficulty with tracking your weight and calories.

That being said, you should always work with your health care provider whenever possible to make sure what you’re doing related to food during your pregnancy is helping instead of hurting you. (Though some health care providers can be unhelpful and stressful when it comes to anything weight-related, which only makes this more complex.) As long as your baby is growing properly on ultrasounds and you’re not excluding whole food groups or consistently deficient in any single nutrient, then you’re probably doing just fine, says Tucker. 

It’s true there are some foods you should try to avoid during pregnancy.

The following foods make this short list because they are associated with an elevated risk of foodborne illness or other potential risks to a baby’s healthy development. Foodborne illnesses, like listeriosis, salmonella, and E.coli, can make a person very ill and dehydrated, which can lead to poor pregnancy outcomes like preterm labor and contractions and even cause someone to pass out and fall, Dr. Kamyar says. Listeriosis, in particular, has been linked to more serious complications, including miscarriage and stillbirth.

Raw and smoked seafood, raw meat, raw eggs, deli meat, hot dogs, and unpasteurized dairy

The reason experts recommend avoiding these foods is because they all come with a higher-than-normal risk of contamination. “Sushi made with raw fish can have parasites that can make you ill; unpasteurized milk products (like some soft cheeses, though you can eat pasteurized versions) can carry listeria and other diseases,” Dr. Kamyar says. Ditto with raw meat, smoked seafood, deli meats, and yes, even hot dogs. “The problem with hot dogs and lunch meats is that if they’re left out and not refrigerated and they aren’t handled hygienically, that’s when you risk infection with bacteria,” Dr. Kamyar says. It’s also important to note that some conventionally “healthy” foods like sprouts, celery, and cantaloupe have also caused listeria outbreaks, the CDC says.

That being said, you could of course get food poisoning from other foods. It’s just that it tends to happen more frequently in these ones, so avoiding them is a realistic way to minimize your risk, Dr. Kamyar says.

High-mercury fish

Fish is actually a really healthy food to eat during pregnancy. ACOG recommends eating at least two servings of fish or shellfish per week to get a good dose of omega-3 fatty acids, which are important for your baby’s brain development. Fish is also a great source of protein, Dr. Kamyar adds.

But you want to avoid fish that tends to contain a lot of mercury, which has been linked to birth defects. These include marlin, shark, swordfish, tilefish, orange roughy, bigeye tuna, and king mackerel. Instead, stick to smaller fish, like tilapia, catfish, and salmon. Canned white (albacore) tuna is also OK in moderation—ACOG suggests limiting consumption to 6 ounces per week to be mindful of mercury.

Other supplements besides prenatals

Experts recommend taking prenatal vitamins before and during pregnancy, so that you can make sure you’re getting all the important nutrients you and your baby need. But you shouldn’t take that to mean you should load up on all supplements.

For instance, the currently very popular CBD hasn’t been well-studied in pregnancy—“we don’t really know what it does to a pregnancy,” says Dr. Kamyar—so that’s one supplement you should skip. Like other supplements, it’s also unregulated, so there’s no way to know what’s actually in it.

Even regular multivitamins might not be a good idea on top of your prenatals. Dr. Kamyar says that some multivitamins may have high levels of vitamin A. Getting too much vitamin A during pregnancy has been associated with birth defects in the central nervous system and cardiovascular system, and spontaneous abortion. Of course, you need some vitamin A—it’s important most notably for healthy eye development. Dr. Kamyar says that as long as you’re not supplementing with it, and just getting vitamin A from foods like sweet potatoes and carrots and your prenatal, you shouldn’t be concerned about taking in too-high amounts.

Bottom line: Always talk to your doctor before taking any sort of supplement, no matter how natural and harmless it sounds, during pregnancy.

Experts also suggest cutting back on caffeine—and completely avoiding alcohol.

You may not need to stop your daily coffee habit, but depending on how much you’re drinking, you may need to cut down on it: Experts recommend limiting caffeine intake during pregnancy to 200 milligrams or less per day. That’s about the amount in one 12-ounce cup of coffee (though caffeine content varies by roast and brewing method).

The reason? Experts know that caffeine crosses the placenta, meaning it can be passed onto the baby if the pregnant person consumes it. But research about just how much caffeine is OK before it may interfere with fetal development is inconclusive. There are also some concerns about a potential relationship between caffeine and an increased incidence of spontaneous miscarriage, but the studies done so far are, again, inconclusive. Until we know more, it may be best to stick to that 200 milligram max to be safe.

As for alcohol? While you might have heard from a friend or a book that light drinking during pregnancy may be OK, both ACOG and the CDC strongly say that drinking any type of alcohol, at any time during pregnancy, can potentially impact your baby’s development and cause birth defects and lifelong behavior problems. That recommendation is not without controversy, though. Some studies, including a 2012 Danish study of 1,628 women and their children at 5 years of age, have reached confusing conclusions, suggesting that low to moderate alcohol consumption (less than eight drinks a week) during early pregnancy may not ultimately impact the child’s brain function. On the other hand, a 2013 Alcoholism: Clinical and Experimental Research systematic review and meta-analysis found that, based on three studies of approximately 11,900 children aged 9 months to 5 years, moderate drinking during pregnancy (up to six drinks a week) was associated with behavioral problems. And while prior U.K. guidelines limited alcohol during pregnancy to one to two units of alcohol once or twice a week—two units being the equivalent of a medium-sized glass of wine—they revised them in 2016 to show that no level of alcohol is safe to drink.

Similarly to caffeine, we just don’t really have solid research that confirms an exact amount of drinking alcohol is safe at any point in pregnancy (it’s not exactly easy or morally sound to do studies where a pregnant person drinks alcohol and waits to see how it impacts their baby’s health). Until we have more robust studies and concrete evidence on how much, exactly, might be safe, it’s safer to just not do it at all, Dr. Valent says. At the same time, some people find the guidelines of “do not drink if you might have the remote chance of becoming pregnant” paternalistic and overreaching. On that note, if you happened to drink a small amount of alcohol before you knew you were pregnant, serious harm to your baby from that is unlikely, according to ACOG—the best course of action would be to not drink more after learning of your pregnancy.

While having to skip those cups of coffee—or turn down a poached egg for breakfast or your regular glass of wine with dinner—can be annoying, it can be helpful to reframe your pregnancy eating in your mind: Instead of looking at pregnancy as a time when you can’t have certain things, think of it as an opportunity to check in on how you’re nourishing your body. It’s a time to give your body what it needs to be healthy and grow another human—that’s pretty awesome, right? The bonus is that you’ll learn some great things about eating nutrient-rich foods and taking care of yourself that you can keep using beyond pregnancy, too. And on those days when even that change in focus doesn’t take away the sting of foregoing certain foods and drinks during pregnancy, the good news is that it won’t last forever.

Related:

• What Really Is a Heart-Healthy Diet?
• 10 ‘Healthy Eating Rules’ You Should Throw Out Immediately
• Can Pregnant People Get a COVID-19 Vaccine?