Exactly what to eat (and avoid) during pregnancy.

If you were looking forward to indulging your cravings for hot chips and tubs of cookie dough ice cream during your pregnancy, we have some bad news. Avoiding junk food has never been more crucial. 

“I always tell my mums that pregnancy is the most important time of your whole life to eat well,” dietitian Melanie McGrice tells Mamamia. “It doesn’t just impact on you and your nutrition, it can also impact the genetic programming of your baby for their whole future health.” 

Research suggests that what a woman eats before she conceives, while she’s pregnant and breastfeeding and what she feeds her baby in the first couple of years can all help program that child’s genetics. 

“It can impact their life in many ways, from their brain development to their mental health to their risk of chronic diseases to their immunity to their gut microbiome and much, much more,” McGrice adds.

Not only does a woman have to be careful of what she eats during pregnancy, she has to be careful not to eat too much. The idea of “eating for two” was ditched long ago. McGrice says in the first trimester, a woman shouldn’t be consuming any extra calories. In the second and third trimesters, she only needs the equivalent of two extra slices of bread a day.  

Melbourne obstetrician and gynaecologist Dr Peter Jurcevic says the thinking on how much weight women should gain during pregnancy has changed. 

“In years previous, we used to weigh women at every visit,” he tells Mamamia. “We were very particular about wanting to see incremental increases in weight.”

Nowadays, it’s recommended that women’s weight gain in pregnancy should be in proportion to their starting body mass index. Underweight women are advised to gain more weight than overweight women. It’s currently suggested that women with a BMI under 18.5 should gain 12-18kg, while women with a BMI over 30 should only gain 5-9kg. 

“The old saying was, ‘Oh, you need that extra weight when you’re breastfeeding,’” Dr Jurcevic says. “Well, no, you don’t. All that extra weight is ultimately just accumulating fat.” 

So what should a woman be eating during pregnancy?

The basics

The Australian Dietary Guidelines advise that pregnant women should eat a wide variety of foods from these five food groups every day: 

• Vegetables of different colours, and legumes/beans (5 serves)
• Fruit (2 serves)
• Grain foods (bread, cereal, rice, pasta, oats, quinoa, etc), mostly wholegrain and/or high fibre (8 and a half serves – this is up from the usual recommendation of 6)
• Lean meat, poultry, fish, eggs, tofu, nuts and seeds and legumes/beans (3 and a half serves – up from the usual recommendation of 2 and a half)
• Milk, yoghurt and cheese or their alternatives (eg soy or rice), mostly reduced-fat (2 and a half serves)

McGrice is a big fan of fruit. 

“Fruit is obviously rich in vitamins, but it’s also rich in fibre, which helps to reduce the risk of constipation, which is really common during pregnancy,” she explains. “It also helps to optimise hormones and has been found to be one of the best foods for reducing risk of miscarriage.”

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Dr Jurcevic stresses the importance of fibre during pregnancy. 

“Gut bacteria thrive on fibre. A fibre-rich diet will go a long way to improving your microbiome, and a good microbiome is what you want to be transmitting to your baby.”

Vitamins

Should all women take multivitamins during pregnancy? Not necessarily. 

“Folate is the only supplement that is recommended at the start of pregnancy,” Dr Jurcevic says. “That absolutely helps to reduce the incidence of spinal cord defects. From that point on, if you have a healthy diet, you technically shouldn’t need to have another supplement.” 

While iodine is important for a baby’s brain development, not every pregnant woman needs an iodine supplement. 

“If women have thyroid issues, sometimes they don’t need so much iodine,” McGrice explains. 

Pregnant women have an increased need for iron to give them energy, and women are often low on iron late in their pregnancy. But Dr Jurcevic says women shouldn’t take a supplement with extra iron early in their pregnancy unless they’re actually iron deficient. 

“They often feel a bit sicker on it and it can bind you up,” he says. 

Women can increase their iron intake by eating foods such as lean red meat, fish, chicken, green leafy vegies and wholegrains. 

With vitamin D, there was discussion recently about whether to make it a recommended supplement for all pregnant women. McGrice says the decision was made not to. 

“Just as much too little vitamin D can be problematic, too much vitamin D can also be problematic.”

She suggests women should consult with a dietitian to find out their individual supplement needs. 

Fish

It’s good for women to eat fish during pregnancy, but the type of fish does matter.  

“Scandinavian countries have a higher fish intake and they appear to have much lower rates of disease in pregnancy, like pre-eclampsia,” Dr Jurcevic says. “So things like omega-3 appear to be providing benefits.”

Mackerel, herrings, sardines, salmon and canned tuna are all good fish for pregnant women to eat. But they should avoid eating too many fish from the top of the food chain, such as shark (flake), marlin and swordfish, because of the risk of mercury toxicity.

“Because those fish are eating more fish below them, you could be topping up the amount of mercury. That could potentially cause harm to the baby’s brain.”

What to avoid

There’s a long list of foods that pregnant women are told to avoid because of the risk of listeria. These include soft cheeses such as brie and feta, cold cut meats such as ham and salami, raw seafood such as sushi, pre-prepared salads and soft-serve ice cream. 

Listeria can cause miscarriage and stillbirth, but Dr Jurcevic points out that it’s rare. 

“It’s a bad disease, don’t get me wrong, but I’ve been practising for 26 years and I’ve seen one case of proven listeria.”

He says if pregnant women want to have these foods on a special occasion, and they feel confident that the food has been both properly stored and properly prepared, then it’s “very low risk”. 

“But if you’re a worrywart, don’t mess with it,” he adds. 

Pregnant women should also avoid raw eggs because of the risk of salmonella. This includes food that could have been made with raw eggs, such as homemade mayonnaise and chocolate mousse. 

There’s nothing wrong with pregnant women having a cup of coffee, according to Dr Jurcevic. However, when it comes to alcohol, the current advice is to avoid it completely. 

It’s binge-drinking that causes the real damage. But on the question of whether the occasional glass is okay, Dr Jurcevic says he asks his patients if they would put even a small amount of alcohol into a baby’s bottle, because this is essentially the equivalent of drinking while pregnant. 

“You probably wouldn’t. You’ve got to ask yourself, do you feel comfortable about that?”

Snacks

McGrice recommends women eat three snacks a day, as well as three meals. Because high-fat, high-salt and high-sugar foods need to be avoided as much as possible during pregnancy, it’s good to have a long list of snack ideas so you’re not tempted to grab something unhealthy. Here are some suggestions:

• A tub of plain yoghurt with a punnet of berries added
• Tzatziki and celery sticks 
• Fresh fruit
• Wholegrain toast topped with banana 
• Hummus and carrot sticks  
• A bowl of unsweetened cereal with milk
• Baked beans 
• A bowl of vegetable soup
• A fruit smoothie
• Toast with peanut butter

For women who are suffering morning sickness, McGrice suggests grazing throughout the day, starting by eating something before getting out of bed in the morning. She says fruit, a slice of bread or dry crackers are all good. Dr Jurcevic says ginger and vitamin B6 can also help.

Recipes

Chicken breast stuffed with feta and pumpkin risotto

Ingredients:

• 150g Jap pumpkin, diced
• 2 teaspoons olive oil
• 1 clove garlic, crushed
• ¾ cup (120g) arborio rice
• 1 cup chicken stock
• 400g chicken breast fillet
• 40g low-fat feta cheese
• 1 tablespoon almonds, crushed
• 2 teaspoons fresh coriander, chopped

Method:
Preheat the oven to 180°C. Place the pumpkin in a bowl with a small amount of water and microwave for 5 minutes.

Place the rice and garlic in a saucepan with half the oil, slowly bring the pan to a medium heat and cook for 4 minutes. Add 1 ladle of chicken stock at a time, stirring, until the risotto is al dente – this should take about 17 minutes.

Meanwhile, cut a hole in the centre of the chicken. Rub the chicken with garlic, half the chopped coriander, a pinch of pepper and the remaining oil. Seal in a pan over high heat until browned.

When the risotto is ready, stir through the feta, crushed almonds, coriander and pumpkin. Stuff risotto inside the chicken breast, then place chicken breasts on foil-lined baking tray and finish in the oven for 10 minutes. Serve chicken breasts with a side salad and any remaining risotto.

Oven-roasted salmon with lemon and dill crust

Ingredients:

• ½ cup brown rice
• 30g cereal flakes, crushed
• 1 tablespoon crushed almonds
• ½ teaspoon lemon zest
• 1 teaspoon chopped dill
• 1 teaspoon olive oil
• 1 teaspoon cracked pepper
• 2 x 200g salmon fillets
• 2 cups baby spinach leaves
• 1 clove garlic, crushed
• 4 chat potatoes, washed and diced
• 4 roma tomatoes, diced
• 1 teaspoon chives, chopped

Method:
Prepare rice according to the instructions on the packet.

Mix together the cereal flakes, crushed almonds, lemon zest and dill, then combine with the oil and season with pepper.

Place the salmon on an oven tray lined with baking paper, top with the crumb mixture and bake at 180°C for 9 minutes, until the flesh is firm. Remove from the oven and allow to rest for 3 minutes.

Lightly sauté the spinach and garlic in a saucepan over medium-high heat until wilted, and remove from heat. Steam potato in the microwave for 8 minutes. Toss tomatoes and potato through the spinach and season with pepper.

Place the spinach on a plate and top with the salmon. Serve with a side of rice. Garnish with the chives and serve.

Tofu pad thai

Ingredients:

• 680g firm tofu, diced
• Canola oil spray
• 2 tablespoons crunchy peanut butter
• 2 tablespoons sweet chilli sauce
• 1 lemon, juiced
• 1 head broccoli, cut into florets
• Handful bean sprouts
• ½ red capsicum, diced
• 10 snow pea, roughly chopped
• 5 button mushrooms, roughly chopped
• 1 cup baby corn, diced
• 1 head bok choy, roughly chopped
• 1 packet dried Pad Thai rice noodles
• 2 sprigs fresh coriander
• Peanuts, for garnish

Method:
Put noodles into a bowl and cover with boiling water. Set aside.

Put the tofu in a wok on high heat. Add the peanut butter, sweet chilli sauce and lemon juice. Add the vegetables and mix through the sauce until coated. Cook for 5 minutes, until the bok choy is wilted.

Drain noodles and add to tofu and vegetables. Garnish with fresh coriander and a handful of peanuts.

For more recipes, you can visit dietitian Melanie McGrice's website.