Healthy food when you are pregnant

It may be easy to think that you have to eat for two when you are pregnant, but this isn’t the case. How much extra food you need depends on what you weighed before you were pregnant and how much weight you gain throughout the pregnancy. The midwife at the maternity clinic or a nutritionist can provide you with advice on what is right for you. Remember that it is not only additional energy that you need, but above all nutrition.

If you have any questions regarding your lifestyle or concerns that you are gaining too much weight or not enough, you can always talk to your midwife.  It is good to tell them if you have previously had an eating disorder, so that you can receive support during your pregnancy.

If you are feeling very nauseous and have difficulty eating early in your pregnancy, you do not need to worry about not getting enough nutrients. However, if the symptoms last for a long time, you should consult your midwife.

The pregnancy can be divided into three parts, or trimesters. For each trimester, your need for energy and nutrition will increase. Everyone experiences pregnancy differently. How you feel can change during the course of the pregnancy. Some are hungrier at the beginning, some towards the end. Some feel so sick that they can barely eat, while others just crave one single thing for a period of time.

What is described below are guidelines for how much additional nutrition your body needs during each trimester of the pregnancy:

• The first trimester, meaning the first 12 weeks, you hardly need anything extra at all. One fruit per day covers the additional need.
• In the second trimester, between week 13 and 27, you need a little more, such as an addition of one fruit, a sandwich and a glass of milk or unsweetened, vitamin-enriched oat or soy milk every day.
• In the third and last trimester, you need yet a little bit more, an addition corresponding to two snacks and one fruit every day. A good snack can be a sandwich with toppings and a glass of milk, yoghurt, vitamin-enriched oat or soy milk or similar. It could also be a bowl of oatmeal or muesli with berries or fruit and milk or an enriched oat or soy milk.

When you are pregnant, you may think a little extra about what you eat and wonder if the food contains everything that the foetus needs. It may be good to know what you need to think about in particular.

The building blocks that gives us energy are fats, carbohydrates and proteins. All of them are equally important for your body to feel good.

Fat contains the most energy

It may be good to know that fat provides more than twice the energy of carbohydrates and proteins. Something that does not look like much on the plate, such as sauce for example, can contain a lot of energy. If the body gets more energy than it needs, it is possible to gain too much weight. In order prevent this, it can be good to think about what you eat. Perhaps you need to decrease portion sizes or be more physically active. If you do not gain enough weight, you should consider if you are not eating enough or being too physically active.

Chose good-quality fat

The quality of fats is important for both mother and foetus. There are several types of fat: saturated, monounsaturated and polyunsaturated. During your pregnancy, polyunsaturated fat is particularly important.

Rapeseed oil and olive oil both have a good balance between saturated, monounsaturated and polyunsaturated fat and can be used for cooking. In addition, it is good if the cooking fat is enriched with vitamin D, since this is an important nutrient the recommended daily intake of which can be hard to reach.

Omega 3 is an essential polyunsaturated fatty acid found primarily in fish. To get enough of it, you should preferably eat fish two to three times per week. If you do not like fish, shrimp and mussels are good alternatives. Fish-based sandwich spreads are also good sources of Omega 3. Certain algae also contain Omega 3.

If you never eat seafood, you should consult your midwife. Walnuts, rapeseed oil and flaxseed oil can to some extent cover your need for this essential fatty acid.

Enough protein

If you eat a varied diet, meaning food from both the animal and plant kingdom, you will often get enough protein and other nutrients to cover your needs during the pregnancy.

If you eat a vegetarian or vegan diet, excluding all animal products, legumes provide a good source of nutrients. Soy and other beans as well as lentils and peas, as well as ready-made products based on legumes contain protein, iron, folic acid, zinc, selenium and other important nutrients. If you are excluding eggs, dairy and cheese from your diet, you may not get enough calcium, vitamin B12, vitamin D and Omega 3. If you opt for alternative products, for example based on soy, oats, coconut or other nuts, it is important that they are vitamin-enriched. Many on a vegan diet take supplements to get the right amount of nutrients. Contact a dietician if you are on a vegan diet and feel uncertain if you are getting enough nutrients. The dietician can go over what you eat and give you advice on how to increase your nutritional intake. You can also contact a health centre to check your nutritional status. They can help you figure out what supplements you need.

Slow carbohydrates keeps you full longer

Just like when you are not pregnant, it is good to choose slower carbohydrates, meaning those that are not taken up as quickly by the body, which allows you to feel full for longer. This in turn means that you have less of an urge to snack in-between meals. Slow carbohydrates have what is called a low glycaemic index, or a low GI value. Examples include bulgur, quinoa, brown rice, buckwheat, sorghum, wholegrain pasta, fibre-rich bread and other foods that are rich in fibre.

It is good to avoid large amounts of soft drinks, biscuits, snacks and sweets, since most of these contain sugar and have a very high GI value. The energy only lasts a short while, and your body does not get enough nutrients. This means that you will soon feel like eating something sweet again.

During the pregnancy, you not only need additional energy, but also nutrients in the form of vitamins and minerals. If you cover the additional energy need with more food, this normally happens automatically. But there are a few nutrients that you should pay closer attention to.

The following are a few tips on how to best make sure to get the most important of these vitamins and minerals.

Vitamin D

You need vitamin D for your bones and teeth, as well as many of the body’s tissues and functions. It is also important for the body’s immune defence.

Vitamin D is primarily found in oily fish, such as salmon, herring, mackerel and anchovy. The vitamin is also found in eggs, enriched cooking fats, enriched dairy products and in enriched oat and soy drinks. It will say on the packaging if a food is enriched with vitamin D. Chanterelles and porcini mushrooms also contain vitamin D.

Another important source of vitamin D is sunlight. Vitamin D is formed in the body when the skin is hit by the sun’s ultraviolet rays. But since Sweden is a dark country much of the year, the food is an important way for you to get enough vitamin D. Some need vitamin D supplements during pregnancy. Especially if you have dark skin or wear clothes that cover the entire body in the summer. Talk to your midwife or contact a health centre for testing if you are unsure.

Folic acid

Folic acid is a type of vitamin B that is needed for the cell division in the body, and it is therefore particularly important during pregnancy. The vitamin is called folate when it occurs naturally in food.

You should consume 500 micrograms of folic acid per day in your food. Women planning to become pregnant are recommended to take 400 micrograms of folic acid supplement each day to reduce the risk of spina bifida in the foetus. The Swedish Food Agency recommends folic acid supplements until week 12. After that, you can cover the need through your diet.

Folic acid is found for example in greens, fruit, berries, liver and wholegrain products, as well as in lentils, legumes, cabbage, chickpeas and beans. You will get enough folic acid if you follow the general diet recommendations. This means choosing wholegrain products and eating 500 grams of fruit and vegetables per day. This corresponds to five portions of fruit and vegetables, for example a banana, an apple, a carrot plus some spinach and broccoli.

Vitamin B12

Vitamin B12 is for example needed for the baby’s nervous system to develop normally.

If you are eating a varied diet that features meat, fish, eggs or dairy, you will normally get enough vitamin B12.

If you are eating a vegan diet without any animal products, you need to take B12 supplements and choose foods enriched with B12.

Iron

Iron is particularly important during the pregnancy and needed primarily for the body’s oxygen uptake. Fairly soon into the pregnancy, you will likely need to start taking iron supplements. The maternity clinic will monitor your blood count, and the midwife ensures that you are given an iron supplement if needed.

Iron is primarily found in meat, blood sausage and liver. It is also found in fish, eggs, wholegrain products, seeds, nuts and almonds, as well as in greens and legumes, meaning lentils, peas and beans.

Meat and fish have something called the “meat factor” which makes it easier for the body to take up iron from the food. If you include something rich in vitamin C in your meal, such as fruit or vegetables, it is also easier for the body to take up iron from vegetable-based foods. Other acidic foods, such as vinegar and sourdough bread, have the same positive effects.

Coffee and tea reduce the uptake of iron, and for that reason it can be good to wait a while before drinking coffee after a meal. Or add something rich in vitamin C to the meal.

Calcium

Calcium is important primarily for the bones and teeth.

You can cover your increased need during the pregnancy, for example by eating a bowl of yoghurt or calcium-enriched oat or soy milk every day, together with cottage cheese and a few slices of hard cheese, or an equivalent calcium-enriched vegan alternative.

There is also calcium in spinach, cabbage, legumes, fish, shellfish, sesame and sunflower seeds.

In order for the body to take up calcium, you need vitamin D, either from the sun or in your diet. 

Iodine

Iodine is important for the thyroid gland and is needed for the development of the baby’s nervous system.

Salt, fish and shellfish as well as marine algae are good sources of iodine. Since there may not be enough iodine in your food, you should eat iodised salt. The packaging will tell you if the salt is iodised.

It is important not to exceed the recommended daily intake of iodine, but the maximum amount can almost only occur if you eat large amounts of certain algae. Read the label before eating algae. If you are pregnant or breastfeeding, the Swedish Food Agency recommends caution when eating products with sea algae. Do not exceed the maximum recommended daily dose of 250 micrograms from supplements.

Fish contains a lot of healthy things like iodine, selenium and Omega 3, which are all important during pregnancy. More or less all factory-packaged fish found in supermarket freezer is safe to eat during your pregnancy. These are fish from the major seas, with little risk of containing high doses of environmental toxins, or farmed fish such as salmon. You can choose freely when it comes to tinned fish, such as pickled herring, tinned tuna, fish balls, caviar and fish-based sandwich spreads. Vary your diet, eat both fish and shellfish, 2–3 times per week of the safe types of fish recommended by the Swedish Food Agency.

If you do not eat fish or shellfish, and you feel that you are not getting enough Omega 3, talk to your midwife about what you can do.

Certain fish from lakes and the Baltic Sea may contain some environmental toxins, which unfortunately do not disappear during cooking. You should therefore limit your intake of these fishes, such as Baltic herring and halibut. The Swedish Food Agency website has more information about which fishes to look out for.

When you are pregnant, it is particularly important to avoid food which can contain parasites and bacteria. This applies primarily to the Listeria bacteria and the Toxoplasma parasite, which can both be harmful to the growing foetus.

You should avoid the follow while pregnant:

• raw meat
• raw mince
• unpasteurised milk
• cheese made with unpasteurised milk
• smoked and salted fish in vacuum packaging
• sliced sandwich meats, such as ham and sausage, which are not freshly packaged
• cold take away dishes, such as patés, salads and prepared mixes, that are close to the expiration date
• salted, dried or smoked meat, such as Parma ham and salami.

Regular hard cheeses or soft cheeses from a tube or tub can be eaten.

In order to have updated information about which cheeses you can eat and which to avoid, consult livsmedelsverket.se – Food for you who are pregnant.

Try to pay attention to expiration dates when you are pregnant, and always choose freshly packaged sandwich meats.

Newly smoked, newly salted and home salted fish is safer than pre-packaged versions. Sushi is fine too, if it is freshly made with fresh ingredients.

If you want to eat salted, dried or smoked meat, you can freeze it for three days at a minimum temperature of -18 degrees. This will kill any Toxoplasma parasites. They also die if you heat your food to over 70 degrees.

Listeria bacteria also die in cooking temperatures above 70 degrees. However, this bacteria can grow in refrigerator temperatures and survive freezing. If the bacteria have a chance to grow in a vacuum package with several weeks until the expiration date, the amount of bacteria can be very high. This applies, for example, to sandwich meats, cold ready-made dishes and to smoked or salted fish. For this reason, you should opt for freshly packaged food.

If you drink alcohol while pregnant, the alcohol passes to the foetus. No-one knows how much alcohol the foetus can tolerate without suffering permanent damage. It is therefore recommended to avoid alcohol completely when pregnant.

The Swedish Food Agency recommends that you limit your daily intake of caffeine to 300 mg per day when you are pregnant, since high doses of caffeine can affect the foetus. This corresponds to three small cups of coffee, around 5 decilitres, or six cups of tea, around 12 decilitres, per day.

There is also caffeine in colas and energy drinks. For this reason, you should limit your intake of these during your pregnancy. Energy drinks may also contain other substances that are not good during pregnancy.

Water is an excellent drink for meals and when you feel thirsty during pregnancy and breastfeeding. You can flavour the water with fruits and berries, or carbonate it.

Milk and vitamin-enriched oat or soy drinks are also a good alternative. It can be good to choose a low-fat version, since it will contain more vitamin D than whole milk.

Milk, yoghurt and vitamin-enriched oat or soy drinks are also a good way to supplement your snacks.

Soft drinks only give you energy and no nutrients, and for that reason you should not drink them in large quantities. The same is true for juice mixes.

Low-calorie drinks have artificial sweeteners, the most common being aspartame or sucralose. They give a sweet flavour without adding calories and are considered safe to drink during pregnancy. The sweetener steviol glycoside, which is used as an additive in certain foods, is also considered safe during pregnancy.

Sweets usually contains a lot of energy but rarely any nutrients. If you fill up on sweets, it can therefore be more difficult to cover your body’s nutritional needs. You should therefore eat sweets in moderation.

When you are pregnant, you may need to think about the amount of liquorice you eat. The Swedish Food Agency recommends that you eat no more than 50 grams of liquorice per day when you are pregnant. It is also prudent to be careful with liquorice teas.

If you are on a special diet, or you are avoiding various kinds of food, it may be good to consult a dietician. Start by talking to your midwife at the maternity clinic. It can be good to go over the food that you eat so that you can be sure that you are getting the nutrients you need during pregnancy.

It can also be good to have a review of possible supplements and health products, since some of them may be unsuitable during the pregnancy, such as ginseng. The Swedish Food Agency has advice on food supplements during pregnancy.

How you feel during your pregnancy can vary a great deal. Some say they have never felt better in their lives, while others have nausea and vomiting through the whole pregnancy and just want it to be over. It is common to experience some symptoms for a period of time, such as heartburn, nausea or constipation. Do not hesitate to tell others how you feel. It is never wrong to ask for help either. Most people are very understanding and helpful when it comes to pregnancy symptoms.

Some pregnancy symptoms are linked to food, and you can try to ease these yourself. Here are a few tips that can help:

Eat small amounts regularly to ease the nausea

Nausea will often feel worse when your blood sugar levels are low. For this reason, it can be good to eat smaller amounts more regularly, perhaps once every two hours. Carry some fruit or nuts in your bag. In the morning, it can be good to have some crackers or other small snack next to your bed. It can also be good to eat a little before going to bed. Many feel that dry, salty foods will ease the nausea, while others need something sweet. Some find that carbohydrates and cold or boiled foods are easier to eat than warm, fried and protein-rich foods.

A short walk or some fresh air can help with the nausea.

Many ways to ease heartburn

The cardia and the intestines are affected by the pregnancy hormones, which relax the muscles while the growing uterus is pressing against your stomach. This can cause heartburn as acid fluid from the stomach splashes into the oesophagus.

There are many ways to ease heartburn Try the following:

• Avoid eating and drinking a lot at once.
• Avoid eating late at night.
• Avoid greasy and spicy food.
• Avoid acidic drinks, such as juice.
• Try to limit your intake of tea and coffee.
• Try raising the head of the bed. You can do this either by placing something stable underneath the legs of the bed, or by placing some pillows under your mattress.

If this does not help, ask your midwife for a prescription to ease the symptoms.

Reduce constipation with the help of food rich in fibre, water and physical activity

When you are pregnant, your bowel movements slow down, which can easily lead to constipation. This can be aggravated if you do not eat enough fibre or do not drink enough. Physical activity, for example walking, helps the bowels to work.

It is good to eat the following in order to ease problems with constipation:

• Vegetables, fruits and root vegetables are rich in fibre and full of vitamins. It is good if you can eat 500 grams per day. You can for example mix the vegetables into your food. A couple of grated carrots can easily be put into a Bolognese or your pancakes. Grated cabbage is easy to wok, and it not only adds fibre, but plenty of other nutrients as well. Legumes, such as peas, beans and lentils provide fibre and plenty of nutrients.

• Dark bread, preferably with the Keyhole label, is good too. Muesli, cereal or porridge, such as oatmeal or wholemeal, contain both fibre and nutrients.

• Prunes and prune juice contain fibre and vitamins as well as sorbitol, which has a laxative effect.

Remember to drink water throughout the day and at every meal.