 Nutrition
Issues Before And During PregnancyPregnancy
is different from other times in a woman's life, because what she eats and drinks can
affect her unborn baby. This article will not cover the specific nutritional needs of a
pregnant woman. That information is available at http://mypyramid.gov/mypyramidmoms/index.html.
This article will discuss things which women who are thinking of becoming pregnant and
those who are pregnant should know about what they eat and drink.
The topics covered in this article include:
MEETING
YOUR FOLIC ACID NEEDS TO PREVENT BRAIN AND SPINAL CORD DEFECTS IN YOUR BABY;
THE DANGERS OF
TOO MUCH VITAMIN A;
ALCOHOL AND YOUR BABY;
CHOOSING SAFE FISH TO
EAT;
LISTERIA, A
DANGEROUS ILLNESS;
KEEPING
FOOD SAFE TO HAVE A HEALTHY PREGNANCY;
HERBS,
HERBAL MEDICINES AND PREGNANCY.
MEETING YOUR FOLIC ACID NEEDS TO PREVENT BRAIN AND SPINAL CORD
DEFECTS IN YOUR BABY
What is folic acid? Folic acid is a B vitamin. Folic acid
is needed for normal development of the baby's brain and spinal cord. The brain and spinal
cord form in the first four to six weeks after conception. Often women do not even know
that they are pregnant when the brain and spinal cord are already forming. By the time
most women find out that they are pregnant it is too late to start taking folic acid to
prevent brain and spinal cord defects. The time to take folic acid is for the three months
before conceiving and then during pregnancy. Because many women have unplanned
pregnancies, it is recommended that all women who can get pregnant take a folic acid
supplement every day. Even women who are practicing birth control should take folic acid.
Women who have had tubal ligations should take folic acid, because occasionally they can
become pregnant.
Can I eat foods high in folic acid, instead of taking the
folic acid supplement, and still prevent the spinal cord and brain defects in my baby? It
is recommended that all women take a supplement which has 400 micrograms (mcgs) of folic
acid daily. It is also important to eat foods high in folic acid such as orange juice and
spinach. However, the form of folic acid in food is not as well used by the body as the
supplement form. The supplement form of folic acid is the form which has been found to
prevent birth defects of the spinal cord and brain. A woman can take a multivitamin with
folic acid or a tablet of just folic acid. Plain folic acid tablets are small and easy to
swallow. The multivitamin or the plain folic acid tablet should have 400 mcgs or 100%
folic acid.
What if I become pregnant? If a woman becomes pregnant, she
should continue taking the folic acid supplement until she sees a doctor for her
pregnancy. A woman needs more folic acid for herself as well as for her baby when she
becomes pregnant. Often a doctor will have the pregnant woman take a prenatal vitamin
which has more folic acid than the folic acid supplement she was taking.
For more information: http://www.cdc.gov/ncbddd/folicacid/
THE
DANGERS OF TOO MUCH VITAMIN A
There are two basic food forms of vitamin A. One kind is
beta-carotene. This is the kind found in fruit and vegetables. It is what makes carrots
orange and spinach dark green. Beta-carotene is a pro-vitamin A. This means that
beta-carotene can be turned into vitamin A in the body if the body needs vitamin A. If the
body has enough vitamin A, then the beta-carotene will not be turned into vitamin A.
The other kind of vitamin A is called preformed vitamin A.
This means that the vitamin A is already formed in the food. The body does not have to
turn it into vitamin A. It already is vitamin A. This kind of vitamin A is found in milk
fat. Foods with some milk fat such as whole milk and foods made from whole milk such as
some cheeses, yogurts, butter and ice cream have preformed vitamin A. Liver, whether it is
chicken, beef, calf or pork liver, has preformed vitamin A. Some foods such as skim and
low fat milks, some margarines and some cereals have preformed vitamin A added to them.
Words such as vitamin A palmitate, vitamin A acetate, retinol or retinyl may be on the
label in the list of ingredients. These terms all mean preformed vitamin A. Some vitamin
pills also have preformed vitamin A.
If a woman eats more beta-carotene than she needs there is
no problem. The body will turn only the beta-carotene which it needs into vitamin A. If a
woman eats more preformed vitamin A than she needs, her body will store the extra in her
liver. Her liver can store too much vitamin A, because the body stores any extra preformed
vitamin A it gets.
If a woman is thinking about getting pregnant, it is a good
idea to limit the amount of preformed vitamin A for about three months before conceiving
and during pregnancy. Taking in too much preformed vitamin A before conceiving and during
pregnancy can cause birth defects in the baby.
Some medicines for severe acne contain retinoids which are
related to preformed vitamin A. The generic drug name for one medicine is Isotretinoin,
with the brand names Accutane, Amnesteem, Claravis and Sotret. There are other retinoid
drugs used for other medical problems. A pregnant woman should not take these drugs and a
woman should not get pregnant while taking them. In some cases a woman may need to wait
several years before getting pregnant after stopping one of these retinoids. These drugs
can cause miscarriage or very severe birth defects.
Limiting preformed vitamin A means eating cereals which are
not fortified with vitamin A and limiting milk with added vitamin A to a quart a day. It
means not eating liver of any kind at all, including goose liver or Braunschweiger. One
three ounce piece of beef liver has an 11 days supply of vitamin A. It means choosing a
multivitamin, if the woman is taking a multivitamin to meet her folic acid needs, that has
beta-carotene instead of preformed vitamin A. It means telling the dermatologist or other
physician that a woman wants to become pregnant or is pregnant, so that the doctor knows
not to prescribe a retinoid medicine for her skin or for another medical problem. It means
taking a prenatal vitamin with beta-carotene instead of preformed vitamin A.
Women need vitamin A before and during pregnancy. The best
way to meet their vitamin A needs is by eating foods high in beta-carotene, such as
carrots, sweet potatoes, butternut squash, turnips greens, spinach, broccoli, collard
greens, mustard greens, cantaloupe, apricots and papaya. Drinking up to a quart per day of
low fat or skim milk fortified with vitamin A can also help to meet their vitamin A needs.
If a woman eats no foods fortified or enriched with preformed vitamin A, she should talk
with her doctor about whether she is eating enough high beta-carotene fruit and vegetables
to meet her vitamin A needs.
For more information:
http://www.marchofdimes.com/professionals/19695_1168.asp
Reference:
Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper,
Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2000)
Food and Nutrition Board (FNB)
Institute of Medicine (IOM) p119, 128-131, 133, 138, 153, 155
ALCOHOL AND YOUR
BABY
There is no safe level of alcohol which a woman can drink
when she is pregnant. However, it is a good idea to stop drinking alcoholic beverages for
the three months before conception also. In this way if a woman conceives, but does not
know it, her baby will still be safe from the effects of alcohol. When a pregnant woman
drinks an alcoholic beverage, some of the alcohol enters the baby's system. Because a
baby's liver is immature, the baby's liver takes a longer time to break down the alcohol
than the mother's liver does. The alcohol begins to do damage to the baby's body.
For more information:
http://www.marchofdimes.com/professionals/14332_1170.asp
CHOOSING SAFE
FISH TO EAT
During pregnancy if a woman wants to eat fish, it is very
important that she chooses fish carefully. Unfortunately, the oceans and fresh water
bodies in many parts of the world have been contaminated from a number of different
sources. Mercury, PCBs and lead are some of the poisonous materials which contaminate
fishing waters and the fish in those waters. These poisons can have very serious effects
on a developing baby, if the mother eats contaminated fish. Some of the fish which the
Food and Drug Administration tells pregnant women not to eat include swordfish, shark,
tilefish and king mackerel. There are several bodies of water in Ohio where the fish are
not safe to eat.
Among fish which are safer to eat are catfish, cod,
crawfish, croaker (Atlantic), haddock (Atlantic), herring, mackerel Atlantic (North
Atlantic), mackerel chub (Pacific), perch (ocean), pollock, salmon (canned, fresh, frozen;
try to get Alaskan wild salmon rather than farmed salmon; canned salmon is usually wild
Alaskan), sardines, tilapia, trout (freshwater), white fish and whiting. Safer shellfish
include clams, crab, lobster (spiny), oysters, scallops and shrimp.
Pregnant women are advised to eat fish to obtain the
omega-3 fatty acids which their unborn babies need for optimal brain development.
Particularly salmon, sardines, canned light tuna and mackerel (other than king mackerel)
provide the omega-3 fatty acids the babies' brains need and they are lower in mercury than
other fish. It is good for pregnant women to eat two servings of fatty fish per week.
Links to two fish advisories follow. The first is jointly
from the Food and Drug Administration and the U.S. Environmental Protection Agency. The
advisory is intended for women who might become pregnant, women who are pregnant, nursing
mothers and young children. It discusses safe and unsafe fish and shellfish and how much
of any fish is safe to eat in a week.
http://www.cfsan.fda.gov/~dms/admehg3.html
The second link is to the 2007 Ohio Sport Fish Consumption
Advisory for bodies of water in Ohio. It lists advisories for each county in Ohio. The
advisory includes the bodies of water in a county, the kinds of fish in those bodies of
water and how often each kind of fish can be eaten.
http://web.epa.state.oh.us/dsw/fishadvisory/index.html
Reference:
"Fish Guidelines for Pregnancy Catch Some Nutrition Groups Off Guard," Clinical
Nutrition Insight, Lomangino, Kevin; January, 2008
LISTERIOSIS,
A DANGEROUS ILLNESS
Because pregnant women's immune systems are depressed when
they are pregnant, they are more likely to get illnesses. One illness which women are 20
times more likely to get when they are pregnant than when they are not pregnant is
listeriosis. It is an illness which can come from food which is contaminated with the
bacteria listeria monocytogenes. If a pregnant woman gets listeriosis, she can pass it on
to her unborn baby. This can cause the mother to miscarry or to have a baby with serious
health problems. The following link describes listeriosis and discusses the foods which
can carry the listeria monocytogenes bacteria. It explains what a woman who is pregnant or
thinking about getting pregnant needs to know to keep her unborn baby safe from listeria.
For further information:
http://www.cdc.gov/ncbddd/pregnancy_gateway/infection_list.htm#how
KEEPING FOOD SAFE TO HAVE A HEALTHY PREGNANCY
Because pregnant women's immune systems are depressed when
they are pregnant, they are more likely to getting illnesses. One way in which they can
get sick is to eat spoiled food.
Food can spoil in a number of different ways. The following
link explains what pregnant women need to know and do to stay free of spoiled food.
For more information:
http://www.cfsan.fda.gov/~pregnant/safemea.html
HERBS,
HERBAL MEDICINES AND PREGNANCY
The following are some herbs which should not be taken in
pregnancy.
Blue Cohosh can cause abortion.
Catnip can induce menstruation.
Cat's Claw Women who are pregnant or trying to become
pregnant should avoid using cat's claw because of its past use for preventing and aborting
pregnancy.
Cedar can cause abortion.
Chamomile What is labeled chamomile can come from at least
three different plants: English or Roman chamomile, German chamomile and yarrow. English
or Roman chamomile and yarrow should not be used during pregnancy. English chamomile can
cause abortion. It is not known if German chamomile is safe in pregnancy. If a product is
not labeled well, it may not even be possible for someone to know if what is contained in
a package is English or German chamomile or yarrow.
Chasteberry may affect certain hormone levels. Women who
are pregnant or taking birth control pills or who have a hormone-sensitive condition (such
as breast cancer) should not use chasteberry.
Chinese Angelica can induce menstruation.
Cottonroot can cause abortion.
Echinacea can cause problems for someone having surgery. A
pregnant woman should consider not taking echinacea while she is pregnant, so that if she
needs to have an emergency Caesarian section, the echinacea will not interfere with the
surgery.
Elderberries Uncooked or unripe elderberries are toxic and
can cause nausea, vomiting, or severe diarrhea. Only the blue/black berries of elder are
edible.
Ephedra or Ma Huang Women who are pregnant or breastfeeding
and children should avoid taking ephedra. It can cause heart arrhythmias. The Food and
Drug Administration has had ephedra or ma huang taken off the market, but sometimes
products which have been banned still manage to be available to buy.
Fenugreek Given its historical use for inducing childbirth,
women should be cautious when taking fenugreek during pregnancy.
Feverfew Women who are pregnant should not use feverfew
because it may cause the uterus to contract, increasing the risk of miscarriage or
premature delivery. It can induce menstruation also.
Garlic can thin the blood (reduce the ability of blood to
clot) in a manner similar to aspirin. This effect may be a problem during or after
surgery. A person should use garlic with caution if he or she is planning to have surgery
or dental work, or if the person has a bleeding disorder. A cautious approach is to avoid
eating garlic or taking it as a supplement for at least one week before surgery. A
pregnant woman may need to have an emergency Caesarian section which she did not plan. She
may not be able to wait a week after stopping garlic before having surgery. It might be
better for a pregnant woman to avoid eating more than four cloves of garlic per day in
pregnancy.
Ginger is sometimes used in pregnancy to prevent nausea and
vomiting. Taking more than four grams of ginger however, can cause uterine contractions.
Ginkgo can cause bleeding and is therefore not safe to take
if a person is going to have surgery or might need surgery such as a pregnant woman who
needs an emergency Caesarian section.
Ginseng can cause bleeding and is therefore not safe to
take if a person is going to have surgery or might need surgery such as a pregnant woman
who needs an emergency Caesarian section. Ginseng can also cause low blood sugar.
Goldenseal Women who are pregnant or breastfeeding should
avoid using goldenseal. Goldenseal can induce menstruation. The berberine in the herb may
cause the uterus to contract, increasing the risk of premature labor or miscarriage.
Berberine may also be transferred through breast milk, causing life-threatening liver
problems in nursing infants. Other herbs containing berberine, including Chinese
goldthread (Coptis trifolia) and Oregon grape (Mahonia aquifolium), are sometimes
substituted for goldenseal. These herbs may have different effects, side effects, and drug
interactions than goldenseal and may not be any safer. Goldenseal should not be given to
infants and young children.
Hoodia The quality of hoodia products varies widely. News
reports suggest that some products sold as hoodia do not contain any hoodia.
Horse Chestnut Homemade preparations of horse chestnut
should not be used. Raw horse chestnut seeds, leaves, bark, and flowers contain esculin,
which is poisonous.
Kava has been reported to cause liver damage, including
hepatitis and liver failure (which can cause death).
Kava has been associated with several cases of dystonia
(abnormal muscle spasm or involuntary muscle movements). Kava may interact with several
drugs, including drugs used for Parkinson's disease. Long-term and/or heavy use of kava
may result in scaly, yellowed skin. Kava increases sedation from anesthesia, which could
be dangerous if a pregnant woman requires an emergency Caesarian section. She may not be
able to be off kava for a week before surgery to prevent kava's side effects.
Lavender oil is poisonous if taken by mouth. When lavender
teas and extracts are taken by mouth, they may cause headache, changes in appetite, and
constipation.
Licorice and Licorice Root Pregnant women should avoid
using licorice as a supplement or consuming large amounts of licorice as food, as some
research suggests it could increase the risk of preterm labor. Licorice or licorice root
are more likely to be found in chewing tobacco, herbal teas such as apple tea and in
imported candies.
Mistletoe Raw, unprocessed mistletoe is poisonous. Eating
raw, unprocessed European mistletoe or American mistletoe can cause vomiting, seizures, a
slowing of the heart rate, and even death. American mistletoe is unsafe for medicinal use.
Myrrh can induce menstruation.
Noni There have been reports of liver damage from using
noni. A person with liver disease should avoid taking noni, as it contains compounds that
may make the liver disease worse.
Pennyroyal can induce menstruation.
Red Clover Because red clover contains estrogen-like
compounds, there is a possibility that its long-term use would increase the risk of women
developing cancer of the lining of the uterus. However, studies to date have been too
brief (less than 6 months) to evaluate whether red clover has estrogen-like effects on the
uterus. It is unclear whether red clover is safe for women who are pregnant.
Rosemary can cause abortion.
Rue can cause abortion.
St. John's Wort can cause problems for someone having
surgery. A pregnant women should consider not taking St. John's wort while she is
pregnant, so that if she needs to have an emergency Caesarian section the St. John's wort
will not interfere with the surgery. If a pregnant woman has been taking St. John's wort
for depression or anxiety, she should talk with her doctor about what she should take
instead of St. John's wort. She should not quit St. John's wort without replacing it with
something just as effective.
Safflower can cause abortion.
Saffron can cause abortion.
Sage in amounts greater than 500 milligrams may decrease
uterine contractions and increase bile flow.
Thunder God Vine can cause diarrhea, upset stomach, hair
loss, headache, menstrual changes, and skin rash. Thunder god vine has been found to
decrease bone mineral density in women. It can cause severe side effects and can be
poisonous if it is not carefully extracted from the skinned root. Other parts of the
plant-including the leaves, flowers, and skin of the root-are highly poisonous and can
cause death.
Turmeric in amounts greater than one gram may increase bile
flow and promote gall stones.
Valerian increases sedation from anesthesia, which could be
dangerous if a pregnant woman requires an emergency Caesarian section. She may not be able
to be off valerian for a week before surgery.
Yohimbe has been associated with high blood pressure,
increased heart rate, headache, anxiety, dizziness, and sleeplessness. Yohimbe can be
dangerous if taken in large doses or for long periods of time.
Other herbs which are dangerous to take in pregnancy
include:
Aloe Vera Juice, Fennel and Fennel Seed, Guarana, Senna and Raspberry Leaves.
The herbs listed on these three pages are only some of the
herbs which a pregnant woman should not take. Pregnant women should check with their
doctors before taking any herbs. Even if an herb claims to be helpful in pregnancy for one
reason or another, herbs can have side effects which are not well known. Herbs can
interact with medicines and cause problems that the person taking them may not have
expected.
For more information:
http://www.nlm.nih.gov/medlineplus/herbalmedicine.html
References:
Journal of the American Medical Association, July 11, 2001 article on herbs and surgery
"Herbal Use During Pregnancy and Lactation, A Need for Caution," Cartwright,
Martina, The Digest, Summer, 2001.
PDR for Herbal Medicines, Medical Economics Company, Inc., Montvale, 2000.
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