Doctor’s Tip: Special nutritional needs during pregnancy and lactation
This is the final column in a series taken from the book “Nourish, The Definitive Plant-Based Nutrition Guide for Families,” by Stanford-affiliated pediatrician Reshma Shah, M.D., M.P.H., and dietitian Brenda Davis.
If you’re contemplating pregnancy, “Nourish” recommends the following: 1) Achieve ideal body weight through eating a variety of vegetables, fruit, whole grains, nuts and seeds. 2) Avoid tobacco, alcohol and all recreational drugs including marijuana. 3) Avoid exposure to hazardous chemicals. 4) Get daily exercise. 5) Get adequate rest. 6) Practice relaxation through meditation or yoga.
Before and during pregnancy, take a daily prenatal vitamin with 400-800 mcg. of folic acid, which helps prevent fetal neural tube defects. The natural form of folic acid is folate, present in plant foods such as greens, beans/lentils, avocados, asparagus, beets, mangoes, papayas, oranges and sunflower seeds. Be sure your supplement contains iron, iodine, zinc, vitamin B12, calcium and vitamin D. Due to lack of control over supplements, many contain harmful contaminants, so beware. If you are on any prescriptions or across-the-counter medications, check with your doctor to be sure they’re safe during pregnancy.
Avoid environmental toxins such as pesticides, heavy metals and PCPs. The best way to do that is to eat at the bottom of the food chain (plants), instead of animal products at the top of the food chain (meat, poultry, dairy, eggs, seafood). Buying organic also helps, if it’s affordable.
If you’re wondering if total plant-based diets are adequate during pregnancy, “Nourish” notes that vegan pregnant women have fewer c-sections, less postpartum depression, lower rates of neonatal and maternal mortality, less preeclampsia and eclampsia and less pre-pregnancy and post-delivery obesity.
Weight gain for underweight women (BMI < 18.5) is 28-40 pounds; for normal weight (BMI 18.5-24.9) 25-35 pounds; for overweight (BMI 25-29.9) 15-25 pounds; obese (BMI > 30) 11-20 pounds. Extra calories are not needed during the first trimester, an extra 340 calories per day are needed during the second trimester, and 450 extra calories daily during the third trimester. These extra calories should be obtained primarily through plant protein: protein-rich non-dairy soy or pea milk; lentils or beans at least twice a day; soy in the form of tofu, tempeh, edamame and soy-based veggie “meats;” and seeds, nuts and nut butter. Protein supplements can contain heavy metals and BPA, so go to the Clean Label Project to check.
Omega-3 fatty acids (EPA plus DHA) are important for pregnant women and their fetus, and can be obtained from a daily handful of walnuts and 2 tablespoons of ground flaxseed. Note that exposure to potential allergens such as nuts results in a lower incidence of childhood allergies. Women who don’t eat fish should also consider a 500-750 mg. daily supplement of vegan, algae-derived omega-3 such as the Nordic Natural brand at Natural Grocers.
Choline is important for fetal development, and is present in shiitake mushrooms, soy products, legumes, quinoa, nuts, seeds, vegetables and fruit — also in some prenatal supplements. Extra calcium can be obtained through calcium-set tofu, beans, greens, almonds, chia seeds and fortified nondairy products.
Breast-feeding moms need an extra 500 calories and an extra 8-12 cups of fluids a day. Most things the mom ingests — including pollutants, meds and supplements — appear in breast milk, so take the same precautions noted above under pregnancy.
Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment or email email@example.com.
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