What is the recommended diet for pregnant women?

Recommended Diet During Pregnancy

Pregnant women should eat a nutrient-dense diet based on whole foods including fruits, vegetables, whole grains, legumes, healthy fats with omega-3 fatty acids (nuts, seeds, fish), while limiting processed foods, fatty red meat, and sweetened beverages—the message is "eat better, not more." 1, 2

Core Dietary Components

Essential Food Groups

• Fruits and vegetables: Consume a variety daily, ensuring they are thoroughly washed before eating 1, 3
• Whole grains and high-fiber foods: Choose these over refined grains 1
• Fish consumption: Eat fish at least twice weekly, especially oily fish rich in omega-3 fatty acids 1, 2, 3
  • Critical caveat: Avoid high-mercury fish (shark, swordfish, king mackerel, tile fish) 1
  • If fish is avoided, take a DHA supplement 3
• Protein sources: Adequate protein intake of 0.75 g/kg/day plus an additional 10 g/day 1
• Legumes: Include beans, lentils, and other legumes regularly 1, 2
• Healthy fats: Prioritize omega-3 fatty acids from nuts, seeds, and fish 1, 2
• Dairy products: Choose low-fat options, but avoid unpasteurized dairy and soft French-style cheeses 4, 5

Foods to Limit or Avoid

• Processed foods: Minimize consumption 1, 2
• Fatty red meat: Limit intake 1, 2
• Sweetened foods and beverages: Reduce consumption 1, 2
• Saturated fats: Limit intake 1
• Trans-fatty acids: Avoid completely 1
• Sodium and added sugar: Restrict 1
• Alcohol: Avoid entirely 1, 3

Critical Food Safety Requirements

All meat must be cooked until well-done to prevent Toxoplasma gondii infection, which can cause miscarriage and fetal harm. 4

Additional Safety Measures

• Avoid raw or undercooked foods: This includes seafood (oysters, clams), eggs, and meat 4
• Avoid unpasteurized products: No raw dairy, soft cheeses, or unpasteurized juices 4
• Avoid unheated deli meats: These pose listeriosis risk 4, 3
• Avoid pre-packaged fresh salads: Risk of contamination 3
• Wash all fresh produce thoroughly: Consume promptly after washing 3

Energy and Caloric Intake

Trimester-Specific Needs

• First trimester: No increase in calories needed unless starting with depleted reserves 1
• Second and third trimesters: Add 300 kcal/day above pre-pregnancy intake 1
  • Some women may achieve successful outcomes with only 100 kcal/day increase 1
  • Obese women with adequate fat stores may require fewer additional calories 1

Weight Gain Goals (Based on Pre-Pregnancy BMI)

• Underweight (BMI <19.8): Gain up to 18 kg 1
• Normal weight: Gain 1.4-2.3 kg in first trimester, then 0.5-0.9 kg/week 1
• Overweight: Gain at <50% of normal-weight rates 1
• Obese (BMI >30): Gain approximately 7 kg total 1

Critical pitfall: Hypocaloric diets (<1,200 calories/day) cause ketonemia and ketonuria, which may harm fetal development 1, 6

Essential Supplementation

Mandatory Supplements

• Folic acid: 400 µg/day starting before conception and continuing through at least the first trimester 1, 6, 3
  • Women with BMI >30 or diabetes need 4-5 mg daily 6
• Iron: 30-60 mg elemental iron daily during second and third trimesters 1, 6
• Iodine: 100-150 µg/day supplement plus iodized salt 3
• Vitamin D: >40 mcg (1000 IU) daily to maintain levels ≥50 nmol/L 6, 3
• Calcium: 1200-1500 mg daily (including dietary sources) 6

Additional Recommended Supplements

The American College of Obstetricians and Gynecologists recommends a daily prenatal multivitamin containing essential micronutrients throughout pregnancy 6

Important caveat: Vitamin A should be in beta-carotene form, NOT retinol, due to teratogenicity risk 6. Calcium and iron should be taken at different times as calcium inhibits iron absorption 6

Diets to Avoid

Severely restrictive diets must be avoided during pregnancy: 1, 2

• Ketogenic diet: Lacks carbohydrates and causes harmful ketosis
• Paleo diet: Restricts dairy inappropriately
• Any diet with excess saturated fats: Increases metabolic risks

Vegetarian and Vegan Considerations

• Vegetarian diets: Can be adequate with proper supplementation and counseling 3
• Vegan diets: Inadequate without additional micronutrient supplementation and require professional guidance 3

Meal Timing and Distribution

• Regular meals and snacks: Important to maintain stable blood glucose 1
• Evening snack: Usually necessary to prevent overnight hypoglycemia and fasting ketosis 1
• Carbohydrate distribution: Spread throughout the day in 3 small-to-moderate meals and 2-4 snacks 1
• Breakfast consideration: Carbohydrates are generally less well tolerated at breakfast 1

Beverages

• Coffee: Up to 3 cups daily considered safe 3
• Energy drinks: Should be avoided 3
• Alcohol: Complete avoidance required 1, 3
• Water and healthy fluids: Prioritize hydration

Physical Activity Integration

Physical activity should complement dietary efforts, with moderate-intensity exercise recommended throughout pregnancy 1, 3. This supports appropriate weight gain and metabolic health without requiring dietary restriction 1.