Q: I love seafood and eat it regularly. Can I continue to eat it during pregnancy?
A: Eating raw or undercooked shellfish is risky and should be avoided since it can contain harmful viruses and bacteria. Raw oysters can carry a virus called Norovirus, which causes nausea, abdominal pain, and diarrhea, and raw or partially cooked shellfish can contain hepatitis A, a virus that affects the liver. However, eating well-cooked shrimp, lobster, oysters, clams, scallops, or crab is now considered safe, since cooking kills any bacteria or viruses. Nutritionally, too, cooked shellfish are beneficial since they are low in fat, high in proteins, and rich in minerals. A well-cooked shrimp or lobster turns red and its flesh opaque, while a cooked scallop is opaque, white, and firm to touch. Clams, mussels, and oysters open their shells when they are well cooked—throw away any that don't open. Make sure you buy shellfish from a reputable source.
Q: My midwife said I should avoid pâté. Why?
A: All pâtés, including those made from vegetables or fish, should be avoided during pregnancy unless they are canned or have been heat treated. This is due to the risk of listeriosis, a rare infection caused by the bacterium Listeria monocytogenes found in pâtés, blue-veined and some soft cheeses, unwashed salads, and raw milk. Listeriosis resembles a mild flu, with symptoms such as aching, sore throat, and a raised temperature. However, even a mild infection can cause miscarriage, stillbirth, or severe illness such as meningitis or septicemia in the newborn. Another reason to avoid liver pâté (and also fish liver oils, liver sausage, and liver) is that it contains high levels of vitamin A, which has been linked to birth defects, when taken in excess.
Q: I like to eat rare steaks—are they allowed in pregnancy?
A: No. You should make sure that you eat only meat that has been well cooked, since raw meat contains bacteria that can cause food poisoning. This is especially important with poultry and products made from ground meat, such as sausages and burgers. Meat should be cooked until it is piping hot all the way through. Wash your hands after handling raw meat, and keep it separate from foods that are ready to eat. You should also avoid eating raw eggs and undercooked poultry because of the risk of salmonella.
Q: I eat a lot of mozzarella, but is it counted as one of the “soft cheeses” to be avoided?
A: Soft processed cheeses, such as mozzarella, cottage cheese, and cream cheese, are safe to eat throughout pregnancy. However, the advice is to avoid Mexican-style cheeses such as queso blanco fresco. Also avoid feta, as well as cheeses such as Camembert, Brie, Chévre, feta, Mexican-style cheeses such as queso blanco fresco, or others that have a similar rind, and blue-veined or mold-ripened cheeses. These could contain listeria, a type of bacteria that could harm your baby (see avoid pâté). According to the US Food and Drug Administration (FDA), cooking should kill any listeria, so it should be safe to eat food containing soft, mold-ripened, or blue-veined cheeses, provided it has been properly cooked and is piping hot all the way through.
Q: I've started to crave chocolate all the time—is this likely to harm my baby?
A: It's not unusual for women to experience cravings in pregnancy. Most are “normal”, while others, such as urges to eat soil, coal, chalk, or soap, are not, although they do sometimes happen!

Normal cravings can include a desire to eat anything from pickles and ice cream to chocolate. Mention this craving to your midwife since she may want to check that you are not deficient in magnesium, B vitamins, or iron, all found in dark chocolate. A little indulgence is fine, but giving in to a pregnancy full of chocolate could cause nutritional deficiencies if it stops you from eating a well-balanced diet, and leads to excessive weight gain. (Some people feel that eating chocolate in pregnancy leads to contented babies; this may be due to a high intake of phenylethylamine, a mood-enhancing chemical present in chocolate—also present in larger quantities in tomatoes and fruit—or it may be due to happy, relaxed mothers who have indulged!)

Q: I love spicy foods but have been told these may trigger an early labor—is this true?
A: Many people believe that eating spicy foods encourages the start of labor, but this is completely untrue. Although the reasoning behind this sounds logical, the theory does not work. One of the less talked about first signs of labor is a loose bowel movement or even diarrhea. This occurs because the cervix (neck of the womb) and part of the bowel have a common nerve supply. As the cervix starts to soften in readiness for labor, so the bowel is stimulated. This may cause faster movement of food and more frequent, looser bowel movements. If at term, labor may follow in the next few hours or it may not happen for a day or so. Some people think that if you eat spicy foods, for example, to bring on a bout of diarrhea, this will help to stimulate the cervix and labor will start. Unfortunately, the process doesn't seem to work reliably. Labor following self-induced diarrhea is probably coincidental, and the side effects of abdominal cramps, diarrhea, and soreness are disagreeable.

However, if you regularly eat spicy food, and have not been suffering from heartburn or indigestion, then there is no harm in treating yourself every now and then.

Q: I'm fed up with people telling me what I should and shouldn't eat and drink—what do you say?
A: While no health promoter wants to be prescriptive, there is plenty of research highlighting the ill effects of poor nutrition, smoking, alcohol, and drug misuse on the fetus. Members of the health profession, and even friends and family, may have personal experience of babies born with low birth weights, birth defects, syndromes, withdrawal symptoms, or infants who go on to develop allergies in childhood, such as eczema and asthma.

The reason people offer advice is because they want what is best for you and your baby. In the first three months in particular, while your baby's organs are developing, lifestyle choices carry a risk. If you can, try to take in this advice as long as you are sure it is correct, current, and evidence-based. Your doctor or midwife can readily answer any questions regarding nutrition and substance use in pregnancy.

Q: I'm really overweight—could this affect my pregnancy?
A: The medical consensus is that women with a high body mass index prior to pregnancy should try to limit the amount of weight they gain, since putting on too much weight increases the risk of developing high blood pressure, gestational diabetes, and having a big baby. If you were overweight before pregnancy, the recommended weight gain during pregnancy is 15–25 lb (7–11.5kg). If you gain weight within this range, you have a lower risk of complications during labor and birth.

However, pregnancy is not the time to go on a diet. Research shows that, for a pregnant woman who is overweight, a low-calorie diet does not reduce her chances of developing high blood pressure or preeclampsia and doesn't benefit the baby. Instead, seek advice from your midwife or doctor about how to eat a healthy, well-balanced diet that will ensure you don't pile on the pounds, but which keeps you and your baby healthy (see Pregnancy diet).

Q: I want to get back into my jeans right after the birth. How can I make sure I don't get too fat?
A: These days, it is almost impossible to pass a newspaper stand without seeing the latest celebrity who not only fits right back into her clothes after having her baby, but who actually weighs less than she did before her pregnancy. However, this is concerning for health professionals, since a dramatic weight loss after the birth is not good for the mother or for her baby. The average weight gain during pregnancy is 22–28 lb (10–12.5 kg)). Your baby (including the placenta and the water surrounding the baby) makes up approximately 11 lb (5 kg) of this, with 13 lb (6 kg) gained from increased fluids, fats, and an enlarged uterus and breasts. Much of this extra weight will be lost as soon as your baby is born. Also, after the birth, some of this extra weight provides nutrients for breast-feeding, which uses up to 500 calories a day. The most sensible approach to controlling your weight during pregnancy is to eat a healthy diet and exercise to ensure that weight gain is not too dramatic. You should consume around 2,100–2,500 calories a day, increasing this by 200 calories in the last trimester—the equivalent of two slices of toast and a glass of low-fat milk. Be realistic about postpartum weight loss. A sensible guide is “nine months on, nine months off” and most dieticians recommend losing no more than 2 lb (0.9 kg) a week. This may not seem much, but adds up to 14 lb (6 kg) in seven weeks—achievable with healthy eating and exercise.
Q: Is it alright for me to have the occasional glass of wine throughout my pregnancy?
A: This is a personal choice you need to make in pregnancy. Although experts do not agree on the exact level of alcohol needed to cause harm to babies during pregnancy, the general consensus is that there is no safe level of alcohol to consume in pregnancy. Alcohol use can cause a condition known as fetal alcohol syndrome.

You should be aware that alcohol crosses the placenta to your baby very easily and quickly, and that drinking during pregnancy could potentially damage your baby and your own health. The US surgeon general's advice is not to drink alcohol when you are pregnant or trying to conceive.

If you do decide to drink, you should be aware that you could be putting your unborn child at risk. Many women give up alcohol during pregnancy and you may feel that you simply no longer enjoy the taste. It's also worth noting that although alcohol doesn't contain fat, it's high in calories, with a glass of dry white wine containing over 100 calories.

Q: I really have a sweet tooth—is it OK to indulge this during pregnancy?
A: While occasional treats of sweets or chips are fine, processed foods usually contain hidden fats and sugars and provide few nutrients, so it's best to try to curb the amount of sweet foods you eat. Read food labels and look for alternative foods containing less fat and added sugars. Just as you would consider carefully how you feed your growing child, you should take care of yourself in the same way.

One of the best ways to curb your sweet tooth is to eat smaller meals throughout the day. This helps steady your blood sugar level and reduce sweet-tooth cravings. Try not to go longer than three hours without eating something and, if you are hungry, have a healthy snack between meals. Good snack choices might include carrot or celery sticks, a glass of low-fat milk, a serving of low-fat yogurt, cottage cheese, skinless chicken, or turkey. Fruit, including fresh, canned, or dried, such as raisins or apricots, is also a good option. Also, try to ensure that you drink at least one quart of fluids a day, as perceived hunger is often really dehydration. While you should aim to eliminate foods containing trans-fats from your diet, the consumption of “good fats”, such as those found in nuts, avocados, olives, and olive oil may help to satisfy your cravings.

Q: Should I be taking vitamin supplements during my pregnancy?
A: There is still uncertainty about whether women with a well-balanced diet need dietary supplements during pregnancy. If you do decide to take a supplement, it is important to choose one that is designed specifically for pregnant and breast-feeding women and which contains the appropriate mix of vitamins and minerals. A good pregnancy supplement contains more folic acid, calcium, and iron than a general multivitamin.

If you do take a supplement, it's still important to eat a varied, well-balanced diet. If you are unsure at all about which medicines and supplements are safe during pregnancy, your local pharmacist will be able to advise you. You can buy prenatal supplements at almost any pharmacy, or your doctor may prescribe them if he or she feels that your diet is providing insufficient nutrients.

Q: I don't have a very balanced diet—does this matter?
A: Maintaining a balanced diet is important and especially so in pregnancy. Now is a time when you need to make sure that your diet is providing you with enough energy and nutrients for the baby to grow and develop, and for your body to deal with the changes taking place. So yes, your diet does matter.

Your daily intake should include foods in approximately the following proportions: a third fruit and vegetables (at least five portions a day); a third carbohydrate-based foods like whole-grain bread, potatoes, cereals, and pasta; a sixth of protein foods like meat, poultry, legumes, cheese, and other dairy products; a small amount of sugar and fat; and at least eight glasses of water each day. It's a good idea to cut down on foods such as cakes and cookies, which are high in fat and sugar, to avoid putting on too much weight. If you feel you need some advice, discuss your diet with your midwife or doctor, who may also recommend that you take vitamin supplements in addition to your food.

Q: Is it safe to eat peanuts or foods containing peanuts during my pregnancy?
A: Some experts feel that if a child is at risk of developing a peanut allergy, the problem may have started to develop before birth, when a sensitivity to peanuts may have started due to exposure in the womb from the mother's diet. However, some recent studies have suggested that avoiding peanuts may actually be increasing the incidence of allergies, pointing to countries where peanuts are a staple food and allergies relatively rare.

Your baby may be at risk of a peanut allergy if you, or your partner, or your baby's siblings suffer from asthma, eczema, hay fever, or other allergies. If you fit into any of these groups, the American Academy of Pediatrics advises that you should not eat peanuts, or peanut products, in pregnancy or while breast-feeding. There is no need to avoid peanuts if your baby is not at risk of peanut allergy. Other nuts, such as hazelnuts, Brazil nuts, and walnuts, are safe to eat during pregnancy.

Weaning information has also changed, with “at risk” families being advised to delay the introduction of peanuts until the age of three.

Q: Does what I eat in pregnancy influence my baby's long-term health?
A: There are reasons to believe that what you eat in pregnancy can influence your baby's health long term and possibly her tastes too. Some experts have suggested that problems that occur later in life, such as obesity, diabetes, and other health problems, may be caused not only by what a person eats in their own lifetime, but also by what their mother ate while she was pregnant.

Also, there have been studies to look at links between a pregnant mother's protein and carbohydrate intake and a baby's blood pressure.

Research at Tommy's Maternal and Fetal Research Unit suggests that a mother's diet in pregnancy and while breast-feeding does influence the health of her offspring throughout their lives. Studies reveal that pregnancy diets rich in fat have been associated with the later development of breast cancer in children and further research is currently being carried out. Talk to your midwife for advice on eating a varied, well-balanced diet.

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